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Cardiac Theory II > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Cardiomyopathy

A

primary disease of the myocardium excluding myocardial dysfunction due to ischemia or chronic valvular disease

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2
Q

Dilated Cardiomyopathy

A

all four chambers are enlarged with impaired systolic function of both the LV and RV due to a wide range of underlying causes

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3
Q

Hypertrophic Cardiomyopathy

A

an autosomal dominant inherited disease of the myocardium related to abnormalities in gene coding for contractile proteins

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4
Q

Restrictive Cardiomyopathy

A

fibrotic stiff ventricles due to altered myocardium with significantly impaired diastolic function

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5
Q

Causes and symptoms of Dilated Cardiomyopathy

A

Causes: idiopathic, infections, toxins, metabolic, inherited, Tako-tsubo, autoimmune/systemic inflammatory disease
Symptoms: Dyspnea, orthopnea, DOE, cough, rales, crackles, sputum

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6
Q

Causes and symptoms of Hypertrophic Cardiomyopathy

A

Causes: inherited
Symptoms: angina, syncope, DOE, Paroxysmal Nocturnal Dyspnea, pulmonary edema

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7
Q

Causes and symptoms of Restrictive Cardiomyopathy

A

Causes: infiltrative, deposition or scarring to organs, endomyocardial fibrosis, myocardial fibrosis
Symptoms: heart failure due to impaired diastolic filling and inability to maintain cardiac output

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8
Q

5 parameters of Diastolic Algorithm

A
  1. Average E/e’ > 14
  2. Septal e’ velocity < 7 cm/s
  3. Lateral e’ velocity < 10 cm/s
  4. TR velocity > 2.8 m/s
  5. LA volume index > 34 ml/m^2
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9
Q

E/A ratio for Grades 1, 2, and 3

A

Grade 1: E/A ≤ 0.8 and E ≤ 50 cm/s
Grade 2: E/A ≤ 0.8 and E > 50 cm/s OR E/A > 0.8 - < 2
Grade 3: ≥ 2

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10
Q

Additional Parameters of Diastolic Dysfunction:
Normal

A

DT: 160-200 ms
E/e’: ≤ 14
AR-A: < 0 ms
IVRT: 50-100 ms
PVA: ≤ 35 cm/s
S~D
L Wave: < 20 cm/s
Propagation Velocity: > 50 cm/s

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11
Q

Additional Parameters of Diastolic Dysfunction:
Grade 1

A

DT: > 200ms
E/e’: increasing ratio implies worsening
AR-A: < 0 ms
IVRT: > 100 ms
PVA: ≤ 35 cm/s
S significantly > D
L Wave: > 20 cm/s
Propagation Velocity: decreasing slope implies worsening

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12
Q

Additional Parameters of Diastolic Dysfunction:
Grade 2

A

DT: 160-200 ms
E/e’: increasing ratio implies worsening
AR-A: ≥ 30 ms
IVRT: 50-100 ms
PVA: > 35 cm/s
S<D
L Wave: > 20 cm/s
Propagation Velocity: decreasing slope implies worsening

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13
Q

Additional Parameters of Diastolic Dysfunction:
Grade 3

A

DT: < 160 ms
E/e’: increasing ratio implies worsening
AR-A: ≥ 30 ms
IVRT: < 50 ms
PVA: > 35 cm/s
S significantly < D
L Wave: > 20 cm/s
Propagation Velocity: decreasing slope implies worsening

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14
Q

DD and age

A

~ 60 E/A ratio = 1
> 60 E/A ratio = < 1
> 60 increased decel time and IVRT
> 50 S > D

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15
Q

Valsalva and DD

A

valsalva can convert restrictive LV inflow to a pseudonormal

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16
Q

Corrective Treatments for Dilated Cardiomyopathy

A

-Periodic Echocardiograms
-Conventional Medications
-Sizing down annulus
-Implantable defibrillators
-BiVent pacemakers
-LVAD and transplant
-MV repair/ reopposing the chordae

17
Q

Corrective Treatments for Hypertrophic Cardiomyopathy

A

-Echo
-Medical Therapy
-AICD (Automatic Implanted Cardiac Defibrillator)
-PTSMA (Percutaneous Transluminal Septal Myocardial Ablation)
-Myotomy-Myectomy (cutting of the myocardium)

18
Q

Corrective Treatments for Restrictive Cardiomyopathy

A

-treat Underlying Etiology
-treat CHF
-transplant

19
Q

Patterns of Hypertrophy

A

Type 1: 10 %, hypertrophy confined to antero septum
Type 2: 20 %, hypertrophy of both antero and infero septum
Type 3: 52 %, hypertrophy of septum and anterolateral free wall
Type 4: 18 %, hypertrophy of other regions, apical hypertrophy “ace of spades”

