Know It Pt.9 Flashcards
The etiology of HCM is ______but may be transmitted by an __________ with ____ penetrance
Idiopathic; autosomal dominant gene; variable
ASH stands for?
Asymmetric septal hyper trophy
SAM stands for?
Systolic anterior motion
IHSS stands for?
Idiopathic hypertrophic subaortic stenosis
HOCM stands for?
Hypertrophic obstructive cardiomyopathy
IHSS is?
A) SAM & HCM
B)SAM
C)ASH
D)SAM & ASH
D
HOCM is?
A) SAM & HCM
B)SAM
C)ASH
D)SAM & ASH
A
Which cardiomyopathy is autosomal dominant?
A) dialated
B) Infiltrative
C)Hypertrophic
D)restrictive
C
HCM has _____ dysfunction
Diastolic
HCM had a myocardial ______ disarray
Fiber
With HCM there’s increased LV hypertorphy and _______load. This causes _____issues and results in _____ dysfunction which results in _____ enlargement.
Afterload; filling; diastolic; LAE
Why does HCM result in LAE?
Because the LV is hypertrophied, unable to relax and fill and is noncompliant. This results in the LA enlarging and LA not filling properly
Due to HCM causing LAE, this can also result in ____
MR
Which is the most common?
A) HOCM
B)HCM
C)SAM
D) ASH
D
IHSSS has what 2 things?
SAM & ASH
HOCM has what 2 things ?
SAM & HCM
With HOCM it has the thickened ___ which causes the AMVL to ?
Septum ; to hit the septum causing an obstruction
MV thickening and scarring may result from?
The MV leaflets constantly striking the thick IVS and obstruction
_____ and fibrosis may be present with HCM
MAC
What are some symptoms of HCM?
-syncope
-sudden death
-arrhythmias
-angina
-DOE
Valsalva or amyl nitrate will ___ the murmur/sound of HCM
Increase
What’s the murmur associated with HCM?
Crescendo descendo -systolic murmur
What are the 4 variants of HCM?
-Sigmoidal
-Reverse curve
-Apical
-Neutral
Which HCM variation is the most common?
A)Apical
B)Neutral
C)Sigmoid
D)Revers curve
C
Describe the Sigmoid HCM variant
The septum is thicker- caused AMVL to hit it
Describe reverse Curve HCM variant
Entire IVS curves downward into LV
Describe apical HCM variant
Apex is thicker than the rest of the walls
Describe Neutral HCM variant
Concentric LVH
How common is the sigmoid HCM variant?
40-50% most common!
How common is the Reverse curve HCM?
30-40%
How common is the apical and neutral HCM?
10%
Apical HCM is more common what country?
Japan
What is the etiology of apical HOCM?
Genetic
With apical HCM on Doppler you will typically see flow ____in mid ____
Acceleration ; LV
With apical HCM you will see increased ___ voltage on EKG. And giant negative ___ wave
QRS; T
The “ace is spades sign” is?
Apical HCM
With HCM the myocardium may a ___ appearance from the ____ disarray
Bright; fiber
With HCM will you have a small LV cavity or thick LV cavity
Small
Pt. With HCM usually have ____ LV contraction or _____ LV contraction
Hyperdyanmic ; normal
Thickness of ventricular walls with HCM may be ____ or ____
Asymmetric or symmetric
If the HCM is asymmetric what is the septal to PW ratio?
A) >1.3-2
B)<1.3-1
C)>1.3 to 1
D)<1.2-2
C) >1.3-1
Duration of septal contact with the AMVL will increase with ___ or ____ of the pt. Is NOT on beta blockers
Valsalva or amyl nitrate
If the pt. Is on beta blockers will valsalva or amyl nitrate increase the septal contact sound?
No
With HOCM there will a _____ closure of Av
Mid systolic
If HCM is obstructive what occurs to the AV?
