Myocardial diseases Flashcards

Question 1

Q

HCM is characterized by unexplained ……… LV hypertrophy where the LV chamber is not dilated and is often ……. than normal.

Answer

A

HCM is characterized by unexpöained concentric LV hypertrophy where the LV chamber is not dilated and is often smaller than normal.

Question 2

Q

HCM: …………… failure secondary to impaired relaxation is a common complication resulting in elevated LV ……….. pressure and a dilated LA chamber

Answer

A

HCM: Diastolic failure secondary to impaired relaxation is a common complication resulting in elevated LV filling pressure and a dilated LA chamber

Question 3

Q

LV outflow obstruction is also a common occurrence.

Answer

A

LV outflow obstruction is also a common occurrence.

Question 4

Q

The hypertrophy in cats displays varying morphology. Most cats present with symmetric hypertrophy with both the ventricular septum and the free wall affected to a similar degree. Figures 7.1 and 7.2

Answer

A

The hypertrophy in cats displays varying morphology. Most cats present with symmetric hypertrophy with both the ventricular septum and the free wall affected to a similar degree. Figures 7.1 and 7.2

About as many cats however, present with asymmetric hypertrophy affecting primarily the septum. Figures 7.3, 7.4).

Fewer cats (17%) present with asymmetric hypertrophy affecting the LV free wall. Figures 7.5 and 7.6.

Question 5

Q

In other cases, only the apex, mid ventricular areas, segmental areas of marked transitions between normal thickness, and increased thickness or the very base of the septum are hypertrophied. Fig 7.7.

Answer

A

In other cases, only the apex, mid ventricular areas, segmental areas of marked transitions between normal thickness, and increased thickness or the very base of the septum are hypertrophied. Fig 7.7.

Question 6

Q

Asymmetric septal hypertrophy was the most common form of hypertrophy in one study in dogs with HCM with 80% of 20 dogs in one study displaying this asymmetry.

Answer

A

Asymmetric septal hypertrophy was the most common form of hypertrophy in one study in dogs with HCM with 80% of 20 dogs in one study displaying this asymmetry.

Question 7

Q

Infarction and aneurysmal dilation of the LV apex may develop.
Although this has not been studied in the cat, in man there is no correlation between the degree of hypertrophy and clinical signs of heart failure.

Answer

A

The degree of hypertrophy does correlate with the incidence of sudden death in man however.

Question 8

Q

Hypertrophic cardiomyopathy:
Features:

Concentric LV hypertrophy
-Most have symmetric or just VS hypertrophy

LA does not have to be dilated.

Mot have obstruction to outflow

SAM seen
Systolic aortic valve closure seen

Elevated FS

Answer

A

Concentric LV hypertrophy
-Most have symmetric or just VS hypertrophy

LA does not have to be dilated.

Mot have obstruction to outflow
-SAM seen
Systolic aortic valve closure seen

Elevated FS

Question 9

Q

The hypertrophy may obstruct flow in the LV outflow tract. This occurs primarily when?

Answer

A

When the base of the ventricular septum impinges upon the outflow tract, and it may occur when extensive free wall thickening displaces the mitral valve upward into the outflow tract.

Question 10

Q

Abnormally long mitral valve leaflets are a cause of LV outflow obstruction in man. Cats with ……….hypertrophy or hypertrophy primarily affecting the ……… tend to have a significantly higher incidence of murmurs, probably associated with outflow tract obstruction.

Answer

A

Abnormally long mitral valve leaflets are a cause of LV outflow obstruction in man. Cats with symmetric hypertrophy or hypertrophy primarily affecting the septum tend to have a significantly higher incidence of murmurs, probably associated with outflow tract obstruction.

Question 11

Q

hearts with mid ventricular hypertrophy may have mid cavity obstruction associated with contraction.

Answer

A

hearts with mid ventricular hypertrophy may have mid cavity obstruction associated with contraction.

Question 12

Q

Significant …… hypertrophy in addition to the LVH has been seen in several cats.

Answer

A

Significant RV hypertrophy in addition to the LVH has been seen in several cats.

Question 13

Q

large prominent papillary muscles are common in cats with HCM. Using either of the area methods to measure papillary muscle size, a papillary muscle area of greater than …. cm upphöjt i 2 exceeds that found in normal cats.

Answer

A

0.8

Fig 7.8

This is not specific to HCM and may reflect enlargement of the papillary muscles secondary to other causes of LV hypertrophy.

Question 14

Q

Left atrial size may or may not be increased in animals with HC;. LA enlargement is considered to be an indicator of severity and chronicity of diastolic failure in man. The larger the LA, the worse the prognosis. The cause of LA enlargement is typically secondary to ……….. dysfunction but may be because of …………..failure or abnormal mitral valve function.

Answer

A

The cause of LA enlargement is typically secondary to diastolic dysfunction but may be because of systolic failure or abnormal mitral valve function.

Question 15

Q

LV outflow obstruction:

Systolic anterior motion (SAM) of the mitral valve occurs in the presence of moderate to severe LV outflow tract obstruction. Several theories exist for the underlying cause of SAM. Such as?

Answer

A

High velocity flow within an outflow tract narrowed by a hypertrophied septum creates a Venturi effect and tends to pull one or both mitral valve leaflets into the outflow tract.

The presence of abnormal ventricular architecture and papillary muscle misalignment may allow the septal or parietal mitral valve leaflets to be pushed into the outflow tract during systole.

Alignment of the sub auricular papillary muscle into the middle of the ventricular chamber may also play a role in the development of SAM. This displacement causes the flow of blood to slip in under the septal leaflet pushing it into the outflow tract like a cowl.

Question 16

Q

In man reports of elongated mitral leaflet, direct papillary muscle attachment to the septal mitral leaflet, and ……… chordae tendinae are all associated with obstruction to LV outflow.

Answer

A

In man reports of elongated mitral leaflet, direct papillary muscle attachment to the septal mitral leaflet, and short chordae tendinae are all associated with obstruction to LV outflow.

Question 17

Q

There is reason to believe that ………..contributes substantially more to any outflow obstruction than the …………………

Answer

A

There is reason to believe that SAM contributes substantially more to any outflow obstruction than the hypertrophied ventricular septum.

Question 18

Q

Systolic anterior motion of the ………….. mitral valve leaflet secondary to a hyperdynamic state without LV hypertrophy has been documented.

Answer

A

Systolic anterior motion of the parietal mitral valve leaflet secondary to a hyperdynamic state without LV hypertrophy has been documented.

Question 19

Q

Outflow tract obstruction is worsened by volume ……….., decreased …………. (aortic pressure), and increased ………….., which all allow the LV chamber to achieve smaller systolic dimensions and ………….tension on chordae teninae allowing the mitral valve leaflet to move up into the outflow tract.

Answer

A

Outflow tract obstruction is worsened by volume contraction, decreased afterload (aortic pressure), and increased contractility, which all allow the LV chamber to achieve smaller systolic dimensions and decrease tension on chordae teninae allowing the mitral valve leaflet to move up into the outflow tract.

Question 20

Q

The degree and duration of ………………….during systolic anterior mitral valve motion correlate with severity of dynamic outflow obstruction.

Answer

A

The degree and duration of septal contact during systolic anterior mitral valve motion correlate with severity of dynamic outflow obstruction.

Question 21

Q

Although muscular septal hypertrophy and SAM are the most common causes of LV obstruction, mid ventricular obstruction may occur. This is usually caused by?

Answer

A

This is usually caused by severe hypertrophy that allows the septum and free wall to meet each other during systole resulting in cavity obliteration.

Question 22

Q

Often a severely hypertrophied papillary muscle is caught between the 2 walls. Identification of mid ventricular obstruction is possible with color-flow Doppler that shows turbulence within the ……….. of the ventricular chamber and with PW Doppler, that defines an aliased signal at the point of obstruction.

