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50 Cards in this Set
- Front
- Back
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Define dilated cardiomyopathy
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Dilation of all 4 chambers, biatrial and biventricular. Causes both systolic and diastolic dysfunction.
Can be due to systemic HTN |
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Define Hypertrophic cardiomyopathy
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Idiopathic asymetrical hypertrophy of the heart walls, especially seen in the septum. It can be obstructive or non-obstructive. Usually does NOT affect basal posterior wall.
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The most common cause of hypertrophic cardiomyopathy is _____
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Hereditary
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Hypertrophic Obstructive cardiomyopathy can be found in which 2 locations
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1) LVOT
2) Mid-cavity |
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What are the etiologies of dilated CMP?
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Idiopathic
Hereditary (20%) Alcohol abuse Viral infection Secondary to other heart/valve disease Long standing systemic HTN CAD complication AIDS complication |
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What causes the septum in ASH, HOCM and etc to become enlarged?
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Septum gets large due to myocardial disarray
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Regurge causes ____
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Volume overload
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Stenosis causes ____
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Pressure overload
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Atrial fibrillation can lead to _____
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Atrial fib can lead to thromubs in LAA and then result in Systemic embolism
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What are the signs and symptoms of patients with dilated CMP?
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Right and Left heart failure symptoms.
Stroke symptoms due to embolism palpitations tachycardia dyspnea weak pulse |
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What are symptoms of right heart failure?
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Edema
ascites anasarca hepatomegally jugular dissention |
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What are symptoms of left heart failure?
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Weakness
weight gain cough dyspnea orthopnea paroximal noctural dyspnea fatigue |
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What are the complications in patients with dilated CMP?
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Heart failure
thrombus due to slow flow Embolism (pulmonic or systemic) Infective endocarditis Sudden cardiac death |
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What causes sudden cardiac death in patients with dilated CMP?
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Malignant ventricular arrythmia
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An EPSS of > 2 cm indicates what (including EF)
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Englarged/dilated LV and an EF of < 30%
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What are the most common M Mode findings in patients with Dilated CMP
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Aortic Valve = straightened aortic root (due to decreased systolic function)
LA enlargement Early cusp closure (due to low cardiac output) MITRAL VALVE = Enlarged EPSS Doulbe diamond appearance B Notch (increased LV pressure end diastolic) Decreased D to E LEFT VENTRICLE - LV enlarged (more than 6 cm) RV Enlargement Low EF Global hypokinesis |
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What are the most important 2D findings in patients with dilated CMP
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-enlargement of all 4 chambes
- Tenting of MV (due to stretching) - Spontaneous contrast - Lateralzation of pap muscle - Low EF, CO, and FS - Thrombus in apex or LAA |
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What is the formula for stroke volume?
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SV = CSA x VTI
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What are the most important doppler fidnings in patients with dilated CMP?
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-Regurge in all 4 valves
MR (100%) TR (90%) PV (50%) AoV (20%) - Low velocities and VTI in Aov & PV & LVOT - Check for signs of Pul. HTN |
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What are the normal valve velocities...
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AoV 1.0 to 1.7
PV 0.6 to 0.9 TV 0.3 to 0.7 MV .06 to 1.3 LVOT 0.7 to 1.1 |
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What is the normal VTI in MV?
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10-13 cm
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What is the normal VTI in LVOT?
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18-24 cm
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What is dp/dt and what is it used to detect?
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dp/dt is change in pressure over time. It is used to evaluate LV systolic performance
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What are the etiologies of hypertrophic CMP?
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Hereditary 80% "autosomal dominant"
Idiopathic |
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What are the signs and symptoms in patients with hypertrophic CMP?
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-Often asymptomatic
- Untreated can lead to severe V-tach and sudden death (symptoms of V tach are dyspnea, dizzyness, loss of consciousness, angina pectoris) |
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What are the complications in patients with Hypertrophic CMP?
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Sudden death upon exertion
Infective endocarditis Systemic embolism (most likely in LAA due to atrial Fib) Heart failure |
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What are the most important M mode findings in patients with hypertrophic CMP?
