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Echo 2 > Module 15 : Dilated and Hypertrophic Cardiomyopathies > Flashcards

Module 15 : Dilated and Hypertrophic Cardiomyopathies Flashcards

1
Q

definition of cardiomyopathy CMO

A
  • primary disease of the myocardium

- excluding myocardial dysfunction due to ischemia or chronic valve disease

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2
Q

what are the 2 classifications of CMOs

A
  • 1st physiology

- 2nd etiology

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3
Q

what are the 4 main types of CMOs

A
  • dilated
  • hypertrophic
  • restrictive
  • other
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4
Q

what are 2 main characteristics of dilated CMO DCMO

A
  • biatrial and biventricular dilation

- ventricular systolic and diastolic dysfunction of the LV and RV

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5
Q

what are 2 main characteristics of hypertrophic CMO. HCMO

A
  • idiopathic asymmetric hypertrophy of heart

- hypertrophic hyper dynamic non dilated left ventricle

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6
Q

what are 3 main characteristics of restrictive CMO RCMO

A
  • increased resistance to ventricular filling due to lack of compliance
  • heart failure with increased LVEDP, LAP
  • global systolic function preserved
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7
Q

what are 3 main characteristics of other CMOs

A
  • arrhythmogenic RV dysplasia
  • LV non compaction
  • idiopathic
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8
Q

what is dilated CMO called when there is no known cause

A
  • idiopathic dilated CMO
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9
Q

what will all 4 chambers of the heart look like with dilated CMO

A
  • all 4 may be dilated
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10
Q

what will the systolic and diastolic function be of the LV and RV with dilated CMO

A
  • reduced CO and EF
  • elevated LVEDP
  • grade 3 DD
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11
Q

what are the 8 main causes of DCMO

A
  • infectious
  • toxic
  • peripartum
  • metabolic
  • genetic
  • endocrine disease
  • idiopathic
  • stress induced
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12
Q

what are 3 infectious causes of DCMO

A
  • viral myocarditis
  • parasitic
  • AIDSq
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13
Q

what are 3 toxic causes of DCMO

A
  • alcohol abuse
  • chemotherapy
  • drugs
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14
Q

what is perpartum DCMO caused by

A
  • immune system reaction
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15
Q

what is metabolic DCMO caused by

A
  • thiamine deficiency
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16
Q

what is genetic DCMO caused by

A
  • x linked familial disorder
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17
Q

what are the 3 causes of endocrine DCMO

A
  • hypothyroidism
  • hyperthyroidism
  • pheochromocytoma
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18
Q

what are the signs and symptoms of DCMO related to CHF

A
  • Low BP, fatigue, weaknes
  • peripheral cyanosis
  • dyspnea/SOB
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19
Q

what are 5 other symptoms of DCMO related to underlying disease

A
  • chest pain
  • palpitations
  • afib/PVCs
  • wet cough
  • embolic events
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20
Q

what are 4 complications of DCMO

A
  • systolic embolization
  • sys-synchrony of contraction
  • cardiac death
  • consequences of underlying disease
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21
Q

what will the ECG look like with dCMO

A
  • sinus tach
  • conduction defects
  • LVH (large QRS complex)
  • afib
  • LAE
  • ventricular arrhythmias
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22
Q

what 2 characteristics will an X-ray have of DCMO

A
  • cardiomegaly

- pulmonary congestion

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23
Q

what are the 2 different treatments of DCMO

A
  • medical

- surgical

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24
Q

what are the medical treatments of DCMO

A
  • treat etiology if known
  • dietary changes (less salt)
  • alcohol cessation
  • drugs
  • biventricular pacing
  • cardioverter
25
Q

what are the surgical treatments of DCMO

A
  • mitral valvulolasty/replacemtn
  • ventricular reduction
  • revascularization
  • LVAD
  • cardiomyoplasty
  • transplant
26
Q

what are 4 general echo findings of DCMO

A
  • 4 chamber dilation
  • pericardial effusion
  • aneurysmal apex
  • decreased global LV and RV systolic and diastolic function
27
Q

what are 5 m mode findings of DCMO

A
  • reduced wall excursion (PW < 10mm)
  • MV B bump from high LVEDP
  • increased EPSS (e point to septum separation)
  • decreased AV cusp excursion or opening
  • early AV closure
28
Q

what is the normal EPSS meauremtn

A
  • < 7mm
29
Q

what would an EPSS of > 20mm indicate about the EF

A

< 30%

30
Q

what are 8 2D findings associated with DCMO

A
  • increased LV diameter both systolic and diastolic
  • RV enlarged
  • decreased EF,FS,CO
  • sphericity index > 0.76
  • spontaneous contrast in LA and LV
  • LV thrombus
  • MV tenting
  • biatrial enlargement
31
Q

what are 7 doppler findings with DCMO

A
  • MR 100% of the time
  • TR
  • PR
  • AR
  • decreased LVOT velocity
  • color doppler fill reduced
  • decreased PV acceleration time
32
Q