Answer

A

Often a severely hypertrophied papillary muscle is caught between the 2 walls. Identification of mid ventricular obstruction is possible with color-flow Doppler that shows turbulence within the middle of the ventricular chamber and with PW Doppler, that defines an aliased signal at the point of obstruction.

Question 23

Q

The increase in mid ventricular velocity may not reflect true obstruction and may simply be the result of high velocity flow secondary to a ………………….. chamber.

Answer

A

The increase in mid ventricular velocity may not reflect true obstruction and may simply be the result of high velocity flow secondary to a small hyper dynamic chamber.

Question 24

Q

An experienced eye can detect systolic anterior motion on real-time 2 D images, but the motion is easier to detect and document on M-mode images of the mitral valve.

Question 25

Q

The duration of mitral valve septal contact is directly correlated to severity of the outflow tract gradient.

Answer

A

The duration of mitral valve septal contact is directly correlated to severity of the outflow tract gradient.

Question 26

Q

Longer apposition with the septum indicates ………….?

Answer

A

Longer apposition with the septum indicates more severe obstruction.

Question 27

Q

………. peaking SAM with little if any contact suggests mild obstruction to flow. Small gradients will not create any SAM.

Answer

A

Late peaking SAM with little if any contact suggests mild obstruction to flow. Small gradients will not create any SAM.

Question 28

Q

LV outflow obstruction because of SAM is …………. in nature and may not be present at rest.

Answer

A

LV outflow obstruction because of SAM is dynamic in nature and may not be present at rest.

Question 29

Q

Systolic anterior motion may be the cause of LV outflow obstruction and the resultant concentric LV hypertrophy in young dogs.

Answer

A

Systolic anterior motion may be the cause of LV outflow obstruction and the resultant concentric LV hypertrophy in young dogs.

Question 30

Q

The systolic anterior mitral valve motion may be due to abnormalities of the mitral apparatus in dog. ……….. valve tissue has been seen in several of the dogs with SAM.

Answer

A

Redundant valve tissue has been seen in several of the dogs with SAM.
The hypertrophy and systolic anterior motion resolved with beta-blocker treatment in dogs that lived.

Question 31

Q

It is important to point out that SAM may be seen in patients without HCM. It is reported in patients with elevated RV pressure caused by ………………(3)

Answer

A

It is important to point out that SAM may be seen in patients without HCM. It is reported in patients with elevated RV pressure caused by pulmonic stenosis, tetralogy of Fallot, and pulmonary hypertension.

All of these patients had LV volume contraction, and the abnormal LV geometry is thought ot be the cause of the SAM.
Outflow gradients were present in most cases and even when peak flow velocity was normal, the flow profile showed lated peaking velocity.

Question 32

Q

Systolic anterior mitral valve motion is also reported in association with a handful of other situations; transposition, double chamber right ventricle. anomalous papillary muscles, conotruncal abnormalities, systemic hypertension, and anemia.

Answer

A

Systolic anterior mitral valve motion is also reported in association with a handful of other situations; transposition, double chamber right ventricle. anomalous papillary muscles, conotruncal abnormalities, systemic hypertension, and anemia.

Question 33

Q

SAM may be seen with RV pressure …………. presumably due to poor LV ……………. and altered LV geometry.

Answer

A

SAM may be seen with RV pressure overload presumably due to poor LV preload and altered LV geometry.

Question 34

Q

Aortic valve motion may be altered in people and cats with hypertrophic obstructive cardiomyopathy.

Answer

A

Aortic valve motion may be altered in people and cats with hypertrophic obstructive cardiomyopathy.

Question 35

Q

Ejection time increase in direct proportion to the degree of subvalvular dynamic obstruction.

There is evidence of early systolic closure of the aortic valve corresponding to the ……….in forward flow as the dynamic obstruction occurs.

This motion is also called?

Answer

A

Ejection time increase in direct proportion to the degree of subvalvular dynamic obstruction.

There is evidence of early systolic closure of the aortic valve corresponding to the decrease in forward flow as the dynamic obstruction occurs.
Fig 4.97, 7.13

This motion is also called mid systolic notching or mid systolic closure.

Question 36

Q

This aortic valve motion usually involves only 1 or 2 of the aortic cusps, and M-mode images of the aortic valve taken from parasternal long-axis views may not show it while M-modes obtained from transverse views may.
This motion may be seen with? (2)

Answer

A

This motion may be seen with dynamic hypertrophic obstructive cardiomyopathy or with fixed sub aortic obstruction (stenosis).

there is no correlation with the severity of the pressure gradient. Early aortic valve closure has been reported with ventricular septa defect, and double outlet right ventricle.

Question 37

Q

Systolic function:

Fractional shortening in HCM is typically increased and the hearts are very visibly ………

Answer

A

hyperdynamic. Fig 7.2

This is not necessarily indicative of increased intrinsic contractility but may only be secondary to altered loading conditions in the heart. Paradoxically this increase in function often impedes cardiac output as dynamic obstruction is aggravated by the hyper contractile septum.

Question 38

Q

Only in rare cases, as end-stage HCM is reached, does function of the septum or free wall decrease. With advances in tissue Doppler imaging systolic dysfunction can be identified before FS and EF decrease.

Answer

A

With advances in tissue Doppler imaging systolic dysfunction can be identified before FS and EF decrease.

Question 39

Q

In one study, 72% of cats with FS less than 30% were dead 3 months after their initial examination.

Answer

A

Fig 7.14, 7.15

Question 40

Q

Whether these cats have reduced FS because of systolic dysfunction alone or diastolic disease, which has progressed to include systolic dysfunction, is not known.

Answer

A

Whether these cats have reduced FS because of systolic dysfunction alone or diastolic disease, which has progressed to include systolic dysfunction, is not known.

Question 41

Q

Doppler evaluation of HCM:

A pressure gradient across the LV outflow tract in man is now considered a predictor of complications, disease progression, and death. This predictive feature was present when outflow gradients reached …….. mm or greater, and prognosis did not become worse with worsening pressure gradients.

Answer

A

This predictive feature was present when outflow gradients reached 30 mm or greater, and prognosis did not become worse with worsening pressure gradients.

Question 42

Q

There also appears to be a direct relationship between LV outflow obstruction and both systolic and diastolic dysfunction in humans with HCM. The gradient correlated with LV filling pressure, hypertrophy, and LA size.

Answer

A

There also appears to be a direct relationship between LV outflow obstruction and both systolic and diastolic dysfunction in humans with HCM. The gradient correlated with LV filling pressure, hypertrophy, and LA size.

Question 43

Q

The obstruction to outflow seen in many cases of HCM occurs primarily during ………………

Answer

A

The obstruction to outflow seen in many cases of HCM occurs primarily during late systole.

Question 44

Q

Spectral Doppler displays show the outflow obstruction in late systole nicely by dagger-shaped late peaking velocity on LV outflow-tract flow profiles.

Answer

A

Spectral Doppler displays show this nicely by dagger-shaped late peaking velocity on LV outflow-tract flow profiles. Fig 7.16.

Question 45

Q

Spectral Doppler displays show this nicely by dagger-shaped late peaking velocity on LV outflow-tract flow profiles. Fig 7.16.

This late-peaking maximal velocity correlates with the increased flow velocity as the ………. narrows the outflow tract or …….obstructs flow.

Answer

A

This late-peaking maximal velocity correlates with the increased flow velocity as the septum narrows the outflow tract or SAM obstructs flow.

Question 46

Q

Pressure gradients are measured sing the …..

Answer

A

Bernoulli equation

Question 47

Q

Outflow obstruction is subvalvular, and the Doppler cursor is not necessarily aligned with the wall of the aorta to record peak velocity.