Mid systolic closure of AV due to obstruction shutting the AV early
LVOT obstruction causes the AV to?
A) flutter in systole
B)close mid systole
C)flutter in systole
D)close late systole
B
Another name for SAM is?
IHSS
HCM will show what kind of MV diastolic dysfunction filling pattern?
A) Restrictive
B) Pseudo normal
C)Abnormal relaxation
D) none of the above
C
The IVRT will be right before the?
E wave
What is the Doppler spectrum of a HCM look like?
Dagger shaped (late peaking jet)
With HCM have a decreased or increased E/A ratio?
Increased
The ____ peaking ___ jet often seen with ____ is also called
Late; systolic; HCM; dagger shaped
A late peaking Doppler jet (dagger shape) goes with?
A)ASH & HOCM
B) HOCM & IHSS
C) IHSS
D) ASH & SAM
B
What is the drug Inderal?
Best blocker
Beat blockers will ____ SAM with excercise. Hence why we ask patients to ___ take their beta blockers before a stress echo
Decrease; not
With HOCM or IHSS you get a mid_____ or subaortic gradient due to the _____
Ventricular; obstruction
What are 2 treatments for HCM?
-ETOH -Ethanol alcohol septal ablation
-Surgical Septal Myectomy
Surgical Septal Myectomy involves?
Open heart surgery to remove thickened
myocardium
ETOH ablation treatment involves?
Non surgical procedure
A catheter put into the groin up into the aorta then into the vessel that feeds that IVS.
Doctor injects alcohol into thick area to kill the area causing the thickness to shrink due to alcohol toxicity
What is a contradiction to amyl nitrate?
Allergic to nitrates
Severe fixed AS
Recent CVA
Hemodynamic instability
Strain measures the?
Deformation within the myocardium
What is the acoustic signature in tissue what strain software tracks called?
Speckle
Strain is a ____ number
Unitless
Normal GLS is?
-16- to -20% or more
GLS with HOCM is typically?
A)+20%
B)-10%
C)-20%
D)+16%
B
People think strain changes before the ____ does
EF
HOCM pt. Have lower strain pattern of -____ to -____ % typically
-8 to -10
Dilated cardiomyopathy is also called?
Congestive
What are some etiologies of Dilated cardiomyopathy ?
-idiopathic
-Ischemic
-Peripartum
-Toxic
-Infective (viral, bacterial, fungal Chagas)
-metabolic (thiamine deficiency)
What are some infectious etiologies of dilated Cardiomyopathy?
Fungal
Parasitic
Bacteria
Viral
Chagas
What are some toxic etiologies of dialated cardiomyopathy?
Alcohol, lead, cobalt or adriamycin poisoning
What is adriamycin poisoning? And which cardiomyopathy is it consistent with
A cancer drugs that is toxic, associated with dilated cardiomyopathy
What is Chagas’ disease?
Tropical parasite that causes posterior and apical thinning of the septum
What affect does Chagas’ disease have on the heart?
Tropical parasite that causes posterior and apical thinning of the septum
What Tropical parasite that causes posterior and apical thinning of the septum associated with dilated cardiomyopathy)
Chagas’ disease
Chagas’ disease is associated with which cardiomyopathy?
Dilated
What is a thiamin deficiency?
A vitamin found in food that can reduce systemic vascular clearance decreasing cardiac function
Dilated cardiomyopathy have increased LV ____
Mass
What is thin walled by has dilated chamber?
Dilated cardiomyopathy
Dilated cardiomyopathy has ____ dysfunction due to multi chamber ___
Systolic ; dilation
What are some symptoms of dilated cardiomyopathy?
-edema
-fatigue
-Dyspena
Murmurs of the ___ valve and ___ valve are usually present with dilated cardiomyopathy
MV & TV
True or false- pt. With dilated cardiomyopathy usually have bradycardia
False! Tachycardia
What is pulses alternans?
Alternating strong and weak pulses
Alternating strong and weak pulses is called?
