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67 Cards in this Set
- Front
- Back
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Most common/obvious 2-d finding?
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Bi-atrial and bi-ventricular enlargement.
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Most common type of cardiomyopathy?
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Dilated cardiomyopathy.
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End diastolic and end systolic dimensions are increased with dilated cardiomyopathy.
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True.
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What portion of the cardiac cycle is affected by dilated cardiomyopathy?
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Global systolic and diastolic function.
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What shape does dilation result in?
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Spherical. Dilation increases along the short axis.
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What is the sphericity index?
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Long axis dimension divided by short axis dimension. Normally, this is greater or equal to 1.5. With dilated cardiomyopathy this number decreases.
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What are the primary features of DCM?
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LV dilation and systolic dysfunction. Secondary common features:
1. Diastolic dysfunction 2. Chronic elevated LAP 3. RV dysfunction 4. MR and TR 5. Pulmonary hypertension |
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Is systole or diastole affected by DCM?
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Systole initially, diastole is affected later.
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What is causes DCM?
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1. Idiopathic
2. Infective 3. Toxic 4. Ischemic |
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How does ischemia result in DCM?
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Not a myocyte issue, but congestive heart failure due to coronary artery disease. It falls under the category of ischemic DCM which is actually different. Everything else falls under non-ischemic DCM.
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What are some infective causes of DCM?
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1. Viral
2. Bacterial 3. Fungal 4. Parasitic 5. Postpartum |
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Toxic causes of DCM?
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1. Alcohol
2. Cocaine 3. Cobalt/lead 4. Adriamycin: chemotherapy 5. Severe sepsis |
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Patient presentation with DCM?
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1. SOB, exercise intolerance is most common
2. Fatigue, weakness 3. Lightheadedness, syncope 4. Palpitations 5. X-ray:cardiomegaly 6. Low BP 7. Tachycardia 8. Pulsus alternans (strong and weak pulses - end stage - due to arrhythmias) |
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What is Pulsus alternans?
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Weak and strong pulses due to arrhythmia. Presentation in late stage DCM.
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Why do you get tachycardia in DCM?
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Heart tries to maintain cardiac output.
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What about DCM can be seen on x-ray?
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Cardiomegaly.
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What is a significant DCM LVID?
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Greater than 6cm.
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What happens to EF, CO, SV in DCM?
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Decreases.
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What is spontaneous contrast?
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With reduced stroke volumes and low ejection fraction, blood flow can be seen on 2-d images. Can be seen in DCM.
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DCM 2-d findings?
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1. Increased end systolic and end diastolic dimensions.
2. LVID greater than 6cm. 3. Reduced EF, SV, CO. 4. Spherical LV. 5. Spontaneous contrast in LA and LV when EF is less than 25% 6. Apical thrombus or mural thombi 7. Mitral tenting. 8. Evidence of pulmonary hypertension. 9. May be small pericardial efffusion. |
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Major risks of DCM?
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Systemic embolus and malignant arrhythmias.
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M-mode findings for DCM?
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1. Increased LVEDV and LVESV
2. Reduced aortic excursion 3. Reduced mitral valve excursion 4. Increased EPSS 5. B-bump or AC shoulder on MV |
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Define DCM.
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Characterized by four-chamber enlargement with impaired systolic function of both ventricles. LV diastolic dysfunction coexists, but separating them is difficult.
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In DCM, what is significant about the EPSS, and why does it happen?
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EPSS increases due to LV dilation and reduced mitral leaflet motion resulting from low transmitral flow rates.
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What is a B-bump?
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Indicates a delayed rate of mitral valve closure, and shows an elevated LVEDP.
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When should you look for an apical thrombus?
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When EF is below 35%.
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Why is MR common with DCM?
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Ventricular lateral dilation (outward) and papillary displacement reduces the length of the MV apparatus.
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What may be indicated in response to MR as a result of DCM?
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Annuloplasty. Improves patient's lifestyle, but not a fix. No mortality benefit.
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How is doppler useful in DCM?
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1. To determine Cardiac output.