Answer

A

Outflow obstruction is subvalvular, and the Doppler cursor is not necessarily aligned with the wall of the aorta to record peak velocity.

Align the cursor with the outflow tract, using CF Doppler do define the orientation of the turbulent flow. A low frequency transducer may define high outflow flow velocity that is not found with high frequency high-resolution transducers.

Question 48

Q

Occasionally there is obstruction in the middle of the ventricular chamber. A late-peaking outflow profile is sen if the middle of the chamber is interrogated or when the CW Doppler beam crossed that portion of the chamber while evaluating the outflow tract. PW Dopler should be used to interrogate the midventruuclar area for obstruction. CF Doppler aids in identifying this.

Answer

A

Occasionally there is obstruction in the middle of the ventricular chamber. A late-peaking outflow profile is sen if the middle of the chamber is interrogated or when the CW Doppler beam crossed that portion of the chamber while evaluating the outflow tract. PW Dopler should be used to interrogate the midventruuclar area for obstruction. Fig 7.16.

CF Doppler aids in identifying this.

Question 49

Q

Midventricular obstruction should be considered when there is no SAM and secondary……… but there is a murmur.

Answer

A

Midventricular obstruction should be considered when there is no SAM and secondary MR but there is a murmur.

Question 50

Q

Late peaking ventricular outflow profiles are seen with dynamic outflow obstructions.

Answer

A

Late peaking ventricular outflow profiles are seen with dynamic outflow obstructions.

Question 51

Q

Systolic anterior motion is not only responsible for obstruction to LV outflow, but also for resultant mild to moderater MR as the valve leaflets are pulled out of a properly closed position. The MR jet is directed toward the lateral wall of the LA, and seeing a jet directed ………… from the outflow tract should provide a hitch that SAM is present.

Answer

A

The MR jet is directed toward the lateral wall of the LA, and seeing a jet directed away from the outflow tract should provide a hitch that SAM is present.
Figures 7.17, 7.18

Question 52

Q

The presence and degree of regurgitation is directly related to SAM. The greater the obstruction, the greater the degree of SAM the greater the degree of insufficiency.

Answer

A

The presence and degree of regurgitation is directly related to SAM. The greater the obstruction, the greater the degree of SAM the greater the degree of insufficiency.

Question 53

Q

Alleviation of the outflow tray obstruction results in reduction or elimination of the SAM and MR:

Answer

A

Alleviation of the outflow tray obstruction results in reduction or elimination of the SAM and MR:

Question 54

Q

There are patients with MR unrelated to their hypertrophic disease however, and this should be suspected when?

Answer

A

When the regurgitant jet is not directed downward toward the lateral wall of the LA away from the outflow tract and is centrally directed instead.

Question 55

Q

When color-flow or an imaging Doppler probe is not used, it is easy to record MR flow as opposed to LV outflow from left apical 5 ch views of the heart.

Answer

A

When color-flow or an imaging Doppler probe is not used, it is easy to record MR flow as opposed to LV outflow from left apical 5 ch views of the heart.

Question 56

Q

MR starts …………. in the cardiac cycle near the beginning of the QRS complex. When the late-peaking flow profile is seen, you know it is the ……….. and not MR.

Answer

A

MR starts earlier in the cardiac cycle near the beginning of the QRS complex. When the late-peaking flow profile is seen, you know it is the outflow tract and not MR.

Question 57

Q

Evaluation of Diastolic function:

PW Doppler Evaluation of …… function. While systolic function is generally not impaired in patients with HCM, ……….. dysfunction is a common abnormality.

Answer

A

PW Doppler Evaluation of diastolic function. While systolic function is generally not impaired in patients with HCM, diastolic dysfunction is a common abnormality.

Question 58

Q

Diastolic dysfunction is the result of impaired myocardial relaxation, restriction to LV filling, and increased LV filling pressures.

Answer

A

Diastolic dysfunction is the result of impaired myocardial relaxation, restriction to LV filling, and increased LV filling pressures.

Question 59

Q

…………failure is a major factor in the development of congestive heart failure in feline cardiomyopathy.

Answer

A

Diastolic failure is a major factor in the development of congestive heart failure in feline cardiomyopathy.

Question 60

Q

Assessment of LV diastolic function involves the Doppler evaluation of transmitral flow, isovolumic relaxation time, pulmonary venous flow, and myocardial motion.

Answer

A

Assessment of LV diastolic function involves the Doppler evaluation of transmitral flow, isovolumic relaxation time, pulmonary venous flow, and myocardial motion.

Question 61

Q

Impaired myocardial relaxation is reflected in the rate of relaxation, and isovolumic relaxation time will be ……………….

Answer

A

Impaired myocardial relaxation is reflected in the rate of relaxation, and isovolumic relaxation time will be increased.

Question 62

Q

The LV filling patterns of most patients, both animals and human with HCM, is abnormal. It shows?

Answer

A

Decreased early filling (E) and a larger late diastolic filling component (A) with the atrial contraction. Figures 4.73, 7.19, 7.20

Question 63

Q

Mitral valve early diastolic deceleration time is ……….. in HCM, and this is reported as an early predictor of disease development.

Answer

A

Mitral valve early diastolic deceleration time is prolonged in HCM, and this is reported as an early predictor of disease development.

Question 64

Q

HCM: The increased deceleration time reflects impaired LV filling associated with delayed relaxation and results in a larger atrial contribution to LV volume and a decreased E:A.

Answer

A

The increased deceleration time reflects impaired LV filling associated with delayed relaxation and results in a larger atrial contribution to LV volume and a decreased E:A.
Increased heart rate results in summation of E and A transmitral flow.

Answer 64

A

The summated EA has higher flow velocity than isolated E flow velocity in the same cat.

Answer 65

A

The sum of individual E and A velocities in cats with slow heart rates is similar to the summated EA flow velocity in normal cats.

Answer 66

A

As discussed in chapter 4, diastolic dysfunction is a continuum of events, and flow profiles will transition through a pseudonormal phase into a patterns of restrictive physiology typical of decreased compliance. Table 4.3

Answer 67

A

Increased IVRT
Decreased MV E peak
Pulmonary vein Ar flow of increased duration and increased velocity.

Answer 68

A

Acceleration and deceleration times of systolic pulmonary venous flow into the LA is also evaluated.

Answer 69

A

Whereas parameters assessing LV filling patterns are similar in human patients with HCM and hypertrophic heart disease secondary to aortic stenosis and systemic hypertension, pulmonary venous flow differs between idiopathic HCM secondary forms of hypertrophy

Answer 70

A

Patients with HCM have decreased systolic acceleration times, increased deceleration times and reduced rate of systolic deceleration.

Answer 71

A

Patients with secondary forms of hypertrophy had parameters similar to normal controls.

Answer 72

A

There is no difference in the pulmonary venous flow velocities, acceleration or deceleration times, or rates between human patients with obstructive versus non-obstrcutive HCM, not between the varying patterns of hypertrophy (asymmetric, symmetric, and apical).

Answer 73

A

In the presence of elevated LV filling pressure, secondary to impaired relaxation, despite normal IVRT and normal transmitral flow, there will be enhanced reverse flow into the pulmonary vein during the atrial contraction.
This includes both duration of reverse flow and velocity of reverse flow.

Answer 74

A

Systolic pulmonary venous flow may be decreased in the presence of elevated LA pressure, and diastolic flow will be greater than systolic flow as the atrial component of filling plays a more dominant role.

Fig 7.21

Answer 75

A

MV flow appears normal

-IVRT normal:
use pulmonary vein flow to identify pseudonormal diastolic function

-Ar flow increased in duration and velocity

Answer 76

A

Tissue Doppler imaging is able to define abnormalities of systolic and diastolic function in the myocardium.

