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DMST 367 Echo 3 > Dilated And Hypertrophic CMO > Flashcards

Dilated And Hypertrophic CMO Flashcards

1
Q

Label

A

Everything here is right except for hypertension and CAD

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2
Q

What does this image represent?

A

LV chamber enlargement which leads to rounder, spherical shape

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3
Q

What does this image represent?

A

Spherical shape vs bullet shaped LV from DCM

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4
Q

What does this image represent?

A

LIV size and function in four chamber for DCM

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5
Q

What does this image represent?

A

Grade 3 DD

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6
Q

What does this image represent?

A

M-mode findings for DCM.

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7
Q

What does this image represent?

A

B-bump and EPSS

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8
Q

What does this image represent?

A

AV - M mode

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9
Q

What does this image represent?

A

M-mode in DCM (Look at the EPSS) specifically, LV global or multi segmental hypokinesis

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10
Q

What is Dilated cardiomyopathy?

A

Disease of the myocardium characterized by the dilation and decreased systolic function of the LV or both ventricles

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11
Q

What is the etiology of DCM? 3

A
  1. Idiopathic
  2. Genetic/ familial (20-50%)
  3. Stress induced
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12
Q

What is S/S of DCM? 3

A
  1. Related to CHF
  2. Dyspnea/ SOB
  3. Sudden death
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13
Q

What are some S/S of DCM that are related to CHF? 4

A
  1. Low BP
  2. Fatigue
  3. Weakness
  4. Peripheral cyanosis
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14
Q

What are things that result in Dyspnea/ SOB? (In terms of DCM)3

A
  1. Orthopnea
  2. Tachypena
  3. Paroxysmal Nocturnal dyspnea (PND)
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15
Q

What does ECGs look like with DCM? 6

A
  1. Tachycardia
  2. Atrial Arrythmias
  3. LBBB
  4. LVH (large QRS complexes)
  5. LAE
  6. Ventricular arrhythmias
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16
Q

What does DCM look like on X-ray?2

A
  1. Cardiomegaly
  2. Pulmonary congestion
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17
Q

In terms of Echo findings with DCM, it is important to rule out what?

A

Other causes of LV/RV dysfunctions such as Valvular disease and IHD

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18
Q

What do we assess with echo in 2D? 3

A
  1. Chamber size
  2. Systolic function
  3. Potential thrombus
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19
Q

Why would we use M-mode for DCM?

A

To confirm findings

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20
Q

Why do we use doppler in echo for in terms of DCM assessment?3 (what do we look for)

A

To look for
1. Diastolic function
2. Valvular regurgitation
3. Potential PHTN

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21
Q

What do we see in terms of LV chamber enlargement with DCM? 8

A
  1. LV takes a rounder, spherical shape
  2. Mitral annular dilatation
  3. LV thrombus/ aneurysm
  4. Increase LV mass index
  5. Increase EPSS on m-mode
  6. Decrease LV function
  7. Decrease in EF/FS/CO
  8. Spontaneous contrast in LA and LV
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22
Q

What is the abnormal spherical index of DCM?

A

> 0.76

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23
Q

What is found during the 2D echo assessment of DCM?3

A
  1. 4 chamber dilation
  2. CHF/Pulmonary HTN
  3. Decrease in global LV/RV S+D fxn
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24
Q

What is seen in the 4 chambers dilation for DCM?

A
  1. Increase chamber volumes
  2. Increased LV mass index
  3. Increased EPSS on M-mode
  4. Functional MR
25
Q

Why is there CHF/ pulmonary HTN with DCM?

A

Response from increased LAP

26
Q

Why is there a decrease in global LV/RV S+D fxn? 4

A
  1. Reduced EF
  2. Reduced LVOT/AV velocity
  3. Abnormal Dp/DT
  4. Increased filling pressures
27
Q

How can we measure LV size and function with DCM? 5

A
  1. LV global assessment
  2. Systolic function (Dp/Dt)
  3. Simpsons
  4. LV size
  5. LV mass index
28
Q

How do we measure RV size and function?3

A
  1. RV free wall thickness
  2. Dimension
  3. Systolic function
29
Q

What are some doppler findings in DCM? 4

A
  1. Color doppler fill is reduced at a normal scale
  2. Decreased Pulmonary V acceleration time (PAT)
  3. Decreased LVOT velocity
  4. Increased RVSP
30
Q

What do we need to do to better see the color fill in DCM?

