Echo Mayo: M mode/HCM/DCM/PHTN Flashcards
MV inflow
PW at MV inflow at apical 4 chamber
E Wave: Early diastole (after T-wave on EKG)
M mode elevated LVEDP
B bump
Only occurs if LVEDP > 20mmhg
M mode DCM
Increased septal e point separation
M mode SAM/HOCM
Septum thick
Normal: MV closed during systole
SAM: MV reopens and hits septum
May not occur at rest. Check Valsalva
M mode mitral stenosis
View: PSAX through leaflets
Thickened AML
Normal: open in diastole, leaflets in opposite direction
Mitral stenosis: AML and PML both move anteriorly. Square pattern
m-mode aortic valve
m-mode mitral valve
m-mode LV
HCM: definition and ddx
Def:
Any segment >15mm
LVH
DDx: HTN, AS, infiltrative CM, Fabrys, glycogen/lysosomal, mitrochondrial myopathies
HCM: associated with
Associated with
-LVOT obstruction
-SAM (70%) - low CO, MR, ischemia (dt high filling pressures), fibrosis
-Asymmetric septal hypertrophy
-Gene positivity
-Diastolic sequalae (100%) - increase LA pressure (dt MR), low CO
HCM: Echo eval-Extent/distribution of LVH
–Thickness>30mm cf sudden cardiac death
–Phenotype
HCM: Echo eval-MV apparatus
-With Valsalva
-Papillary muscle hypertrophy/different insertion point
HCM: Echo eval-SAM or not
-Mmode-premature closure of AV
-SAM MR jet is posteriorly directed
HCM: Echo eval-MR jet
-Due to SAM, prolapse, flail, abnormal chord/papillary support, anterior leaflet thickening/sclerosis
HCM: Echo eval-CW LV outflow
-Resting gradient >50mmg
-Late peaking
-Provoked with valsalva, exercise, amyl nitrate, stress gradient, cath gradient
HCM: Echo eval-CW MR jet
Compared to LVOT:
-MR jet has higher velocity, longer duration
Estimate LVOT gradient
LVOT gradient = LV pressure - systolic BP
LV pressure = 4 (MR velocity)2 + est LA pressure
HCM: intervention
-Septal myectomy
-Alcohol septal ablation
Complications:
Post-myectomy VSD
DCM: definiton
Dilation and impaired contraction
LVEF <40% without ischemia
Associated with increased LV mass and volume (chamber is larger
DCM: 2D assessment
Chamber dimensions, geometry, thickness
Dilated LV
- Increased LVEDD and LVESD
- Global hypokinesis
- Increased LV mass with normal wall thickness
LV mass
- Based on end diastolic LV diameter, posterior wall thickness, septal wall thickness
- Indexed to BSA, gender
RWT = 2 x (post wall thickness) / LVIDD
Mitraclip in HF
Mitralclip = transcatheter edge to edge repair
LVEF <50%
Persistent symptoms on optimal GDMT
Favorable mitral anatomy
No pulm HTN: PASP<70mmHg, LVESD <70mm
Diastology: definition
Normal relaxation with sufficient dilation = normal filling
Delayed relaxation with sufficient dilation = normal filling
Delayed relaxation with insufficient dilation (increased stiffness) = increased filling pressures
Diastology: progression
Pseudonormalization with normal and grade 2
- MV annular velocity is tie breaker (e’<7cm/s)
Mitral inflow velocity (E) increases with worsening diastolic dysfunction
Mitral annulus velocity (e’) stable reduced with worsening diastolic dysfunction
- e’ 12ish in young normal. Reduced with age ~9, but still above 7 if healthy
Therefore, E/e’>15 is specific for increased filling pressure (not sensitive)
Diastology: Tips
If mitral e’ normal, then normal relaxation and normal diastolic function
- LV relaxation is key: medial e’>7cm
- Use e’ velocity avg (medial and lateral) if >30% difference between the two
- E/e’>15 is specific for increased filling pressure (not sensitive)
- E/e’ may not work with MAC, HCM, LBBB, RWMA
- If TR velocity normal, then chance of high fillings pressures are very low
- Strain imaging-LA reservoir 20% or lower = high filling pressures
- Pulm vein: S>D is normal diastology