Answer 77

A

Hypertrophic cardiomyopathy has abnormal longitudinal systolic shortening (reduced systolic annular velocity) and abnormal diastolic lenghtening (reduced early diastolic annular velocity) and abnormal diastolic lengthening (reduced early diastolic annular velocity), which can be documented with TDI

Answer 78

A

TDI has the ability to identify subclinincal HCM in asymptomatic patients and provide a measure of LV filling pressure in man.

Answer 79

A

Annular systolic and diastolic velocities are lower in human patients with subclinical hypertrophic cardiomyopathy even before the development of any LV hypertrophy. Some of these parameters have been studies in the cat, and the differences in PW tissue Doppler parameters between cats with HCM and normal cats are listed in Tables 7.1, 7.2 and 7.3

Answer 80

A

Cats with HCM have lower E´at all apical 4 ch locations, and lower
E´:A´at all myocardial locations, lower Se´at both sides of the mitral annulus and at the chordal level in the ventricular septum on the apical 4 ch view, lower S’ at both sides of the mitral annuls, and at the chordal level i the ventricular septum on the apical 4 ch view, lower E’ acceleration and deceleration rates at all locations on the apical vies and in the LV free wall on the apical 4 ch view. Fig 7.22

Answer 81

A

Asymptomatic cats with HCM have increased A’ velocity in the ventricular septum on both apical and parasternal 4 ch views. This probably reflects preserved or increased atrial contractility in the setting of high LA pressure.

Answer 82

A

Several systolic and diastolic time intervals are also significantly different in HCM cats when compared to normal cats. These parameters show that peak early PW diastolic myocardial velocity is both decreased and occurs later in the diastolic time period, and that isovolumic relaxation times are prolonged in cats with HCM.

Answer 83

A

there is longer E´acceleration time at both sides of the mitral annulus on the apical view and the LV free wall at the chordal level on both apical and right parasternal 4 ch views, longer E´ deceleration time at the free wall mitral annulus on the apical 4 ch and on the right parasternal 4 ch imaging plane at the level of the chordae in the free wall, longer early systolic (se´) acceleration time at all locations on apical 4 ch views except at the septal annulus, longer E´duration at the free wall mitral annulus and free wall chordal level on both imaging planes, and longer time interval between the start of Se´to start of late systolic motion (Sl´) at the free wall annulus on the apical view and at the chordal level of the septum on the right parasternal 4 ch plane.

Answer 84

A

TDI changes from normal are also evident in subclinical dystrophic-deficient HCM even before the presence of any documented hypertrophic changes.

Answer 85

A

The E’:A’ relationship in these cats was less than 1 in most cats for radial motion and all cats for longitudinal motion of the lateral wall. These changes were more prominent at the base than the apex and in the endocardium than the epicardium. This may indicate that longitudinal fibers are affected earlier in the course of the disease than radial fibers.

Answer 86

A

It is thought to represent impairment of systolic function, but its mechanism is not fully understood.

This systolic motion is present late in systole or early in diastole rather than during early systole. This contraction often occurs during the time when early diastolic motion should occur resulting in the absence of an E´ wave.

Answer 87

A

Depressed systolic function despite normal systolic dimension and normal FS was also verified by decreased S´ motion on longitudinal but not radial myocardial fibers.

One study reports that decreased S’ in the longitudinal fibers of cats with HCM is seen only in symptomatic cats with HCM

Answer 88

A

The differences in longitudinal early diastolic wall motion between segments of the septum and the free wall seen in normal feline hearts is no longer present in most portions of the myocardium in cats with HCM.

This heterogeneity in myocardial motion along the longitudinal axis is though to be an important component for optimal myocardial function.

Answer 89

A

The E´acceleration rate of the interventricular septum at the chordae level is greater than the acceleration rate at the septal mitral annulus on apical 4 ch imaging planes and the E´ acceleration time was decreased at the chordal level when compared to the level of the mitral annulus of the septum.

Answer 90

A

Cats with HCM have greater E´:A´ ratios at the LV free wall when compared to the septum on right parasternal long-axis 4 ch views.

Answer 91

A

Lower E´at all apical locations
Lower E´:A at all apical locations
Lower S´ at all apical locations

Answer 92

A

Summation of early and late diastolic motion is seen at rapid heart rates. Summated EA´ has higher velocity than when they are separate.

One study shows that this does not affect the interpretation of myocardial velocity when compared to cats without heart disease and rapid heart rates.

Answer 93

A

Therefore, summated EA´myocardial velocity and summated EA transmitral flow may potentially be used to assess diastolic function in cats with HCM.

Answer 94

A

It is important to use different reference ranges in order to interpret summated and non-summated diastolic tissue Doppler variables.

Answer 95

A

When early diastolic motion is decreased and summated with a potentially increased late diastolic velocity, the interpretation of events can become difficult. There is up to 30% variation in these variables from study to study, and small changes in tissue velocity should not be over interpreted as a significant change unless a trend is established.

Answer 96

A

PW tissue Doppler of the right side of the heart exhibits some differences from normal in cats with HCM. The E´velocity is decreased at the tricuspid valve annulus and the A´velocity is increased in cats with HCM when compared to normal cats.

Answer 97

A

Early diastolic myocardial velocity is preload dependent and can be used to identify diastolic failure in cats with pseudonormal transmitral flow profiles.

Answer 98

A

An E´value of > 7.2 cm/sec separates normal feline hearts from hearts with HCM.

Figures 7.22 and 7.23

This value has a specificity of 87% and a sensitivity of 92%

Answer 99

A

Diastolic pressure in the LA affects the PW Doppler transmitral flow profile and velocity.

Answer 100

A

The relationship of E:E´ is strongly correlated to LV filling pressure in man and in cats.

Answer 101

A

Normal E´ is > 7.2 cm/sec and normal E:E´is

Answer 102

A

In man, the degree of LV outflow obstruction is significantly correlated with poorer systolic and early diastolic myocardial motion and a higher E:E´

Answer 103

A

Transmitral flow
Pulmonary venous flow
Tissued Doppler
Size of LA

These parameters allow indirect evaluation of relaxation, compliance, atrial function, and LV filling pressure.

Answer 104

A

Complications:

Thrombus may form within the LA (figures 7.24-7.26)

Answer 105

A

LA dilation seems to be a risk factor for the development of arterial thromboembolism, although statistically this is not supported.

Thrombus formation in the LA is reported in 13 to 17% of cats with clinically diagnosed HCM, and 41% of cats post mortem

Answer 106

A

Thrombus forms within the left auricular appendage in cats with dilated LA chambers secondary to stasis of blood.

Answer 107

A

Cats with LA size greater than 20 mm are thought to be predisposed to the development of arterial thromboembolism, but a recent study found that the atrial size in many cats with thromboembolic disease was as small as 14 mm.

Answer 108

A

PW Doppler analysis of left auricular flow can provide evidence for the potential formation of spontaneous echo contrast or thrombus formation in man and in cats.

Answer 109

A

PW Doppler flow velocity lower than 0.25 m/sec is correlated with stasis of blood flow and a high possibility of thrombus formation.

Answer 110

A

Low to nonexistent auricular flow velocities are a sign of significant left auricular dysfunction.

Answer 111

A

Myocardial ischemia may be seen on occasion in cats with HCM: Initially only depressed systolic thickening of either the septum of LV free wall is seen.

Answer 112

A

Chronic ischemia may lead to infarction, and a regional area of hypokinesis with thin walls and potentially an aneurysmal dilatation may be seen.

Answer 113

A

Fractional shortening may be reduced in these cats if the M-mode measurement incorporated this portion of the ventricle. This is typically seen as a sequela to severe long-standing disease.