what are the 5 doppler measurements for DCMO

A
  • CO
  • severity of regurge
  • SPAp, MPAP, PAEDP
  • LV EDP
  • LV Dp/Dt
33
Q

why is the LV Dp/Dt measurement so important for DCMO

A
  • MR always present and reduced afterload which will make EF higher than is
  • can asses global systolic function way better
34
Q

how does the angle of MV inflow change with DCMO

A
  • normal = inflow < 20º lateral to apex

- dilates = inflow up to 40º from apex

35
Q

what are 3 other structs that might occur at the apex other than thrombi

A
  • aberrant chordae
  • ruptured chordae or pap
  • prominent LV trabeculations
36
Q

what are 7 tips for detecting LV thrombus

A
  • highest frequency
  • harmonics
  • reduce depth
  • focal zone
  • pan through LV
  • confirm thrombus in 2 or more planes
  • color doppler
37
Q

what is the etiology of hypertrophic CMO HCMO

A
  • inherited disease = X linked autosomal dominant

- increased muscle mass due to myofibril disarray producing symmetric hypertrophy of the heart

38
Q

what are the 2 sub groups of HCMO and what are they based on

A
  • non obstructive
  • hypertrophic obstructive CMO
    + HOCMO
  • base on whether hypertrophy is causing any LV outflow obstruction
39
Q

which area of the heart will most likely result in HOCMO

A
  • basal anterior septum
40
Q

what are 3 characteritcs of non obstructive HCMO

A
  • LVOT PG < 30mmHg at rest
  • potential for LVOT obstruction to develop wth time
  • VALSALVA EVERY PATIENT
41
Q

what are 4 characteritcs of HOCMO

A
  • dynamic obstruction
    + occurs when MV leaflets com in contact with thick IVS
  • LVOT PG > 30mmHg at rest
  • latent obstruction discoverable with valsalva
  • if obstruction present at rest then present always
42
Q

what are 7 clinical signs of HCMO

A
  • angina
  • exercise intolerance
  • arrhythmias
  • AV blocks
  • systolic murmur
  • syncope
  • sudden death
43
Q

what are 3 M mode characteristics of HCMO

A
  • systolic anterior motion of MV SAM
  • wall thickness IVS basal vs LVW basal
    + high risk > 30mm
  • mid systolic closure of AV
44
Q

what are the 2D findings of HCMO

A
  • ASH
  • narrowed LVOt
  • IVS > 1.3
  • IVS:LVPW > 1.3
  • thickened ground glass IVS
  • decreased systolic IVS thickening
  • hyper dynamic LV motion
45
Q

what are the 3 forms of HCMO

A
  • basal IVS segment
  • mid ventricular hypertrophy
  • apical hypertrophy
46
Q

what are the 3 types of HOCMO

A
  • persistance obstruction
  • provocable obstruction
  • latent obstruction
47
Q

what is persistant HOCMO

A
  • obstruction at rest no provocation

- high velocity LVOT

48
Q

what is provable HOCMO

A
  • mild obstruction at rest that increases with provocation

- gets worse with valsalva

49
Q

what is latent HOCMO

A
  • near normal velocity at rest that increases with provocation
  • obstruction only during valsalva
50
Q

what 2 factors is obstructive CMO dependant on

A
  • preload

- afterload

51
Q

what will increase the obstruction

A
  • lower preload lower LV volume increased contractiliyc and decreased afterload
52
Q

what are the 3 provocative maneuver to uncover latent obstruction

A
  • amyl nitrate
  • valsalva
  • stress test
53
Q

what will a dynamic flow obstruction look like on doppler

A
  • mid to late systolic peaking of LVOT flow
  • gradient across LVOT
  • use PW to map level of obstruction
  • CW to display peak velocity
  • as gradient increases the degree or severity increases
54
Q

characteristics of mid ventricular HCMO

A 
- entire LV extremely thick 
  \+ concentric
- obstruction in mid ventricular cavity 
- LV contracts on itself
- lv cavity obliterates duding systole
-
55
Q

echo findings of mid ventricular HCMO

A
  • very thick LV
  • small LV cavity
  • color doppler increase velocityes
  • MR
  • LVOT obstruction at higher heart rates
  • saw tooth waveforms
56
Q

characteristics of apical HCMO

A
  • similar to mid ventricle
  • need to image true apex
  • heart cavity globular inchape
  • color doppler to identify obstruction
  • look for apical infarction, clot, aneurysm
57
Q

what are the 2 main treatments of HCMO

A
  • medical

- surgical

58
Q

what are the 2 medical treatments of HCMO

A
  • improve diastolic function with meds

- prevention of sudden death (Cardiac defibrillator)

59
Q

what are the 3 surgical treatments of HCMO

A
  • spatial ablation
  • myectomy
  • percutaneous intervention

Echo 2 (18 decks)

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