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90 Cards in this Set

  • Front
  • Back
Is RCM infiltrative?
Yes
_________ systolic function with RCM.
Normal
_________ diastolic function with RCM.
Impaired.
Underlying abnormality in RCM is ________ of the LV with subsequent ________ due to diastolic dysfunction and _______ filling pressures.
stiffening
CHF
elevated
Classic RCM is _______ in nature.
infiltrative.
RCM restricts the heart from _______.
Stretching
What pressures are increased with RCM?
LAP and LVEDP
What is enlarged in RCM?
Bi-atrial enlargement.
How common is RCM?
Least common of the cardiomyopathies.
Is right or left heart failure evident first in RCM?
Right sided failure is usually evident first.
How does right sided heart failure present?
Ascites
Hepatomegaly
Pulmonary edema
Jugular vein distension
What is infiltrated in RCM?
Myocardium
What is primarily affected in RCM?
Ventricles
What is orthopnea?
Patient needs to sit up to breathe properly.
What are signs of CHF seen in RCM?
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea (PND)
What is Paroxysmal nocturnal dyspnea?
A sign of CHF. Dyspnea, or difficulty breathing occurs at night when the patient slows down. Pulmonary pressures are elevated due to extravascular volume.
Presentation of RCM?
CHF
Fatigue, weakness
Angina
Poor exercise tolerance
Why does orthopnea occur?
Due to elevated pulmonary pressures.
_______ means the patient needs to sit up to breathe properly.
Orthopnea.
Which RCM types are infiltrative?
Amyloidosis
Hemochromatosis
Which types of RCM are inflammatory, rather than infiltrative?
Glycogen storage
Sarcoidosis
Hyperesinophilic syndrome.
How do most patients present with RCM?
Signs of right heart failure.
Hypotension due to low CO
S3 maybe
S4 probably
_________ is when finger print stays on the foot and is a sign of _______.
Pedal edema.
Peripheral edema.
EF in RCM is usually _______.
Normal.
In RCM, the LV wall is ________ and not _______.
Thick but not dilated.
Thickening of the LV in RCM is ________.
Concentric.
Echo findings of RCM?
Thick walled LV with normal EF.
Concentric LV thickening.
Speckling of myocardium
Biatrial enlargement
MR, TR
Moderate Pulmonary Hypertension
Elevated Right Atrial pressure (dilated IVC).
Pulmonary hypertension in RCM is usually ________.
Moderate.
Early in RCM, mitral inflow is _____, followed by _________ pattern, concluding with a _______ pattern.
Impaired relaxation
Psuedonormal
Restrictive
With an increased LAP, mitral valve opens at _______ pressures, resulting in a decreased ______.
higher
IVRT
An increased LAP causes ______ TMPG and a ________ E velocity.
What happens to S velocity?
Increased, Increased.
S velocity decreases.
An increased LVEDP ______ the a-kick contribution? What happens to velocity?
E/A ratio?
Reduces the a kick.
Velocity increases.
E/A ratio decreases.
What does deceleration time represent?
LA/LV pressure equalization.
What happens to LAP in RCM?
It increases.
With a psuedonormal or restrictive inflow pattern, what happens to distolic pulmonary vein flow?
It is normal or increased.
With PN or restrictive pattern, what happens to Pulmonary S flow?
Systolic flow is decreased because of high LAP.
With PN or restrictive pattern, what happens to Pulmonary vein AR?
Velocity and duration increase.
Why is Pulmonary vein flow helpful?
It helps distinguis normal from PN filling patterns.
Pulmonary flow patterns with RCM?
Low S, High D, increased AR duration and velocity.
What is considered a high AR velocity?
Above 35 cm/sec.
What does a fast and long AR indicate?
Elevated LAP.
What TDI pattern is seen in RCM?
low diastolic annular velocities, with an E/e' ratio greater than 15.
What does hepatic flow represent?
Right atrial filling.
______ hepatic flow occurs as a result of atrial relaxation.
Systolic.
Diastolic hepatic flow occurs during_______.
The rapid filling phase of diastole.
AR hepatic flow occurs when?
It occurs during atrial contraction.
With _____ RAP, AR reversal is increased.
High.
If RAP is increased, AR flow will be increased especially during ______.
Inspiration.
RCM may be confused with _______.
