ECHO- CAD and Mechanical complication Flashcards
What are the early echocardiographic abnormalities that occur early in the ischemic cascade?
earliest is diastolic dysfunction/relaxation dysfunction
What are the mechanisms that will lead to pathologic remodeling after LV injury from CAD
What is a normal Wall Motion Score Index (WMSI)>
WMSI of 1
Diastolic parameter that predicts outcome/mortality in MI?
Deleceration time of ≤ 140ms, in restrictive filling pattern,
also E/e’ of >15
LA volume with cut of 32ml/m2
Echo findings that predicts outcome/survival post MI?
moderate-severe MR, with ERO ≥20
Mechanism of Ischemic MR
Tethered chordae
papillary muscle displacement
restricted leaflet closure
annular dilatation
In ischemic MR, consider preload and afterload reduction medication. T/F?
true, use of nitrates ISMN
T/F? Ischemic MR is load dependent
True! increase afterload will increase also the MR. consider Phenylephrine in increasing afterload
What are the 6 echo findings that predict future risk for CV Events after MI?
what echo findings is associated with development of LV thrombus post MI?
low EF and larger infarct size
Differentiate LV aneurysm vs pseudoaneurysm in terms of treatment strategy?
see pic
Differentiate LV apical aneurysm vs pseudoaneurysm
see pic
Differentiate LV apical aneurysm vs pseudoaneurysm in terms of layers of present?
all layer present - aneurysm
only peri cardium present - pseudoaneurysm
Triggers of Takotsubo Cardiomyopathy?
see pic
what are the variants of Takotsubo cardiomyopathy?
mid-wall variant (15%) and reverse takotsubo
Postulated mechanism of takotsubo Cardiomyopathy?
Think of perforation/LV rupture in new MI pt if you see these two echo findings
new pericardial effusion and coagulum
COAGULUM - refers to a solidified, organized blood clot within the pericardial cavity. It is often seen in patients with a history of hemopericardium (blood accumulation in the pericardium) due to various causes. Unlike free-flowing pericardial effusion, a coagulum appears as a fixed, echogenic mass within the pericardial space.
Etiology of Cardiogenic Shock after Acute MI
most common: LV failure
approach to pt with septal rupture post MI?
if clinically stable, wait for days before the surgery to allow the necrotic tissue to fibrose.
suggestive of these echo findings?
LVOT obstruction
CWD- late peaking dagger shaped spectral spectrum
differentiate NEW LOUD SYSTOLIC murmur following MI?
note the Location, Signs, Hemodynamics
think of VSD, papillary mucles rupture or LVOT obstruction. see pic.
How many days post MI does papillary muscle rupture occur?
3-7days
most commonly involves: RCA or circumflex
inferior, inferolateral MI -> rupture of posteromedial papillary muscle due to its single blood supply - posterior descending artery from RCA 80% (RCA dominant) or LCx 8-10% in LCA dominant or both if co-dominant
on the other hand, the anterolateral papillary muscle occurs in anterolateral MI - dual blood supply via diagonal branch of LAD and OM branch of LCx.
