Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DMST 367 Echo 3 > Hypertrophic CMO > Flashcards

Hypertrophic CMO Flashcards

1
Q

What does this image represent?

A

SAM (systolic anterior motion of the MV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is this image represent? Label

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Label the image, What does the arrows mean?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does the errors point to?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does this image represent?

A

Brockenbrough- Braunward morrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does this image represent?

A

Dynamic flow obstruction on M mode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does this image represent

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Label

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does ash stand for?

A

Aymptoeida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Label

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Label

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Label

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is this?

A

ASH: asymmetric septahypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does this image represent?

A

M-mode of HH-colours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does this image represent?

A

HCM- Apical CM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does this image represent?

A

HCM Mid ventricular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does this image represent?

A

HCM Mid ventricular Spectral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does this image represent?

A

HCM Mid ventricular Spectral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is cardiomyopathy?

A

Primary disease of the myocardium, excluding myocardial dysfunction due to CAD, HTN, CHD, or valvular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

All cardiomyopathies can be classified according to what? In what order?

A
  1. 1st physiology
  2. Etiology once known
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are characteristics of dilated CMO? 3

A
  1. Dilation - 4 chambers
  2. LV S+D dysfunction
  3. +/- RV dysfunciton
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are characteristics of hypertrophic CMO? 3

A
  1. ASH
  2. LVH
  3. Hyperdynamic and non-dilated LV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are characteristics of restrictive CMO 3

A
  1. Decreased LV compliance (Restrictive filling DDFxn)
  2. CHF
  3. Systolic function may be preserved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are characteristics of other CMOS besides dilated CMO, Hypertrophic CMO, and restrictive CMO? 3

A
  1. Arrhythmogenic RV dysplasia
  2. LV non-compaction
  3. Idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the abbreviation of Dilated CMO?

A

DCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the abbreviation of hypertrophic CMO?

A

HCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the abbreviation of Hypertrophic obstructive CMO?

A

HOCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the abbreviation of restrictive CMO?

A

RCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is HCM?

A

Disease of the myocardium characterized by the presence of LVH in the absence of another cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the etiology of HCM?

A

Inherited disease: X linked autosomal dominant - scan relatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the most common genetic CMO?

A

HCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the pathophysiology of HCM?

A

Increased muscle mass due to myofibril disarray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

The mutated gene in HCM affects what? What does this lead to?

A
  1. The contractile elements of the sacromere
  2. Leads to inappropriate hypertrophy of the muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are S/S of HCM? 5

A
  1. Possible asymptomatic
  2. Exercise intolerance
  3. Syncope/ fainting (HOCM)
  4. Angina
  5. Increased sudden risk of death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What does the ECG look like for HCM? 2

A
  1. Arrhythmias
  2. AV blocks and bundle branch blocks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

In terms of HCM, what are some arrhythmias seen with ECG?

A

A fib- high prevalence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the AV node location for HCM?

A

IVS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is often the first clinical manifestation of HCM?

A

Increased risk of sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What does decreased exercise intolerance look like for HCM?

A

SOB and fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

HCM can be divided into two sub groups based on what?

A

Whether the hypertrophy is causing any LV outflow obstruction or not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

In terms of HCM, Hypertrophy involving what is the most common and most likely to have an outflow obstruction?

A

Basal anterior septum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

In terms of HCM if the hemodynamic effect of the LVOT PG is above 30 mmHg what does this mean? What if its not?

A
  1. Yes: Obstructive (HOCM)
  2. No: Non obstructive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Non-obstructive HCM has a potential for what?

A

LVOT obstruction to develop at rest over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What needs to be done with every patient with HCM?

A

Valsalva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are two types of HOCM?

A
  1. Dynamic
  2. Latent obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is a dynamic obstruction?

A

Obstruction occurs when MV leaflets come in contact with thick IVS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is Latent obstruction?

A

Discoverable on effect or provoking maneuvers such as Valsalva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are some HCM echo features in Parasternal? 2

A
  1. Wall thickness (IVS and PW)
  2. Potential for SAM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How big should the IVS be in a patient with HCM?

A

IVS > 15mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is some apical echo features in apical?

A
  1. Presence/ distribution of hypertrophy
  2. Assess for SAM (5C/3C)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are some things we can do to get a better 2D assessment of HCM?

A
  1. Use off axis views if needed to see the full thickness walls clearly for measurement
  2. Colour plus 2D to assess where aliasing occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is needed for a good assessment of HCM?

A

Good endocardial definition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

1/3 of individuals that have HCM have what?

A

RV involvement

54
Q

What do we do to map the highest velocity in the LVOT for HCM?

A

Use colour aliasing and PW, specifically increase colour scale to see highest velocity

55
Q

With HCM, it is easy to confuse MR with what?