Constrictive pericarditis.
Beside echo, what modalities can be used to diagnose RCM?
Endomyocardial biopsy
Cardiac cath chamber P measurements at rest and with volume loading.
What is the gold standard in diagnosing RCM?
Endomyocardial biopsy.
Why would CT be used in diagnosing RCM?
To rule out constrictive pericarditis, which can be seen on CT.
What is the prognosis of RCM?
Poor, especially in children.
What are treatments of RCM?
Relieving systemic and pulmonary venous congestion.
Diuresis
Anticoagulants (clots due to a fib with bi-atrial dilation.
Cardiac transplantation.
Late in the course of RCM, there may be ______ dysfunction and and appearance of ______
Systolic dysfunction
DCM.
What is the most common type of RCM?
Amyloidosis.
What happens in Amyloidosis?
Amyloid protein is dumped into the kidney, heart, brain, liver, etc. that damages tissue and causes organ malfunction
What are secondary features to Amyloidosis?
Pericardial effusion, arrhythmias, abnormal myocardial reflectivity (Speckle)
How does the myocardium appear on 2-d with Amyloidosis?
Speckled.
Multisystem inflammatory granulomatous disease is called ______
Sarcoidosis.
What is Sarcoidosis?
A multisystem inflammatory granulomatous disease.
How often does Sarcoidosis involve the heart?
25%
What are the risks of Sarcoidosis?
Dysrhythmia
Heart Block
Sudden Death
What is the issue with Hemochromatosis?
Iron storage disease. Iron is deposited into the myocardium. It is a multisystem disease.
In Hemochromatosis, ______ is deposited into the ______.
Iron
Myocardium.
What are treatments for Hemochromatosis?
Bloodletting to reduce RBCs.
What is the etiology for Hemocrhromotosis?
Unknown origin, but found in patients who have had many transfusions.
What is the issue with Glycogin Storage?
Excess carbohydrates stored in the myocardium, which increases wall thickness.
With Glycogin Storage, excess ________ are stored in the _______.
Carbohydrates.
Myocardium.
In Farby's disease, the LV wall is _______ due to _________ deposits.
Glycosphingolipid (sugar fat).
Where is Idiopathic Hypereosinophilic Syndrome most prominent?
Apex.
In _____________, an overproduction of WBCs destroy organs.
Idiopathic Hypereosinophilic Syndrome.
In Idiopathic Hypereosinophilic Syndrome, the endocardium is ________, with the creation of a _________ involving _______ ventricles.
Inflamed.
Thick Layer
Both
Another name for Idiopathic Hypereosinophilic Syndrome is _________.
Loeffler's endocarditis
Endomyocardial Fibroelastosis.
With what can the PMVL be entrapped?
Idiopathic Hypereosinophilic Syndrome.
Stage 1 of Idiopathic Hypereosinophilic Syndrome.
Acute inflammation of the endomyocardium. Inflitration of eosinophils.
Stage 2 of Idiopathic Hypereosinophilic Syndrome.
Endomyocardial fibrosis and endarteritis of the myocartdial arterioles.
Stage 3 of Idiopathic Hypereosinophilic Syndrome.
Thrombosis Necrotic areas may produce thrombus, without RWMA.
What is the consequence of entrapment of PMVL in Idiopathic Hypereosinophilic Syndrome?
MR.
Is Hypertensive Heart Disease a cardiomyopathy?
No.
In _____________, chronic systemic pressure overload results in LVH.
Hypertensive Heart Disease.
What happens to EF with Hypertensive Heart Disease?
Remains normal.
What pattern is seen in Hypertensive Heart Disease?
Impaired Relaxation.
What is considered systemic Hypertension?
140/90
What needs to be determined in a patient with Hypertensive Heart Disease?
If systolic or diastolic function is impaired.
Can Hypertensive Heart Disease progress to dilation and failure.
Yes.
What findings can you expect with Hypertensive Heart Disease?
Aortic root dilation.
Fibrotic aortic leaflets.
MAC (MR)
LAE (LVEDP, MR)
Examples of Isometric sports.
Weight lifters, wrestlers. They get thickened LV walls.
What is tricky in identifying in Athletic heart?
Whether changes are pathological or adaptive.
Patients in endurance sports like cyclists, will have increased __________ and ________.
Wall thickness and LVID