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Cardiac Imaging > Myocardial Disease > Flashcards

Myocardial Disease Flashcards

1
Q

Definition of cardiomyopathy ?

A

Any structural disease of the myocardium, in absence of ischaemic or significant valvular or congenital heart disease

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2
Q

Different types of cardiomyopathy?

A 
Hypertrophic cardiomyopathy 
Dilative cardiomyopathy 
Restrictive cardiomyopathy 
Arrhythmogenic right ventricular cardiomyopathy (ARVC)
Non compaction cardiomyopathy 
Takotsubo cardiomyopathy 
Peripartal cardiomyopathy
Tachyarrhyrhmic cardiomyopathy 
Athlete‘s heart
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3
Q

Hypertrophic cardiomyopathy — role of MRI?

A 
I1 Indication 
Diagnosis / Severity (volumes, function, mass, wall- thickness)
Form (symmetric vs asymmetric, obstructive vs non-obstructive)
Risk stratification (LGE, myocardial fibre disarray)
Follow up (medical therapy, alcohol ablation, surgery)
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4
Q

Hypertrophic cardiomyopathy — forms and facts?

A

Symmetric and asymmetric phenotypes
Apical, midseptal, basal phenotype
Obstructive and non-obstructive forms

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5
Q

Hypertrophic cardiomyopathy — differential diagnosis?

A

Cardiac amyloidosis
Anderson Fabry disease
Löffler endocarditis (apical)
Cardiac hypertrophy due to valvular heart disease (aortic stenosis)
Cardiac hypertrophy due to congenital heart disease (coarctation)

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6
Q

Hypertrophic cardiomyopathy — MRI diagnosis?

A

Septal wall-thickness > 15mm
Septal wall-thickness > 13mm with known genotype
Myocardial fibre disarray with +LGE at septal hinge points
+/- myocardial edema
LVRI (left ventricular remodeling index) > 1.3

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7
Q

Myocardial crypts?

A

Outpouchings/small cavities of the ventricular wall, most often seen in the inferoseptal parts
Associated with phenotype-/genotype+ HCM

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8
Q

Dilative cardiomyopathy — role of MRI?

A

I1 Indication
Diagnosis / Severity (volumes, function, mass)
DDx (valvular disease, congenital heart disease, LVNCM, Tako-Tsubo)
Establishing the cause (myocarditis)
Prognosis (mass, LGE)
Complications (thrombi)

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9
Q

Dilative cardiomyopathy — MRI diagnosis?

A

Dilated left ventricle, short axis diameter > 60/55 mm (m/f)
EDVI>100/90 ml/m2 (m/f)
LVRI (left ventricular remodelling index) < 0.8
Decreased systolic function
Absence of hypertension or significant valvular disease
Absence of ischaemic heart disease

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10
Q

Differential diagnosis of dilative cardiomyopathy?

A

Non compaction cardiomyopathy
Peripartal cardiomyopathy
Tachyarrhythmic cardiomyopathy
Dilative cardiopathy due to valvular heart disease

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11
Q

Restrictive cardiomyopathy — role of MRI?

A

I1 Indication
Diagnosis / Severity (volumes, function, mass)
Differentiation restrictive cardiomyopathy vs constrictive pericarditis
Establishing the cause (amyloidosis, Fabry disease, hemochromatosis etc.)
Prognosis (mass, LGE)

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12
Q

Restrictive cardiomyopathy — diagnosis?

A

Diastolic dysfunction
Echocardiography — missing A-wave
Atrial dilatation

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13
Q

Arrhythmogenic right ventricular cardiomyopathy (ARVC) — MRI criteria ?

A

Demonstration of right ventricular akinesia/dyskinesia and/or right ventricular aneurysms
Major criteria: Increased right ventricular EDVI > 110/100 ml/BSA (m/f), decreased right ventricular ejection fraction (RVEF) < 40%
Minor criteria: Increased right ventricular EDVI > 100/90 ml/BSA (m/f), decreased right ventricular ejection fraction (RVEF) < 45%

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14
Q

ARVC — additional features in MRI?

A

Fibrofatty replacement of the right ventricular myocardium: often seen in free right ventricular wall and apex, rarely in septum (bad prognosis)
Scarring of the right ventricular wall with +LGE

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15
Q

ARVC — differential diagnosis (DDx)?

A
  • Right ventricular (RV) infarct -usually encompasses the inferior and inferoseptal LV segments
  • Valvular heart disease (PS, PI, MS, MI)
  • congenital heart disease (ASD +/- PAPVR, Ebstein anomaly)
  • cardiac sarcoidosis
  • pulmonary hypertension
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16
Q

Non compaction cardiomyopathy (LVNC) — MRI diagnosis ?

A
  • non-compacted vs compacted myocardium 2.3:1
  • compacted vs compacted LV mass 40%
  • non-compacted vs total LV mass > 20%
17
Q

Non-compaction cardiomyopathy (LVNC) — differential diagnosis (DDx) ?

A 
Hypertrophic cardiomyopathy (HCM) — apical form
Dilative cardiomyopathy (DCM) with hypertrabeculation
Congenital corrected transposition of the great arteries (L-TGA/ccTGA)
18
Q

Takotsubo cardiomyopathy — role of CMR?

