Set 8 Flashcards
How is color flow Doppler examination helpful in the assessment of hypertrophic cardiomyopathy?
The color flow Doppler technique (a pulsed Doppler technique) can indicate an area of obstruction in the left ventricular outflow tract by turning the color display into a mosaic pattern when turbulence is detected.
Color flow Doppler is also helpful in detecting and quantifying mitral regurgitation, which is common in hypertrophic obstructive cardiomyopathy
Name 5 causes of dilated cardiomyopathy
- Idiopathic
- Infection (viral, bacterial, fungal, or parasitic)
- Ischemia
- Toxicity resulting from alcohol abuse, lead poisoning, AIDS, or drugs such as Adriamycin
- A peripartum or postpartum state
What is the most common cause of dilated cardiomyopathy in the United States?
Coronary artery disease (ischemic heart disease) is the most common cause of dilated cardiomyopathy in the United States
What is Chagas’ disease?
Chagas’ disease results in a cardiomyopathy. It is caused by a parasite bite (Reduvid bug) that leads to myocarditis years later. Chagas’ disease is an epidemic in South America, affecting over 20 million people. A history of living or traveling in South America would be an important finding in a patient with unexplained cardiomyopathy
What are the echocardiographic findings in Chagas’ disease?
Like most dilated cardiomyopathies, regardless of the cause, Chagas’ disease results in a dilated and hypocontractile left ventricle.
In some patients the septum has normal contractility and its the apical and posterior walls that are affected.
Name 6 classic M-mode findings associated with dilated cardiomyopathy
- Dilated left ventricle
- Increased E-point septal separation (EPSS)
- Hypocontractile left ventricular wall motion
- B-notch on the mitral valve
- Double diamond mitral valve (when the valve closes in mid diastole)
- Decreased aortic root motion
In a dilated cardiomyopathy, what advantage does 2D echo have over M-mode imaging?
In dilated cardiomyopathy, 2D echo allows better global assessment of ventricular function and atrial size and better detection of thrombi than M-mode imaging.
2D approach is also useful for excluding valvular heart disease and it may detect pericardial effusions, which are common in these patients
How does color flow Doppler imaging contribute to the diagnosis of dilated cardiomyopathy?
Patients with dilated cardiomyopathy often have multivalvular regurgitation. Color flow imaging can quickly detect regurgitation and estimate its severity
In patients with dilated cardiomyopathy, why is biventricular enlargement often present?
Biventricular enlargement is often seen in patients who have a dilated cardiomyopathy from myocarditis.
The infectious organism damages both the right and the left ventricular myocardium
Why is atrial enlargement present in patients with dilated cardiomyopathy?
Whatever the etiology, the diastolic pressure increases as the ventricle enlarges. To counter this increased pressure, the left atrium also enlarges.
Describe the prominent feature of a post cardiac transplant patients echo
The prominent echo feature in a post cardiac transplant patient is enlargement of both the right and left atria. The attaching of the donors ventricles and atria to the recipients atria causes these double atria. This way the recipient’s atrial connections (IVC, SVC, and pulmonary veins) are not disturbed.
FYI - in the past 10 years, the surgeon trims up both the donors and the recipients atria so the classic “double atria” is not seen. However, for exam purposes that is the correct answer
Name 4 causes of restrictive cardiomyopathy
- Amyloidosis
- Sarcoidosis
- Hemochromatosis
- Glycogen storage disorders
What is the most common cause of restrictive cardiomyopathy?
Amyloidosis is the most common cause of restrictive cardiomyopathy
Why is restrictive cardiomyopathy sometimes referred to as Infiltrative?
The disease is restrictive with respect to physiology (the hypertrophied ventricular wall restricts filling), but the disease process is infiltrative, because it involves amyloid or sarcoid deposits within the myocardium
How does restrictive cardiomyopathy affect the atria?
In restrictive cardiomyopathy, the atria enlarge to a greater extent than in any other type of cardiomyopathy
Why does restrictive cardiomyopathy cause biatrial enlargement?