20
Q

Doppler Evaluation of LVOT Obstruction

A

-A5
- PW mapping
- CW mid to late systolic high velocity jet > 1.1 m/s , dagger shaped LVOT envelope

21
Q

LVOT Obstructions

A

-Nonobstructive: PPG < 30 mmHg at rest with provocation
-Obstructive: PPG ≥ 30 mmHg at rest
-Inducible or latent: PPG < 30 mmHg at rest and ≥ 30 mmHg with provocation

22
Q

LVOT Obstruction vs. Midcavitary Obstruction

A

LVOT:
dagger shaped envelope
mid to late systolic high velocity jet

Midcavitary:
seen in dehydrated patients with LVH
late peaking and sawtooth waveform in PW
alleviated by giving volume

23
Q

RCM vs. Constrictive Pericarditis

A

RCM:
- reduced regional and global longitudinal strain
- low medial and septal TDI e’ velocities
- moderate to severe PHT
- low color m-mode propagation velocity

Constrictive Pericarditis:
- treatable
- normal medial strain
- preserved global longitudinal strain “hot septum”
- normal medial TDI e’
- demonstrates significant respiratory changes on doppler inflows

24
Q

Athletic vs Pathological Heart

A

Athletic:
-mild LVH or RVH
- mild RVE, LVE, LAE, or IVC enlargement
- reverses with deconditioning
- normal TDI and strain

25
Q

Common Conditions of Diastolic Dysfunction

A

-Primary Myocardial: Dilated, Restrictive, and Hypertrophic Cardiomyopathy
-Secondary Myocardial: Hypertension, Aortic Stenosis, Congenital Heart Disease
-Coronary Artery Disease: Ischemia, Infarction
-Extrinsic Constraint: Pericardial Tamponade, Pericardial Constriction

26
Q

Typical Grade 1 of Diastolic Dysfunction (Impaired LV relaxation)

A
  • decreased E/A ratio
  • prolonged deceleration time
  • reduced e’
  • increased LA volume
  • increased TR velocity
  • increased IVRT
  • S > D
27
Q

Typical Grade 2 of Diastolic Dysfunction (Pseudonormal Diastolic Dysfunction)

A
  • Normal E/A ratio
  • Normal deceleration time
  • Normal IVRT
  • elevated E/e’
  • reduced E’
  • increased LA volume
  • increased TR velocity
  • S slightly less than D
28
Q

Typical Grade 3 of Diastolic Dysfunction (Abnormal Ventricular Compliance)

A
  • increased E/A ratio
  • decreased deceleration time
  • reduced E’
  • increased LA volume
  • increased TR velocity
  • elevated E/e’
  • reduced IVRT
  • pulmonary vein AR wave prolonged
  • S significantly < D
29
Q

2D/M-mode/Doppler findings in Dilated Cardiomyopathy

A

2D: - significant 4 chamber enlargement, LVIDd > 112%, LVED > 75ml/m^2 , increased LV mass, spherical shaped LV
M-mode: - increased EPSS, decreased aortic root motion, B bump, tapered aortic valve closure

30
Q

2D/M-mode/Doppler findings in Hypertrophic Cardiomyopathy

A

2D: asymmetric hypertrophy of LV, “ace of spades” appearance
M-mode: systolic anterior motion of anterior mitral leaflet

31
Q

2D/M-mode/Doppler findings in Restrictive Cardiomyopathy

A

2D: thickened to fibrotic appearance of ventricular walls, biatrial enlargement, small ventricles
Doppler: MR/TR envelopes may begin at end diastole

32
Q

2D/M-mode/Doppler findings in Amyloid

A

2D: myocardium, valves, and IAS appear thick and granular in appearance, biatrial enlargement

33
Q

2D/M-mode/Doppler findings in LVOT Obstruction

A

2D: systolic anterior motion of anterior mitral leaflet, contact lesion on septum, posterior jet of MR
M-mode: mid-systolic fluttering and closing of AV
Doppler: mid to late systolic high velocity jet, dagger shaped envelope, in PW mapping will determine location of obstruction

34
Q

2D/M-mode/Doppler findings in Hypertension

A

2D: LV dilation, aortic root dilation, aortic valve sclerosis, LAE, mitral annular calcification
Doppler: mid cavitary obstruction = late systolic high velocity sawtooth signal

35
Q

2D/M-mode/Doppler findings in Diabetes

A

2D: thick ventricular walls, myocardium is reflective/hyperechoic, LVE, LVH
Doppler: abnormal strain and TDI

36
Q

2D/M-mode/Doppler findings in Rejected Post transplanted heart

A

2D: RV/LV systolic dysfunction, increased LV mass, increased echogenicity of myocardium, evolving pericardial effusion

Cardiac Theory II (9 decks)

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