A

Decrease the color scale to see lower velocity flow

31
Q

What is the decreased LVOT velocity for DCM? (actual speed)

A

<60cm/sec

32
Q

What increases RVSP in DCM?

A

PHTN due to pressure back up

33
Q

What is the regurg percentage with DCM? 4 (each valve)

A
  1. MR (100%)
  2. TR (90%)
  3. PR (50%)
  4. AR (20%)
34
Q

What does doppler measurements of DCM do?

A

Quantify the severity of any regurgitation

35
Q

How do we calculate pulmonary pressures? 2

A
  1. Use TR jet max (RVSP)
  2. PAT
36
Q

What is the CO formula?

A

SV X HR or (CSA x VTI) x HR

37
Q

How do we calculate LV systolic function?

A

LV dp/dt

38
Q

100% of DCM has what type of regurg?

A

MR

39
Q

What does significant MR do with DCM? Why is this beneficial?

A
  1. Reduces the LV preload which may make LVEF seem better than it really is
  2. Makes dp/dt especially useful for estimating global LV systolic function in DCM patients
40
Q

What is abn dp/dt < what? (for DCM)

A

abd dp/dt < 1200 mmHg/sec

41
Q

What kind of diastolic dysfunction is usually seen with DCM?

A

Grade 3 is typical

42
Q

All patients with DCM have some degree of what?

A

Diastolic dysfunction

43
Q

What are things that we see with Grade 3 DD again? 7

A
  1. Increase in LVEDP
  2. Increase in LAP
  3. E/A >2.0
  4. E/e’ >14
  5. Peak TR velocity >2.8 m/s
  6. IVRT <60ms
  7. DT <160 m/s
44
Q

What are some M-mode findings with DCM? 3

A
  1. Reduced CO due to decreased systolic function
  2. Increased EPSS
  3. B-bump
  4. Decreased AV cusp excursion or opening
  5. May also see early AV closure due to reduced CO
45
Q

Why would we see reduced CO due to decreased systolic function with M-mode for DCM? 2

A
  1. Reduced wall excursion
  2. Both IVS and PW not moving inwards
46
Q

In terms of M-mode and DCM, why would we see increased EPSS? What is abnormal?

A
  1. Due to larger chamber space
  2. > 7mm is abnormal
  3. > 20mm = EF <30%
47
Q

Why would we see a B-bump with DCM on M-mode?

A

MV tries to close early due to high LVEDP

48
Q

Why would we see decreased AV cusp excursion or opening with DCM on m-mode?

A

Due to low output from reduced CO

49
Q

What are some DCM complications? 4

A
  1. Thrombus/ emboli
  2. Dyssynchrony of contraction
  3. Sudden cardiac death
  4. Consequences of underlying disease
50
Q

Why would there be thrombus/emboli in terms of DCM? What would mask it?

A
  1. Due to stasis of blood
  2. Poor image quality
51
Q

What are some consequences of underlying diseases that are complications of DCM? 2

A
  1. Infective endocarditis
  2. Nonbacterial thrombotic endocarditis
52
Q

What are 7 tips for detecting LV thrombus?

A
  1. Use highest frequency possible
  2. Use harmonic imaging
  3. Reduce depth- most thrombi are near the LV apex
  4. Utilize the focal zone
  5. Slowly pan through the LV
  6. Confirm a thrombus in 2 or more imaging planes
  7. Use color doppler as a contrast with reduced scale to confirm thrombus
53
Q

How would we generally treat DCM?

A

Treat etiology if known, clinical Hx is very important to discovering the etiology

54
Q

If we don’t know the etiology, how would we treat DCM? 4

A
  1. Lifestyle modifications
  2. Medications
  3. Interventional
  4. Surgical
55
Q

What are some lifestyle modifications for DCM? 2

A
  1. Restrict salt
  2. Alcohol cessation
56
Q

What are some medications that can be used for treatment of DCM?

A
  1. Diuretics, ace inhibitors, beta blockers
  2. Anticoagulants
  3. Anti-arrhythmic
57
Q

What are some interventional methods to treat DCM? 2

A
  1. Biventricular pacing
  2. Cardioveter/ defibrillator
58
Q

What are some surgical methods to treat DCM? 4

A
  1. MV repair/ replacement
  2. Batista procedure
  3. LV assist device
  4. Transplant
59
Q

What is batista procedure?

A

Removing part of LV

DMST 367 Echo 3 (27 decks)

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