Answer 114

A

Severe long-standing HCM disease may result in depressed function and areas of myocardial ischemia and infarction.

Answer 115

A

Pericardial effusion may be seen in cats with severe HCM and clinical signs of heart failure. Pleural effusion and dyspnea are also often seen as a presenting compliant in cats with HCM:
Fig 7.28, 7.29

Answer 116

A

diff pleural form pericardial effusion.

Answer 117

A

Systemic hypertension
A common sequela of chronic renal failure seen so often in older cats
Hyperthyroidism

Answer 118

A

Hyperthyroidism causes hypertrophy of the septum and wall. One study showed free wall hypertrophy in 72% of cats with hyperthyroidism while sonly 40% of them had septal hypertrophy.

Seventy procent of these same cats also had LA dilation. Almost 50% of these cats are reported to have an increase in ventricular diastolic chamber size.

Answer 119

A

The vast majority of cats have hyperdynamic wall and septal motion and increased fractional shortenings. While there appears to be some differences between idiopathic and non-idiopathic LV hypertrophy in the cat, there is no reliable M-mode or 2D echo way to differentiate between these causes of hypertrophy. They may even coexist.

Answer 120

A

The degree of hypertrophy, the incidence of SAM, and the degree of outflow obstruction are similar in both hypertensive and idiopathic hypertrophic cardiomyopahty patients in man.

The presence of hypertension in conjunction with HCM usually results in a more significant hypertrophy however.

Answer 121

A

Hypertrophic feine muscular dystrophy and other infiltrative disorders

Answer 122

A

Normal systolic and diastolic annular myocardial velocities while they are altered in the pathologic forms.

Answer 123

A

Hypertension and hyperthyroidism. They cannot be differentiated from HCM echocardiographically

Answer 124

A

An unusual presentation for cats with hyperthryroidim is left an right ventricular chamber dilation with normal wall and septal thickness and poor fractional shortening. This is thought to occur secondary to increased systolic wall stress and myocardial dysfunction with chronic hyperthyroidism leading to congestive heart failure. Even these changes are reversible to a certain degree as the hyperthyroid state is corrected

Answer 125

A

Dynamic right ventricular outflow obstruction:
The cause of the obstruction is not well defined and may simply be secondary to excessive hypertrophy of the right ventricular wall or septum into the right ventricular outflow tract or cavity.

Answer 126

A

Color flow Doppler documents the presence of turbulent flow within the RV outflow tract and spectral Doppler displays a late-peaking flow velocity.
This is a dynamic and variable obstruction to flow

Answer 127

A

Frame-by-frame analysis can show septal and right ventricular free-wall apposition at the point where high velocity flow originates.

Answer 128

A

low with velocities ranging from 1.7 to 4.0 m/sec in cats and man
(mean and median 2.4 and 2.3 m/sec, respectively.)
Fig 7.30

Answer 129

A

The absence of other cardiac disease is more common in older cats than in young cats with DRVO.

Answer 130

A

HCM
Chronic renal failure with or without hypertension
Hyperthyroidism
Anemia
Neoplasia
Inflammatory process

Hyperdynamic function especially when associated with some of the listed conditions or with increased sympathetic stimulation are hypothesized as underlying causes of DRVO

Answer 131

A

False tendons or moderator bands may be a normal finding in many animals and are common in the right side of the heart.
Fig 7.31

Occasionally they may restrict LV filling.

Answer 132

A

these tendons cross the ventricular cavity connecting the septa and free wall or papillary muscles.

Answer 133

A

A rounded LV apex, irregular contours to the chamber, and a narrowed ventricular chamber

Answer 134

A

Moderator band: These cats may present with symptoms very similar to cats with cardiomyopathy of any form. Not all moderator bands create problems however, and the identification of a false tendon by echo should not be immediately associated with cardiac malfunction.

Answer 135

A

toxins like ethanol and lead, metabolic abnormalities such as nutritional and endocrine disorders, inflammatory and infectious processes, neuromuscular diseases including several dystrophies, and there is a definite familial component.

Answer 136

A

Carnitine deficiencies
Metabolic abnormalities including hypothyroidism
Myocarditis
Taurine deficiency

Answer 137

A

Plasma taurine levels are not low in dogs with DCM except for possibly the Cocker Spaniel, and were actually found to be significantly higher than levels found in normal healthy dogs.

Answer 138

A

Doberman Pinschers
Boxer
English Cocker Spaniels
Irish Wolfhounds
Young Portuguese water dogs
Great Danes
Newfoundlands

Answer 139

A

In Portugese water dogs, the disease strikes young puppies, and the time from clinical presentation to the development of congestive heart failure is weeks.

Answer 140

A

Ventricular dilation
Atrial dilation
Normal or thin wall and septal thicknesses
Depressed systolic thickening of the wall and septum
Poor fractional shortening
Large E point to septal separation (EPSS)
Reduced aortic wall motion
Global hypokinesis

Answer 141

A

Boxer
Doberman pinscher
Dalmatian

Answer 142

A

The Dalmatian appears to exhibit more ventricular and atrial dilation than any breed with DCM

Answer 143

A

: may have normal ventricular chamber size despite poor LV systolic function.

Answer 144

A

LV diastolic dimensions > 4.6 cm and systolic LV dimensions > 3.8 cm with FS of

Answer 145

A

FS is preload and afterload dependent, and transient depressions in this parameter can occur normally.

Answer 146

A

Increases chamber size and increased EPSS combined with poor fractional shortening are usually indicative of the presence of DCM.

Serial studies are often necessary before the diagnosis can be made with certainty

Answer 147

A

Dilated LV: some breeds do not show this
Atrial dilation
Normal to thin LVW and VS
Poor fractional shortening
Large EPSS

Answer 148

A

Early DCM may exhibit only increased systolic LV dimensions and normal diastolic dimensions as fractional shortening decreases.

Diastolic chamber size will increase as function deteriorates and forward flow is compromised.

Answer 149

A

One study in cats with taruine deficiency showed only increased systolic LV dimensions and decreased fractional shortening with no dilatin of the ventricle during diastole. Another study however, did show LV dilation.

Answer 150

A

LA and sometimes RA dilation develop as myocardial failure progresses. Elevated LV end systolic pressure creates less of a pressure gradient from the atrium into the ventricle resulting in less atrial emptying, high LA pressures, and atrial dilation.

Answer 151

A

Some cats display normal LA size on echo examinations but do have parameters that are at the high end of the normal range. Echo evidence of atrial enlargement may be present before there is radiographic indication of atrial dilation.
As with HCM, a thrombus may form within the LA or auricular chamber.
Fig 7.34

Answer 152

A

Septal and free wall thicknesses may be normal but are typically thin. There is no measurable hypertrophy even though heart size and weight are increased.

Answer 153

A

A decrease in wall thickness to chamber size ratio implies inadequate hypertrophy and myocardial abnormalities.

Prognosis i poorer in human patients with low ratios.

Answer 154

A

The wall and septum also have reduced systolic thickening and excursions as myocardial function deteriorates.

Answer 155

A

The lack of compensatory hypertrophy as the ventricle dilates increases LV afterload and wall stress further decreasing fractional shortening and velocity of circumference shortening.

Answer 156

A

In Irish Wolfhounds with DCM and normal thickness, there is reduced systolic thickening.

Answer 157

A

The E point to septal separation (EPSS) is always increased in dogs and cats with DCM: Fig 4.38

Answer 158

A

The degree of mitral valve motion toward the inter ventricular septum is dependent upon flow from the atrium into the ventricle. As end systolic remains large secondary to poor contraction, elevated LV filling pressure limits the amount of blood flowing from the atrium into the ventricle.

Answer 159

A

Mitral excursion is reduced as a result and EPSS increases. This is a sensitive and specific sign of early DCM even in asymptomatic dogs and in dogs with equivocal values for all other parameters of size and function.