2. Measuring PAP. 3. Evaluating mitral inflow pattern. 4. LV filling pressure and TDI. 5. Pulmonary vein AR velocity and duration. 6. MR, dP/dt. |
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Why is MV inflow important in evaluating DCM?
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Gives prognostic info.
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What type of pattern has a short deceleration time and high velocities?
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Restrictive.
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Concentric enlargement?
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Even.
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Eccentric enlargement?
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Not even.
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What happens to mass with DCM?
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Increases.
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What is mass?
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how much matter there is in an object.
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Properties of mass?
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Volume and specific gravity (density)
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How is DCM treated?
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1. Reduce activity
2. Oxygen when indicated 3. Diuretics 4. Stop drinking 5. Arrhythmia drugs 6. Inotropic drugs to reduce contractility 7. Afterload reduction drugs to increase SV 8. Mitral Valve Replacement to reduce volume overload and PAP 9. LVAD 10. Transplantation 11. Anticoagulants |
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Why is mitral valve replacement indicated in treating DCM?
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To reduce volume overload and PAP from MR.
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Why are afterload drugs indicated in treating DCM?
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To increase stroke volume.
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What type of care reduces symptoms but is not a cure?
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Palliative care.
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What is another name for ventriculectomy?
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Batista procedure. Volume reduction surgery.
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What is an alternative to transplant in DCM?
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Ventriculectomy
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Benefits of ventriculectomy in DCM?
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Improves function by reducing chamber dimensions. Spherical ventricle becomes a more efficient cylindrical shape.
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What can prevent dilation?
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Heart Jacket
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What is echocardiographically evaluated in DCM?
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Systolic function
Diastolic function Pulmonary pressure Chamber size Associated Valvular disease Apical thrombus |
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What differences can be seen in patients with DCM?
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Decompensated patiens have decreased SC and CO and have restrictive filling patterns.
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Manifestations and complications of DCM?
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Low BP
Atrial fibrillation Peripheral cyanosis (feed vitals first) Syncope, SOB, no exercise tolerance Elevated pulmonary pressures Chest pain Apical thrombus Malignant arrhythmias |
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What transmits the parasite Trypanosoma?
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Chagas Disease.
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Where does the Chagas parasite reproduce?
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White Blood Cells.
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Does Chagas disease affect the septum?
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No, generally they get an apical aneurysm. The parasite thins the myocardium, which leads to aneurysm.
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How does Chagas disease cause damage?
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It thins the myocardium, leading to apical aneurysm.
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What kind of bug transmits Chagas?
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Redubae bugs. They generally bite where the skin is thin, eyes and mouth.
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How does Chagas spread?
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Reduvidae bugs have the parasite in their intestine, so shit gets into the wound when they bite you. BAM, Chagas!
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What are the three phases of Chagas?
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1. Acute - Inflammation. May go unnoticed.
2. Intermediate - Clinically asymptomatic. 3. Chronic - 10 to 20 years after infection. Affects heart, esophagus, colon, PNS. |
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Is there treatment for Chagas?
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No vaccine and no treatment. Antiprotozoal drugs used during the early stages, not always effective.
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Where are you at risk for Chagas?
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In a mud, adobe or thatched hut in South and Central America.
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Other names for Broken Heart Syndrome?
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Takotsubo cardiomyopathy
Stress Induced cardiomyopathy |
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What is the response to stress that causes Broken Heart Syndrome?
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Release of large amounts of catecholamines (adrenalin)
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Formula for RVSP?
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TR+RAP
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Formula for PAEDP?
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PREend+RAP
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MPAP formula?
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PRpeak
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PISA equation?
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6.28*r^2*Va
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ERO equation?
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flow/MRpeak
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RV equation?
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ERO*VTImr
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What is particularly affected by noncompaction?
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Prominent trabeculations in the apex and free wall of LV.
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Major risks of Noncompaction?
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Ventricular tachyarrhythmia and thrombic events.
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What is affected in a noncompacted heart?
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Depressed systolic and diastolic function.
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