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