Answer 160

A

The EPSS in Doberman Pinchers shows no overlap between Doberman’s with normal function and those with occult DCM, making it an important factor in the assessment of DCM in this breed.

There is overlap in EPSS measurements between normal Irish Wolfhounds and Irish Wolfhounds with DCM however.

Answer 161

A

A “B” bump at the end of mitral valve diastolic motion signifying delayed closure is a sign of increased end diastolic LV pressures.
This may or may ot be found in dogs with DCM.
Fig 4.99, 5.24

it has routinely only been seen in dogs with severe CHF.

Answer 162

A

Parameters of systolic function are always altered in DCM.

FS, ejection time, and Vcf are decreased while pre-ejection period (PEP) is increased. Fig 7.36

Answer 163

A

The ratio of PEP to LV ejection time (LVET) is increased in DCM secondary to slow rate of pressure rise during isovolumic contraction.
This value is not sensitive however, as PEP/LVET ratios may still be normal in dogs with overt heart signs of heart failure.

Answer 164

A

LVET does not appear to be affected on a consistent basis in cats treated for DCM. These values although still abnormal after the initiated of therapy, improve and move toward the normal range.

Answer 165

A

Even when LVET is normal, gradual closure of the aortic valve may be seen as ventricular systolic pressures decline throughout systole and forward flow declines. Fig 4.95

Answer 166

A

The total systolic time, QAVC, measured from the onset of the QRS complex to closure of the aortic valve, is increased in cats with systolic dysfunction and DCM.

Answer 167

A

The QAVC parameter consistently reflects increases in systolic function as cats with DCM are treated with inotropic drugs.

Answer 168

A

Mitral annular motion (MAM) of the septal mitral annulus obtained from apical 4 ch views reflects long-axis systolic function.

Answer 169

A

Dogs with DCM have significantly decreased MAM, MAM% and MAM index. Fig 7.37

Answer 170

A

Normal MAM is 0.46-1.74 cm while dogs with DCM have MAM ranging from 0.27-1.06 mm.

Answer 171

A

The MAM%, a reflection of the contribution of annular motion to the overall ventricular long-axis shortening, is 31-45% in normal dogs and 32-89% in dogs with DCM.

Answer 172

A

MAM indexed to BSA separates normal from abnormal dogs as well.
MAM index i s0.78-3.78 cm/m upphöjt i 2 in normal canine hearts and 0.16-1.27 in dogs with DCM

Answer 173

A

Mitral annular motion may be useful for early detection of DCM in hearts where longitudinal shortening may be affected before radial shortening is affected.

Answer 174

A

VPCS
VT
Supraventr tachycardia
Brady-arrhythmias

Echo exam in these animals typically reveal normal cardiac dimensions but very mild to moderately depressed FS.

Answer 175

A

Diastolic LV chamber size of > 46 mm, or a systolic chamber size > 38 mm, or even one VPC suggests occult DCM in Doberman Pinschers.

Answer 176

A

The interpretation of ventricular dilation and poor FS is sometimes difficult, especially when breed-specific echo reference ranges do not exist.
The progression of the disease is slow in most cases, and heart failure may not manifest itself for several years.

Answer 177

A

LV chamber size will increase over the years as FS continues to deteriorate.

Repeat echo exams are usually necessary to verify the diagnosis of DCM when subclinical disease exists.

Answer 178

A

Rule out poor preload as a cause

Rule out increased afterload as a cause.

Answer 179

A

The European Society of veterinary cardiology has established criteria for the early diagnosis of DCM in the preclinical phase. A point system is used, and applied to various echo and electrocardiographic parameters. 6 points or greater is highly suggestive of the presence of subclinical DCM.

Answer 180

A

-LV dilation in systole or diastole
Increased sphericity (

Answer 181

A

Arrhyhtmia in Boxers and Dobermans
Atrial fibrillation, increased EPSS, pre-ejection period to ejection time ratio > 0.4 (PEP/LVET), FS in the equivocal range (>20-25%, but less than 30%)
Left atrial or biatrial dilation.

Answer 182

A

Other causes of myocardial failure should be ruled out before the diagnosis of familial or idiopathic DCM is made. These criteria are listed in Table 7.4

Answer 183

A

Sphericity is assessed by comparing LV length obtained from a 4 ch view to the M-mode measurement of diastolic dimension. Fig 7.38

Answer 184

A

1.78 +/-0.16

Answer 185

A

Dilation develops and the chamber becomes more spherical as the ventricular chamber becomes dysfunctional.

Answer 186

A

…that the equivocal parameters of size and function may be normal for the specific animal.

Answer 187

A

6 points highly suggestive of subclinical DCM

Answer 188

A

May be helpful in the early identification of dogs with DCM.

Answer 189

A

Using right parasternal transverse images of the LV chamber at the level of the papillary muscles, PW color-tissue Doppler of radial motion shows decreased endocardial systolic and diastolic velocities when compared to epicardial velocity.

Answer 190

A

A gradient is seen in dogs without heart disease, but the endocardial velocities in systole (Se´) and both phases of diastole (E´, A´) in dogs with subclinical DCM is lower.

Answer 191

A

Radial epicardial velocities in systole and diastole are not different between normal dogs and dogs with subclinical DCM: This results in decreased radial trans myocardial velocity gradients (the difference between endocardial and epicardial velocities) during systole and early diastole.

Answer 192

A

Longitudinal myocardial velocities of the LV free wall from apical 4 ch views although still higher at the base than the apex as in normal dogs, are reduced at the base in systole and early diastole in dogs with subclinical DCM.

The resulting longitudinal myocardial gradient (difference between basal and apical myocardial velocity) is reduced in systole and early diastole in dogs with pre-clinical DCM.
Fig 7.40

Answer 193

A

Late diastolic radial and longitudinal myocardial gradients are not affected in the preclinical setting.

Answer 194

A

The E´-A´ration of radial and longitudinal myocardial velocities is alos decreased in subclinical DCM.

Answer 195

A

Decreased epicardial to endocardial radial gradient.

Answer 196

A

Decreased basal to apical longitudinal gradient.

Answer 197

A

The clinical course of these animals is extremely variable, and the degree of ventricular dilation, the EPSS or FS has no predictive value for survival time.

Answer 198

A

Although 50% of dogs in one study survived past 3 months, M-mode echo parameters could not predict which dogs would be long-term survivors and which would not.
In those studies, only the presence of pleural effusion, pulmonary edema, ascites, or a young age at diagnosis was found to suggest poorer survival times.

Answer 199

A

Measurement of ejection fraction using the area length method on apical or right parasternal 2D
four chamber imaging planes is a predictor of outcome and survival time.
Fig 7.41

An ejection fraction

Answer 200

A

Calculation of the systolic volume index from M-mode using the Teicholz equation and the dog’s body surface area is also predictive of survival time. Fig 7.42

Dogs with a systolic volume index > 140 ml/m2 have a median survival time of 208 days.

Answer 201

A

When the increased LV filling pressure results in a restrictive inflow pattern with a high E wave, rapid early deceleration and a lower A wave, it is associated with poor survival in dogs and in man with DCM.

Answer 202

A

A transmitral E wave deceleration time of

Answer 203

A

The presence of pulmonary hypertension and concomitant poor RV function is associated with a poorer prognosis for human patients with DCM.
In man, tricuspid annular motion of less than 1.25 cm is independent predictor of poor survival.

Answer 204

A

There is currently no report of prognostic indicators for survival time since the advent of pimobendan therapy. The prognostic value of these parameters may be altered as more info is gathered in dogs receiving pimobendan.

Answer 205

A

When taurine deficiency is thought be be the underlying cause of DCM in cats, improvement in cardiac size and function occurs anywhere from 3 to 16 weeks after supplementation.