A 
Confirm diagnosis
Rule out (r/o) important differential diagnosis (DDx)
19
Q

Takotsubo cardiomyopathy — CMR features?

A

„Apical ballooning“
Hypokinesia / akinesia of apical and midventricular segments
Cardiac edema, increased signal in T2w

20
Q

Takotsubo cardiomyopathy — differential diagnosis (DDx)

A

Clinical: embolic (non-stenotic) myocardial infarction (MI), myocarditis
Image related: dilative cardiomyopathy, (Löffler endocarditis)

21
Q

Athlete‘s heart — MRI features? Diagnostic clues?

A

Balanced increase in myocardial wall thickness and ventricular volumes
Concentric hypertrophy usually not exceeding 15mm
LVRI (left ventricular remodeling index) > 0.8 and < 1.3
No myocardial fibre disarray / LGE-
Absence of hypertension or significant valvular heart disease
Decreased extrazellular volume (ECV)

22
Q

Hypertensive Heart Disease — facts?

A

Trias: left heart hypertrophy, myocardial fibrosis, coronary microangiopathy
Cause: long-standing untreated hypertension
Leads to diastolic dysfunction

23
Q

Hypertensive heart disease — bad prognostic factor?

A

Left ventricular hypertrophy

24
Q

Hypertensive cardiomyopathy — pathophysiology?

A

Left ventricular pressure overload secondary to increased vascular stiffness

25
Q

Hypertensive cardiomyopathy — early left ventricular changes?

A

Left ventricular hypertrophy and hyperplasia
Increased inotropy
Prolonged isovolumetric relaxation
Shortened filling phase

26
Q

Hypertensive cardiomyopathy / hypertrophic cardiomyopathy — clinical symptoms?

A

Angina — decreased coronary flow reserve
Ventricular and supraventricular arrhythmias
Hypertensive crisis (emergency)
Sudden cardiac death

27
Q

Hypertensive cardiomyopathy — imaging features?

A

Left ventricular hypertrophy — septal/basal wall
Left atrial dilatation
Normal or mildly elevated left ventricular ejection fraction (LV-EF)
Diastolic dysfunction
Midwall septal and lateral enhancement
Corkscrew appearance of the small distal coronary segments

28
Q

Cor pulmonale — definition?

A

Right ventricular hypertrophy and/or dilatation as a result of pressure overload / pulmonary hypertension

29
Q

Pulmonary hypertension ?

A

Pulmonary artery pressure > 25 mmHg

30
Q

Cor pulmonale / pulmonary hypertension — aetiology?

A

Nizza classification:
Pulmonary hypertension: idiopathic, hereditary, medications/toxins, associated with different conditions
Pulmonary hypertension associated with left heart disease: systolic / diastolic dysfunction, valvular heart disease, congenital outflow tract obstruction
Pulmonary hypertension associated with pulmonary disease or hypoxia: COPD, ILD, other obstructive/restrictive lung disease, sleep apnea etc.
Chronic thromboembolic pulmonary hypertension (CTEPH)

31
Q

Dilative cardiomyopathy — definition?

A

LV-dilatation and LV-systolic-dysfunction in the absence of abnormal loading conditions (hypertension / valvular disease) or CAD sufficient to cause global systolic impairment.
RV-dilatation or RV-dysfunction may be present.

32
Q

Dilative cardiomyopathy — aetiology?

A

Sporadic: myocarditis, toxic, autoimmune,metabolic
Genetic: 20-35%

33
Q

Workup to exclude ischaemic heart disease?

A

Ideally CMR and coronary CTA / coronary angiogram
Why? — Soriano et al. 2005
~10% with myocardial infarction (LGE+) do not show coronary stenosis
~20% with significant stenosis do not have LGE+

34
Q

Non compaction cardiomyopathy (LVNC) — role of MRI ?

A

I1 Indication

  • diagnosis / severity (volumes, function, mass)
  • r/o differential diagnosis (DDx)
  • complications
35
Q

Arrhythmogenic right ventricular cardiomyopathy (ARVC) — role of MRI ?

A

I1 Indication

  • diagnosis / severity (volumes, function, LGE, fibrofatty deposits)
  • complications
  • r/o DDx (e.g. right ventricular infarction)
36
Q

Dilated cardiomyopathy - origins ?

A
  • genetic
  • postpartum
  • infectious (viral, lyme)
  • autoimmune(sarcoidosis, LED)
  • toxic (alcohol)
  • metabolic (Cushing, diabetic)
37
Q

ARVC - epidemiologic facts ?

A
  • prevalence: 1/2000 - 1/5000
  • more severe in males (hormon induced)
  • responsible for ~ 20% of sudden cardiac deaths (SDC)
  • biventricular involvement ~ 60%
38
Q

ARVC - clinical symptoms ?

A
  • arrhythmia, RBBB
  • syncope
  • right sided heart failure (ascites, peripheral edema)
39
Q

Possible causes of cardiac deaths ?

A
  • ARVC ~ 20%
  • hypertrophic cardiomyopathy (HOCM, SAM)
  • coronary anomalies (malignant)

Cardiac Imaging (9 decks)

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