Pulses alternans
Pulses alter and is commonly seen with what cardiomyopathy?
Dilated
What is the B-notch or B-bump on MV m-mode?
After the E/A MV has a little extra wave known as a b-bump.
It’s a sign of increased LVEDP
The B-notch is a sign of?
Increased LVEDP
What cardiomyopathy is the B-notch sign on m-mode associated with?
Dilated cardiomyopathy
A EPSS of > ____ is an increased EPSS
> 7mm
What is the double diamond sign on m-mode a sign of?
A sign of reduced MV excursion or moment
What does the double diamond m-mode sign look like ?
Increased echoes of the AMVL to the PMVL creating a double diamond
What cardiomyopathy is a double diamond sign typically seen with ?
Dilated cardiomyopathy
2D post cardiac transplant has what famous ?
Double atria or bi atrial enlargement
What is Takotsubo cardiomyopathy?
A stress cardiomyopathy
Takotsubo is known as?
Broken heart syndrome
Takotsubo commonly affects ___ and is a ___ CM
Middle aged women; stress
Takotsubo usually presents with ?
Apical ballooning
Takotsbuo usually resolves in?
A few weeks
What is the stress cardiomyopathy called?
Takotsubo
What is the most common cause restrictive cardiomyopathy?
Amyloidosis
Restrictive CM is also known as ?
Infiltrative
Amyloid and Sarcoidosis are what kind of abnormalities?
A) congestive
B)hypertrophic
C)Restrictive
D)Infiltrative
D
____ is a form of infiltrative cardiomyopathy
Sarcoidosis
What is Pompes disease?
Glycogen storage issue
Pompes disease affects what cardiomyopathy?
Infiltrative(restrictive)
What is the name for excess iron?
Hemochromatosis
Hemochromatosis is associated with what cardiomyopathy?
Infiltrative (restrictive)
Endomyocardical fibrosis is associated with what CM?
Infiltrative (restrictive)
With infiltrative (restrictive) cardiomyopathy there’s a ____ of myocardium that results in ____ ventricular walls what impeded____ filing
Infiltration ; rigid ; diastolic
Infiltrative (restrictive) cardiomyopathy has ____ dysfunction
Diastolic
Infiltrative (restrictive) cardiomyopathy has ____ dysfunction
Diastolic
There’s ___ enlargement with infiltrate (restrictive ) cardiomyopathy. Why so?
Bi atrial
Because the ventricles are stiff and rigid (like in HCM) and don’t allow filling so both atria gets backed up
What are some symptoms of infiltrative CM
-Dyspena
-fatigue
-angina
With infiltrative (restrictive) cardiomyopathy there’s a ____ appearance of the myocardium
Ground glass
Sarcoidosis may infiltrative _____ system leading to a ____ block
Conduction ; AV
Amyloidosis is described as ?
Translucent waxy substance that builds up in the myofibrils
With Endomyocardical fibrous the endocardium appears ___ or ____and the ___ valves may been involved
Echogenic or scarred ; atrioventricular
With Endomyocardical fibrous the endocardium appears ___ or ____and the ___ valves may been involved
Echogenic or scarred ; atrioventricular
The term “ground glass” appearance id associated with which CM?
Infiltrative (restrictive)
A restrictive CM has which of the following?
A)increased afterload
B)decreased LV compliance
C) increased preload
D)decreased LA pressure
B
With infiltrative(restrictive) cardiomyopathy there will be abnormal ____ filling patterns.
Diastolic
With infiltrative CM the pulmonary vein flow will have a decreased ____ wave
s
With infiltrative(restrictive) cardiomyopathy there will be abnormal ____ filling patterns.
Diastolic
With infiltrative CM the MV inflow will have a low ___ wave/velocity
A wave
What disease processes heard with the pericardial knock versus a friction rub?
Friction rub= pericardial effusion
Pericardial knock= constrictive pericarditis