A

Increased LVOT velocity because the leaks last longer

56
Q

Doppler with HCM may have a decrease SV with normal ejection fraction due to what?

A

Decrease in cavity size

57
Q

What can we use doppler to do with HCM?2

A
  1. MR assessment
  2. Assess Diastolic dysfunction
58
Q

What is a tip to measure peak velocity with HCM? (using CW)

A

Walk the pulsed wave sample volume from apex all the way to the AV Looking for the point where the flow accelerated. Then use CW to measure peak velocity

59
Q

What can mimic a HCM heart?

A

Athlete heart

60
Q

How does a athlete heart mimic HCM?

A

Heart remodeling in highly trained endurance athletes

61
Q

Athletes hearts may still be normal despite having what? What are two examples?

A
  1. Increased parameters
  2. LV, RV, LA dimensions
  3. LV wall thickness
62
Q

Athletes hearts look like what?2

A
  1. Maintains symmetric, normal shape, No SAM
  2. Normal or supranormal diastolic function
63
Q

What are the parameters for normal LV wall thickness for M/F athletes?

A
  1. Male <16mm
  2. Female <12mm
64
Q

What is HOCM?

A

Obstruction: Higher velocity in the LVOT seen with color and aliasing, mapped with PW and measured the peak velocity and PG with CW doppler

65
Q

How do we determine persistent obstruction?

A

Obstruction at rest and valsalva

66
Q

How do we determine provocable obstruction?

A

Mild obstruction at rest that gets worse with Valsalva

67
Q

How do we determine Latent obstruction?

A

Near normal velocity at rest that increases with provocation

68
Q

When would we see obstruction with latent obstruction?

A

Only with valsalva

69
Q

What are three kinds of provocative maneouvers?

A
  1. Amyl nitrite
  2. Valsalva maneuver
  3. Stress test
70
Q

How is amyl nitrite a provocative maneouver?

A

Lowers arterial resistances/ increases HR

71
Q

How is valsalva a provocative maneouver?

A

Decreases ventricular filling

72
Q

How is stress tests provocative maneouvers?

A

Increases HR

73
Q

Why is stress tests not preferred for provocative maneouvers?

A

Risk of arrhythmias

74
Q

HOCM depends on what?

A

Preload and afterload

75
Q

What are HOCM obstructions increased by? 3

A
  1. Lower preload&raquo_space; leading to LV cavity volume
  2. Increased contractility
  3. Afterload
76
Q

Symptoms of HOCM worsen by what? (Drugs)

A

Diuretics (which reduce preload and make SAM and obstruction worse)

77
Q

IHSS stands for what?

A

Idiopathic hypertrophic subaortic stenosis

78
Q

What is IHSS?

A

A term previously used to describe the classic form of HOCM

79
Q

How many ways are there to categorize SAM? What are they?

A

Three
1. Mild
2. Moderate
3. Severe

80
Q

What is mild SAM?

A

Within 10mm of IVS

81
Q

What is Moderate SAM?

A

Brief contact with IVS

82
Q

What is severe SAM?

A

Prolonged contact with IVS

83
Q

Degree of LVOT obstruction depends on what things? 3

A
  1. Closeness of the AMVL to the IVS
  2. Onset of SAM to the onset of AMVL contact with IVS
  3. Duration of AMVL/ IVS contact
84
Q

In terms of Degree of LVOT with SAM, what question must we ask in relation to closeness of the AMVL to the IVS?

A

Does it actually touch the septum?

85
Q

In terms of Degree of LVOT with SAM, what question must we ask about the onset of SAM to the onset of AMVL contact with IVS?

A

How long does it take from the time MV leaflets starts moving when it touches the IVS

86
Q

In terms of Degree of LVOT with SAM, what question must we ask in relation to the duration of AMVL/IVS contact?

A

How long does the MV touch the IVS

87
Q

In terms of LVOT obstruction and PVCs, following a ventricular ectopic beat, what happens? What is this called?

A
  1. There is a marked increase in the LVOT gradient
  2. Brockenbrough- bruanwald morrow sign.
88
Q

Brokenbrough mraunwald morrow sign only occurs with what?

A

Dynamic obstruction

89
Q

What is seen with HOCM on doppler?3

A
  1. High velocity LVOT flow
  2. Dynamic flow obstruction
  3. MR due to SAM
90
Q

In terms of doppler and HOCM, what does dynamic flow obstruction look like?

A

Mid to late systolic peaking LVOT flow with gradient across LVOT

91
Q

How do we map out dynamic flow obstruction for HOCM? 2

A
  1. Use PW to “map” level of obstruction
  2. Use CW to display peak velocity
92
Q

In terms of HOCM doppler and dynamic flow obstruction, as the gradient S increases, what results?