Biatrial enlargement is caused by the elevated filling pressures of both ventricles
Why does the myocardium appear so bright in patients with restrictive cardiomyopathy?
The high reflectivity (ground glass appearance) of the myocardium results from amyloid deposits (in Amyloidosis) or iron deposits (in hemochromatosis)
Although this “ground glass” appearance is classic for infiltrative cardiomyopathies and should be included on any exam question, with todays improved transducers and equipment many easy to image patients will have very bright myocardium
Describe the appearance of restrictive cardiomyopathy, as documented by 2D echo imaging
In restrictive cardiomyopathy, 2D echo imaging usually reveals:
- Left ventricular hypertrophy
- A bright, reflective myocardium
- A ventricular cavity that is normal or near normal in size
- Atrial enlargement
- Small to moderate pericardial effusion (cardiac tamponade is rare)
What are the Doppler findings associated with restrictive cardiomyopathy?
In restrictive cardiomyopathy, Doppler findings include mitral and/or tricuspid regurgitation (which is usually mild) and abnormal mitral inflow patterns)
The classic Doppler pattern consists of a tall E wave, with rapid deceleration and a very small A wave
Name 5 types of cardiac wall motion that can be seen echocardiographically.
- Normal
- Hypercontractile (exaggerated) motion
- Hypocontractile (sluggish) motion
- Akinesia (absence of motion and thickening)
- Dyskinesia (motion opposite to the normal pattern)
Describe the difference between a true ventricular aneurysm and a pseudoaneurysm
The walls of a true ventricular aneurysm include all 3 cardiac layers - the endocardium, myocardium, and epicardium. Although the lesion may contain thrombus, the aneurysm’s mouth is wider than its body.
In contrast, a pseudoaneurysm is a ruptured portion of the ventricular free wall. Its wall includes the epicardial and pericardial layers. These aneurysms almost always contain thrombus.
Which type of aneurysm has a higher rate of rupture: true ventricular aneurysms or ventricular pseudoaneurysms?
Ventricular pseudoaneurysms rupture more frequently than true aneurysms and are considered surgical emergencies
Name 8 potential complications of a myocardial infarction
- Arrhythmias
- Aneurysm formation
- Pseudoaneurysm formation
- Pericardial effusion
- Mural thrombus
- Papillary muscle dysfunction
- Ventricular septal defects
- Death
Which structural complication is most commonly seen with myocardial infarction?
Aneurysm formation is the most common complication of myocardial infarction, occurring in 8-15% of cases
Name 7 risk factors for coronary artery disease
- A positive family history
- Male gender
- Hyperlipidemia
- Increased age
- Smoking
- Hypertension
- Diabetes
What is Dressler’s syndrome?
Dressler’s syndrome is a form of pericarditis that is also known as postmyocardial infarction syndrome
It occurs 6-8 weeks after an infarction and is characterized by positional chest pain and a pericardial effusion
Describe the post infarction changes that the myocardium might exhibit, as documented by 2D imaging
- Fixed segmental wall motion abnormalities
- Myocardial scarring, as indicated by increased brightness and decreased wall thickening
- Ventricular aneurysms, which are seen in up to 15% of cases of pericardial effusion, which is usually small left ventricular mural thrombi
What information from an echo does a surgeon need before operating to reduce a left ventricular aneurysm?
- Size of the aneurysm
- Location
- Presence of thrombus in the aneurysm
- Movement of other walls
Note: of these, the movement of other walls is the most important piece of information. If there is not enough salvageable myocardium, then the patient is not a surgical candidate
2 weeks after sustaining an inferior wall myocardial infarction, a 44 year old man returns to the ER with SOB, chest pain, and a new systolic murmur. What is the most likely diagnosis? Why?
The most likely diagnosis is rupture of a papillary muscle, producing severe, acute mitral regurgitation.
90% of papillary muscle ruptures occur after infarction of the inferior left ventricular wall
The posteromedial papillary muscle has one coronary artery feeding it while the anterolateral has dual blood supply (LAD and circ)