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AORTIC VALVE
Mid systolic closure of valve Fluttering leaflets (due to increased velocity) LA enlargement (due to MR) MITRAL VALVE Thickened IVS SAM B Notch Very small EPSS Thickening of anterior leaflet LEFT VENTRICLE Thickened IVS ASH LV obliteration (very small) Increased EF |
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A septum of > 1.5 indicates
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HYPERTROPHIC CARDIOMYOPATHY
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What are the most important 2D findings with patients with Hypertrophic CMP
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SAM
ASH Normal posterior wall (basal) Thickened & ellongated MV leaflets (due to stretching) Contact lesion @ septum (from MV tapping it) Enlarged LA (MR & diastolic dysfunction) RVH (in 40%) |
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What are the most important doppler findings in patients with Hypertrophic CMP?
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Grade 1 diastolic dysfunction
Eccentric MR (towards posterior wall) Increased velocity of LVOT Dagger shape (late peak in systole) Turbulent flow in LVOT (due to increased velocity in systole) |
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What 3 things does the valsalva manueveur accomplish?
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Decreases venous return
Decreases preload Increases contractility |
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Name the surgical treatment of hypertrophic CMP
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- Alcohol septal ablasion (therapeutic MI)
- Septal Myotomy/myectomy - Clipping of MV to prevent SAM |
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What is central functional regurge and what is it often associated with?
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Central functional regurge is due to the chambers being dilated, there is nothing actually wrong with the valve itself. It is associated with DILATED CARDIOMYOPATHY
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Eccentric regurge is seen in patients with....
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MV prolapse
SAM (due to HOCM) Flail leaflets |
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Speckle glass appearance is seen in what 4 pathologies
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Systemic HTN
ASH with HCM Infiltrative CMP (amylodosis) Chronic renal failure |
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Define restrictive infiltrative cardiomyopathy
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Uniform thickening of all heart walls. Usually due to abnormal protein deposits in myocardium. The valves, walls and septum are all thick.
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What common findings are there with restrictive infiltrative CMP
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TR
MR Increased diastolic dysfunction |
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What are the etiologies of Restrictive infiltrative CMP?
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it is a secondary disease which usually starts in another organ or system and then leads to the heart.
Often due to a systemic disease such as amyloidosis, sarcoidosis, hemacratodosis, hypereosinophilic syndrome |
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What are the signs and symptoms in patients with restrictive infiltrative CMP
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Diastolic dysfunction (progressively worsens)
Enlargment of all 4 chambers (late stage) Left Heart failure symptoms Pul. Effusion **patient ends up with pulmonary HTN |
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What are the most important M Mode and 2D findings in patients with amyloidosis?
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-ground glass appearance
-LV normal or small - Concentric LVH and RVH - ASH - Thickened Pap muscle - Biatrial dilatation - Thickened IAS - PE and Pl E - Abnormal wall motion - All walls thickened |
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What are common Echo findings with patients with pul. HTN
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Enlarged RV
D shaped LV Pancake septum |
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What is the most common echo findings in patients with hyperesonophilic syndrome
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Thrombus
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What is the most common echo finding in patients with sarcoidosis
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Segmental abnormal wall motion
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What are the important doppler findings in patients with amyloidosis
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Reguarge on all 4 valves
Diastolic dysfunction Pul HTN (TR, PR, decreased Acceration time of PV flow) |
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What is normal accleration time of PV flow?
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Normal > 120 msec
Severe Pul HTN < 60 msec |
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What is Grade 1 diastolic dysfunction? Abnormal findings?
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Impaired relaxation with normal filling pressure
E/A ration < .75 E/E' ration < 8 E/A reversal DT > 220 msec |
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What is grade 2 diastolic dysfunction? Abnormal findings?
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Pseudo-normal. Impaired relaxation with mild decrease in LV compliance with mild to moderate increase in filling pressure.
E/A normal E/E' > 15 Increased AR S < D |
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What is grade 3 diastolic dysfunction? Abnormal findings?
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Reversible restrictive. Impaired relaxation with severly decreased LV compliance with Increase in filling pressure.
E/A ratio > 1.5 DT < 1400 S < D AR increased E/ E' > 15 E'/A' < 10cm/sec (very small) |
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What is grade 4 diastolic dysfunction? Abnormal findings?
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"Fixed" Irreversible restrictive. Same as grade 3 but no change with valsalva
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An EF that is ____ or less is considered good media for ___ formation at the apical region
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An EF of 30% or less is considered good media for THROMBUS formation in apical region
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