These cats had essentially normal echocardiograms 6 months to 1 year after initial presentation.

Answer 206

A

The usually reversible systolic dysfunction found in dogs with hypothyroidism does not manifest itself with any significant dilation of the LV chamber during diastole.

Answer 207

A

Increased systolic dimensions
Decreased FS
Decreased Vcf
Increased PEP

Dogs with hypothyroidism and impaired function do not typically show signs of show signs of heart failure unless pre-existing myocardial failure exists.

Answer 208

A

Dilation
Decreased FS
Secodnary MR
Large end systolic volume indices

Answer 209

A

Myocardial dysfunction is seen in 40-50% of people with sepsis. Myocardial depression is thought to be secondary to circulating myocardial depressant factors, nitric oxide, tissue hypoxia, reperfusion injury, and increased circulating catecholamines.

Answer 210

A

Cancer treatment with doxorubicin is a documented cause of DCM. There is early depression in systolic function that occurs within the first few days. This is reversible. With cumulative doses however, there are irreversible changes in systolic function.

Answer 211

A

diastolic dysfunction early in the course of myocardial function
Doppler echo shows increased isovolumic relaxation times and decreased early LV filling.
Global systolic failure occurs later.
LV dilation is present is mild, a feature that differentiate it from idiopathic DCM and most other cause of left-sided CHF.

The septum in man is usually more affected than the rest of the left ventricle.

Answer 212

A

Color Doppler evaluation:
MR is common in animals with DCM secondary to dilation of the mitral annulus. The insufficiency varies from mild to severe when present and contributes to the clinical signs of CHF. valvular lesions will not be evident if the insufficiency is truly secondary to the dilation.

Answer 213

A

Maximal aortic flow velcoity is typically reduced in animals with DCM. Fig 7.44
Aortic flow velocities that remain within the normal range suggest maintenance of adequate cardiac output.
Acceleration rate (dv/dt) may be a better indicator, but there is tremendous variation in this parameter in both healthy and DCM dogs.

Answer 214

A

The progression of occult to overt DCM may develop as ventricular filling is altered causing LA dilation and elevated LA pressure.

Answer 215

A

table 7.5 summarizes the diastolic parameters that change in the presence of DCM

Answer 216

A

Mitral inflow studies in dogs with overt DCM show increased E wave velocity, no change in A wave velocity, increased E wave duration , and increased E:A ratio and decreased E wave deceleration time.

Figures 4.75, 7.45.

Answer 217

A

Dogs with occult DCM have variable and inconsistent transmitral flow patterns probably reflecting different stages of disease progression

Answer 218

A

The presence of moderate to severe mitral insufficiency will aslo increase E velocity and must be considered when evaluating diastolic function and atrial pressures.

Fig 4.81

Answer 219

A

An increase in E:A ratio signified deterioration of clinical status while decrease in E:A ratio is observed as signs of heart failure resolve.

These changes correlated to changes in capillary wedge pressure.

Answer 220

A

Rapid deceleration times (

Answer 221

A

A restrictive transmitral flow patterns (E:A ratio > 2.0) and a rapid early diastolic deceleration (

Answer 222

A

A restrictive filling pattern represents high LA pressure and a rapid equilibration of ventricular and atrial pressure in the presence of reduced LV compliance.

Answer 223

A

impaired relaxation, a sower decline in LV pressure, and a slower rate of LA emptying.
An S:D ratio greater than 1.0 will be seen.

Answer 224

A

Decreased compliance is seen in later stages of this disease. Systolic pulmonary venous flow becomes low as LA pressure remains high during this phase of the cardiac cycle.

Answer 225

A

Diastolic flow becomes more predominant as flow into the ventricle is enhanced with the elevated LA pressure and passive flow into the LA via the veins is enhanced. This S:D ratio becomes less than 1.0.

Answer 226

A

Velocity and duration of reverse diastolic flow (pulmonary vein A wave) late in diastole are both increased in man, but this has been difficult to show in dogs due to technical difficulties in obtaining these flow profiles.

Answer 227

A

Because increased LA pressure causes the mitral valve to open sooner aborting the relaxation time period. This is consistent with restrictive physiology as the disease progresses.

Answer 228

A

PW tissue Doppler evaluation of systolic myocardial motion at the LV free wall mitral annular level shows reduced velocity from normal. Dobermans with overt cardiomyopathy have lower Sm velocity than those with occult DCM. This is a relatively early predictor in man for the presence of DCM, but has only been reported in one canine study to date.

Answer 229

A

Early diastolic myocardial motion is reduced in some Dobermans with overt cardiomyopathy but is a consistent pattern in humans with DCM. The Doberman population was small and further study is warranted.

Answer 230

A

Decreased compliance and restrictive physiology.

Answer 231

A

A´ velocity decreased progressively from occult to overt diseases.

Answer 232

A

PW:

S´ decreased at lateral mitral annulus
E´may be decreased

Answer 233

A

Reduced radial and longitudinal gradients

- Perhaps dyssynchrony between wall and septum.

Answer 234

A

decreased radial endocardial systolic and diastolic velocities.

Epicardial velocity did not change resulting in decreased trans-myocardial velocity gradients in these dogs with DCM.
Longitudinal velocity of the LV free wall was decreased at the annulus in systole and diastole, also resulting in a decreased gradient between the base and the apex.

Answer 235

A

Dogs with DCM have a strong negative relationship between the timing of systolic color-tissue Doppler motion with respect to the beginning of electrical systole and ejection fraction. The parameters are heart rate corrected by dividing each parameter by the square root of the R-R interval.

Answer 236

A

Heart rate corrected parameters that are longer in dogs with DCM and that are negatively correlated with EF include the times from Q to start S´, Q to end S´at the base of both the LV free wall and septum. These changes are consistent with delays in longitudinal shortening of the LV myocardium in DCM

Answer 237

A

There is also a significant positive correlation between S´ velocity at the base of the free wall and the EF. Peak velocity is depressed in dogs with DCM and may be an early indicator of disease.

Breed variations exist and tis parameter needs further study in various breeds.

Answer 238

A

increased pre-ejection periods, shortened ejection time, and increased isovolumic relaxation and contraction time periods, with resultant significantly increased Tei index in dogs with overt DCM.

Normal newfoundlands had Tei index of 0.28 +/- 0.12 while dogs with DCM had a Teid index of 0.51 +/- 0.32

This parameter does not show any more specificity in differenting normal from abnormal function, and it cannot reliably differentiate subclinical from normal hearts.

Diastolic dysfunction with restrictive physiology is only present in the these dogs with more advanced stages of DCM.

Answer 239

A

Right ventricular dysplasia

Answer 240

A

There is severe right ventricular and atrial dilation with poor RV systolic function and paradoxical septal motion secondary to the elevated right-sided diastolic pressures.

Answer 241

A

pleural effusion and pericardial effusion may be seen both radiographically and echocardiographically.

There may be TR and if present, spectral Doppler should be used to rule out pulmonary hypertension as a cause of the right-sided heart failure instead of cardiomyopathy.

Answer 242

A

RV dilated cardiomyopathy: The foramen oval may become patent when right atrial pressure become excessive.

Answer 243

A

In man, RV cardiomyopathy is associated with highly irregular endocardial surfaces with prominent bulges and deep fissures.

Answer 244

A

Significant dilation of the RV and atrium with systolic dysfunction and arrhythmia (ventricular tachyarrhythmia, atrioventricular block, atrial fibrillation) are seen in these cats that present in right-sided congestive heart failure.

Answer 245

A

Arrhythmogenic right ventricular cardiomyopathy is reported in dogs, and Boxers have a predisposition to developing the RV ventricular arrhythmias sometimes without echo evidence of abnormal myocardium or function

Answer 246

A

RV dilation
RA dilation
Paradoxical septal motion
Irregular endocardial surface

Answer 247

A

Intermediate, intergrade, or unclassified cardiomyopathy.

RCM is the preferred term however, and intermediate cardiomyopathy should be resered for cases where the features of more than one type of cardiomypathy exists and differentiation is not possible

Answer 248

A

Primary RCM is typically idiopathic with predominant diastolic failure secondary to infiltrative fibrosis of the myocardium.

Answer 249

A

A less common form of RCM is endomyocardial fibrosis, an obliterative process.

Answer 250

A

Amyloid heart disease
Hypertension
HCM
DCM

Answer 251

A

Reduced ventricular compliance where compliance where diastolic filling is completed early in the diastolic time period.

Answer 252

A

Myocardial restrictive cardiomyopathy typically involves normal to near normal LV chamber size and wall thicknesses with significant LA dilation

Answer 253

A

Moderate to severe LA enlargement is one consistently requires criteria for RCM however.

Answer 254

A

Atrial dilation occurs secondary to high LV filling pressure and reduced ventricular compliance.

Answer 255

A

Often there is no regurgitation at all, but there might be mild MR.

Answer 256

A

At times a thrombus is seen within the LA or auricular cavity, more often however the smoke-like echoes (spontaneous echo contrast) of sluggish blood may be seen within the atrial chamber.
Fig 7.26, 7.47

Answer 257

A

LA dilation; usually severe. Often with only mild MR
Hypertrophy only mild of present
Increased echogenicity in areas of myocardium (fibrosis)
Function normal early, coming depressed as fibrosis develops

Answer 258

A

LV chamber size is usually normal but may be slightly increased.

Answer 259

A

Irregular with areas of the septum or free wall that are visibly thicker than other areas,

There may be echogenic areas within the myocardium representing fibrosis, but this is not a consistent finding. Fig 7.48

Answer 260

A

One uncommon form of RCM involves endomyocardial scarring with connections between the septum and LV wall.
There may be mid ventricular obstruction associated with this form of the disease as the fibrotic muscle becomes obliterative.
There is usually fibrosis of the chordae and the papillary muscles resulting in mitral regurgitation. There may be evidence of myocardial infarction and involvement of the right side of the heart.

Answer 261

A

When cats decompensate, right-sided heart changes become evident on the echo exam. These signs include RV dilation with hypertrophy and pleural and pericardial effusions.

Answer 262

A

Diastolic dysfunction is the predominant feature of RCM

Answer 263

A

Doppler evaluation of mitral inflow may show increased E velocity, rapid early deceleration, and little if any filling late in diastole resulting in reduced or absent atrial filling component on the inflow profile.

Fig 4.75, 7.49

Answer 264

A

impaired relaxation

This mitral inflow patterns shows reduced early filling with a strong atrial component to filling resulting in an E:A ratio less than 1.

In the cat, this is a very difficult pattern to record. Heart rates are usually too rapid to differentiate the 2 phases of LV filling.

Answer 265

A

Increased transmitral E wave
Reduced or absent transmitral A wave
Short IVRT

Answer 266

A

Increased E´ at mitral annulus

Answer 267

A

Tissue Doppler imaging in cats with RCM shows increased diastolic velocity at the mitral annulus on apical 4 ch views and on the LV wall on right parasternal transverse views at the level of the papillary muscles.

Acceleration and deceleration rates are increased at both locations.
A study showed a subgroup of cats with unclassified cardiomyopathy with tissue Doppler velocity that were no different from tissue velocities in cats with hypertrophic cardiomyopathy.

Answer 268

A

HCM and constrictive pericarditis.

Answer 269

A

Constricitve pericarditits is associated with respiratory variation in peak mitral and tricuspid inflow velocities, pulmonary venous flow, and isovolumic relaxation times. RCM does not show this respiration variation.

Answer 270

A

HCM may show the restrictive inflow pattern associated with RCM. In man when restrictive obstruction physiology is present in the absence of outflow obstruction and only mild to moderate myocardial hypertrophy as well as a disproportionately large atrium compared to ventricular changes are present, then the diagnosis of RCM is made versus HCM.

It is a challenge to differentiate, but the therapeutic approach is often the same, and so the distinction is often not critical.

Answer 271

A

A dilated LV chamber with decreased wall and septal motion
Depressed fractional shortening
Dilated LA and auricle
Abnormal mitral valve morphology and motion

Answer 272

A

Necropsy findings showed extensive endocardial and myocardial fibrosis with variable areas of hypertrophy. The mitral apparatus us involved in this disease process with thickening of the leaflets and chordae.

Answer 273

A

by the excellent systolic function present in most hearts with mitral insufficiency secondary to endocardiosis.

This disease is only reported in young dogs, and its status as an acquired defects is debatable.

Answer 274

A

An infiltrative disease of the right ventricular myocardium. Fatty and fibrous infiltration leads to ventricular and supraventricular arrhythmias that often result in sudden death. The infiltrative process may involve the LV chamber in some cases.

Answer 275

A

Pronounced right atrial and ventricular dilation, paradoxical septal motion, abnormal trabeculation of the right ventricular wall, and aneurysmal dilation of the right ventricular wall with akinetic and dyskinetic muscle.

Answer 276

A

Atrial dilation: The LA dilation ranges from mild to severe in these cats.
Abnormal fractional shortening in the presence of paradoxical septal motion.

Answer 277

A

Most affected dogs with ARVC have no detectable echo abnormalities. Some boxers, with arrhythmia, have LV dysfunction, but it is not a common occurrence.
Careful evaluation of the right side of the heart may show some enlargement and dysfunction, but this is a challenge.

Answer 278

A

Does not occur frequently in animals and when it does is typically secondary to other cardiac disease such as aortic stenosis, cardiomyopathy, neoplasia, or endocarditits.

Answer 279

A

Reduced wall or septal systolic thickening, dyskinetic wall motion, and systolic thinning as opposed to thickening of the wall or septum. The infracted myocardium will become thinner and appear echo dense as the affected areas become fibrotic.

Answer 280

A

decreases.
Fig 7.53, 7.54

This is evident on 2D and M-mode images if done carefully.

Answer 281

A

is not gradual from infracted areas to adjacent normal areas. It is a sudden decrease in thickening.

Answer 282

A

The appearance of reduced motion toward the center of the ventricular chamber during systole on transverse or long-axis real-time images reveals infracted areas of myocardium but usually overestimated the extent of the affected area. Actual analysis of systolic thickening in the region will define the extent of the affected segment more accurately.

Answer 283

A

Dyskinetic.

Answer 284

A

Regional areas of decreases systolic LVW or VS thickening or systolic thinning of VS

Answer 285

A

Fibrosis and thin areas of muscle are seen with old infarction.

Answer 286

A

Not all abnormally moving or thickening myocardium is indicative of permanent damage. Myocardial muscle may simple be stunned or hibernating. Function will spontaneously return to normal on its own if this is the cause of poor muscle contraction.

Answer 287

A

Myocardial contusions and traumatic myocarditis resulting from trauma may also impair myocardial function. Features seen echocardiographically on 2 D images include increased diastolic wall or septal thickness in the affected segment, increased echogenicity of the affected myocardium, and decreased systolic thickening in the affected area. There may also be pericardial effusion and hypo echoic areas due to hematoma within the myocardium. The increased wall thickness is associated with edema of the injured muscle, and the increased echogenicity is the result of hemorrhage and altered tissue structure.

Answer 288

A

The poor function may be related to edema and hemorrhage in the area creating less myocardial compliance within the affected segment.

Brainscape's Knowledge GenomeTM

Myocardial diseases Flashcards

Brainscape's Knowledge Genome^TM