A

Severity of the condition S also increases

93
Q

In terms of HOCM, how is there MR due to SAM?

A

Lack of coaptation as the AML gets “sucked” toward the septum, the leaflet tips come apart

94
Q

What does LVOT gradient look like on doppler?3

A
  1. Starts later
  2. Peaks mid-late
  3. “Dagger sign” of PW flow
95
Q

How does MR look like on doppler compared to LVOT gradient? 5

A
  1. Starts earlier
  2. Ends later
  3. High velocity throughout
  4. Peaks mid
  5. Higher gradient/ velocity than LVOT
96
Q

What is medical treatment options for HOCM?

A

Improve diastolic functions with Meds

97
Q

What are drugs we should use to treat HOCM? 2

A
  1. Beta blockers
  2. Calcium blockers
98
Q

What are types of drugs we should not use for HOCM treatment? why?

A
  1. Diuretics
  2. Reducing preload makes it worse
99
Q

What are surgical options for HOCM treatment?3

A
  1. Septal myectomy
  2. Percutaneous intervention
  3. Implanted cardiac defibrillator (ICD)
100
Q

What are some percutaneous interventions used for HOCM treatment?

A

Alcohol septal ablation

101
Q

What does alcohol septal ablation do? 2

A
  1. Catheterization with alcohol injected into portion of LAD
  2. Kills and thins basal septal wall
102
Q

What does implanted cardiac defibrillator do for HOCM treatment?

A

Prevention of sudden death

103
Q

What is a myectomy?

A

A portion of the basal IVS is removed or ablated

104
Q

How does a myectomy benefit HOCM?

A

Obstruction is eliminated

105
Q

Myectomy may result in what? (In terms of HOCM)

A

May result in iatrogenic complications such as VSD, AI

106
Q

Why is echo important in pre/ post op monitoring for HOCM?

A
  1. Pre-op: identify the problem
  2. Post-op: Assess the success of the procedure
107
Q

What are three forms of HCM?

A
  1. ASH
  2. Mid ventricular hypertrophy
  3. Apical hypertrophy»LV systolic cavity obliteration
108
Q

What does ASH stand for?

A

Asymmetric septal hypertrophy

109
Q

What is ASH?

A

Thickened, echogenic IVS (>1.3cm), but normal PW

110
Q

What is the IVS: PW ratio which determines abnormality?

A

> 1.3:1

111
Q

What is the appearance of ASH?

A
  1. May have speckled appearance
  2. Narrowed LVOT
112
Q

What is seen with ASH with HCM?

A

Decreased Systolic IVS thickening

113
Q

What happens as a result of decreased systolic IVS thickening? (In terms of ASH with HCM)

A

Other walls hyperdynamic to compensate

114
Q

What can be noted of the PLAX M-mode of HCM?2

A
  1. SAM
  2. Basal wall thickness ratio
115
Q

What is the DDX from M-mode for HCM ASH?2

A
  1. Aging
  2. Sigmoid septum
116
Q

What can be noted about the basal wall thickness ratio of HCM- ASH? What do we need to do?

A
  1. High risk >30mm = 40% risk sudden death
  2. Compare to SAX
117
Q

Which part of HCM - Apical CM is involved?

A

Apical LV

118
Q

What do we need to do to determine HCM- Apical CM? 3

A
  1. Image the true LV apex (contrast may enhance definition)
  2. Use colour doppler to define obstruction or increase velocities
  3. Look for apical infarction aneurysm, and clot
119
Q

With HCM-Apical CM, 15% have what disorder?

A

Apical aneurysm

120
Q

What kind of appearance does HCM- apical hypertrophy have in 2D?

A

Ace of spades appearance

121
Q

What is HCM-Mid ventricular?

A

Obstruction in the mid-ventricular cavity

122
Q

What happens in the LV with HCM-mid ventricular? 2

A
  1. LV contracts on itself
  2. Both sides of the LV walls touch each other
123
Q

What does the LV cavity do during systole with HCM-Mid ventricular?

A

LV cavity obliterates

124
Q

What is the DDX for HCM-mid ventricular

A
  1. Chronic HTN
  2. AS
125
Q

What are echo finds of HCM- Mid ventricular?5

A
  1. Thick LV walls
  2. Increased velocities
  3. Late systolic peaking
  4. MR
  5. LVOT obstruction at higher HR
126
Q

In terms of HCM- mid ventricular, the LV walls thicken where?

A

Pap level

127
Q

Where is the increased velocities with HCM- mid ventricular?

A

Mid cavity with gradient

128
Q

What is the late systolic peaking waveform look like in HCM?

A

Saw tooth waveform

129
Q

In terms of HCM-mid ventricular, MR is concordant with what?

A

Degree of obstruction

130
Q
A

DMST 367 Echo 3 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions