State the most common symptom of a dilated cardiomyopathology.

dyspnea

Sarcoidosis clinically mimicks what other disease?

Constrictive Pericarditis

A patient has an EF of > 75%, LVH, a small LV cavity and a small LVOT less than 1.9 cm.  What condition does this pt. have?

HCM

When encountering the thick and shaggy valves d/t Amyloidosis infiltration, what action should the sonographer take?

Turn off harmonics

In HOCM what does the obstruction cause and what would be seen on M-mode?

The obstruction behind the aortic valve in the LVOT results in a pressure drop.  This drop causes the valve to close prematurely.  There will also be an enlarged LA.

Basic findings of bilateral enlargement which is stiff and non-compliant, JVD, peripheral edema, normal LV function early on and hepatomegaly are seen in what type of cardiomyopathy?

Restrictive Cardiomyopathy

In non-ischemic DCM would you have global or variable wall motion?

Global

What is the name given to a rare form of hypertrophy that could cause a H.S. athlete to die on the playing field? 

I.H.S.S.

(Idiopathic Hypertrophic Subaortic Stenosis)

What is the treatment for Hemocromatosis?

Repeated phlebotomy

Clues to disease:

Elevated RA pressures, JVD, concentric LVH & RVH, thick shaggy valves, bilateral enlargement d/t elevated RA & LA pressures w/only a small amt of MR and/or TR, grainy unusal reflectivity, frequent pericardial effusion

Amyloidosis

Early diastolic filling as seen in ___________ ______________ shows tall E waves and short little A waves.

Restrictive Cardiomyopathies

A disease of young children characterized by chronic elevation of eosinophils w/o any dilation of the LV.  Apical thickening and fibrosis resulting in MS or TS.

Endomyocardial Fibrosis

(Loffler's Endocarditis)

In the beginning of restrictive/infiltrative diseases, is the abnormality a diastolic or systolic event?  Explain why.

Diastolic problem.  ALL filling occurs early, before mid-systole.  LA pressures rise d/t resistance to LV filling.  Mimimal atrial contribution to filling.

What (specific term) preceeds S.A.M.?

Venturi Effect causes S.A.M.

Ischemia secondary to coronary disease would show which type of wall motion abnormality on 2D?  Regional or Global?

Regional

What is ASH?

Assemetrical Septal Hypertrophy

There is a hypertrophied IVS with a small LVOT less than 2 cm.

I.H.S.S. has a "give away" sign on 2D; what is it?

The IVS has the appearance of "cracked glass"; a speckled appearance.

S.A.M. would take place at what point on the EKG?

Right after the QRS upward suction motion would be seen.

How does a sonographer tell the difference between pleural and pericardial effusion?

Use landmark of Descending Aorta. If fluid is above Descending Ao it is pericardial effusion, if fluid is below it's pleural effusion.

The best way to determine if LVOT obstruction is present is with:

a. M-mode

b. Doppler

                             c. 2D

b. Doppler

LVOT obstruction occurs at ______ cm?

< 1.9 cm

 Actual LVOT obstruction is caused by

           a. anterior MV leaflet

           b. posterior MV leaflet

           c. both anterior and posterior leaflets

           d. cordae tendinae

           e. abnormal papillary muscles

           f.  any of the above

f. any of the above

What is the treatment for Amyloidosis?

          a. non-invasive (beta blockers)

          b. ablation by catheter

          c. none

          d. myectomy

c. none - there is no proven treatment

Speckling of the septum d/t myofibril disorganization along with characteristics of ASH and SAM would be a sign of what condition?

I.H.S.S.

Idiopathic Hypertrophic Subaortic Stenosis

A 32 yr. old woman has given birth recently and returns to the hospital ER complaining of shortness of breath.  Upon exam an S3 is heard along with crackling lung sounds.  Her heart rate is 145 bpm.  Her EF is 35%.  Identify her condition.

DCM

Dilated Cardiomyopathy

The #1 cause of a DCM for a male in his 20's or 30's is?

alcohol

When atria are acting as a pump during contraction what abnormal heart sound could be heard?

S4 - stiff ventricle

When the atria are acting as a conduit, what abnormal heart sound is a sign of a DCM?

S3 - rapid filling

What EKG findings could be seen with a DCM?

tachycardia

LBBB, A-fib

If a pt. with a DCM showed regional abnormalities on 2D, the most common cause of their ischemia was secondary d/t?

coronary disease

 The correct definition of DCM is:

An enlarged spherically shaped heart that has extremely poor global systolic function (pump failure - CHF) and 35% or less for EF.

DCM presents with LVE ______ cm with systolic thickening _______ % in the IVS, LVPW.

           LVE > 5.6

           < 30 % systolic thickening

On M-mode the drifting closure of the AV cusps, a flat Aortic root and enlarged LA would be indicative of which cardiomyopathy?

DCM

HCM and HOCM are due to

a. diastolic dysfunction

b. systolic dysfunction

a. diastolic dysfunction

A pt is experiencing faintness and is taken to the ER.  Auscultation reveals a SEM and EKG displays tall E waves.  EF is 85%.  ASH is present and the LVOT is < 2cm.  Based on these facts which type of cardiomyopathy does the pt have?

HOCM

What are the 3 treatments for HCM/HOCM beginning with the 1st approach that would be tried?

1. non-invasive tx with beta blockers - keeps hr low and keeps obstruction from developing

2.  septal ablation

3.  myectomy

A valsalva maneuvor is one method of provoking an increase in the pressure gradient.  What is the name of the pharmaceutical agent which produces the same effect?

Amyl Nitrate

Define Restrictive Cardiomyopathy

Ventricular walls become stiffened which results in decreased LV filling

90% of RCM is due to what?

Amyloidosis

- from the protein amyloid infiltrating

True or False. All 4 chamber could be dilated with a DCM?

True

Give another name for Dilated Cardiomyopathy

Congestive Cardiomyopathy

What is the recovery rate for a post partum cardiomyopathy?  What procedure might be the only means of saving the mother?

  50 %

  heart transplant

DCM has an EF of?

less than 35 %

Hypertrophic Cardiomyopathies have an EF of what?

more that 75 %

What is the best way to determine if an obstruction exists and to quantify the severity?

Doppler

How can the duration of S.A.M. be measured?

M-mode

> 75% EF

LVH

small LV cavity

small LVOT less that 1.9 cm

Is HOCM present?

No.  This is only HCM. 

>75% EF

LVH

small LV cavity

small LVOT less than 1.9 cm

What other 3 elements in the correct order make up HOCM?

1. Venturi effect
2. S.A.M. - Systolic Anterior Motion
3. obstruction

Infiltrative Cardiomyopathy is another name for?

Restrictive Cardiomyopathy

List the signs and symptoms of Amyloidosis (4)

1. Elevated RA pressures

2. JVD

3. Hepatomagaly/pulsatile liver

4. Peripheral edema

An Asian female is brought to the ER w/chest pain.  An angiogram shows no blockage or CAD.  An echo reveals ballooning of the apex.  She is stressed over her sister's cancer battle.  After several days the ventricle is normal again.  What condition is suspected?

Takotsubo Cardiomyopathy

DCM has a poor __________ dysfunction.

systolic (pump failure)

Hypertrophic cardiomyopathy mainly has a ____________ dysfunction.

diastolic

A pt has a disease which appeared simliar to Amyloidosis in the initial stages, but now late in the disease there is a localized thinning and dilation of the LV, bilateral atrial enlargement, and a knocking or rubbing type noise.  Identify the disease.

Sarcoidosis

Describe the EKG waveforms of a pt with Restrictive Cardiomyopathy

big E waves, little A waves

In a Hypertrophic Cardiomyopathy, pulmonary venous congestion and dyspnea may occur due to what?

increased LVEDP

List 3 EKG findings for Hypertrophic Cardiomyopathy

1. LVH with strain (T wave repolarization abnormalities)

2. LVH with tall R waves

3. Large voltage V1 - V6

What are the 2 types of DCM's?

type 1 - ischemia secondary to coronary dx and causes regional wall motion abnormalities

type 2 - idiopathic (viral, alcohol, post partum, genetic) causes global wall motion abnormalities

In a DCM, what causes the aortic valve cusps to slowly drift close on M-mode?

from the inability of the weak damaged myocardium to keep the cusps open throughout systole

A B-bump is an M-mode finding in which cardiomyopathy and why?

DCM

when there is increaed LVEDP

In a DCM, poor contraction of the LV might cause?

the formation of a thrombus

In a dilated cardiomyopathogy MR and LAE can be seen on 2D.  Why?

The mitral valve cusps fail to coapt and cause systolic doming which results in MR and LAE.

What is the reason for a large EPSS in a Congestive Cardiomyopathy?

Enlarged chambers cause increased distance from anterior mitral valve leaflet to the IVS.

Normal is .9 cm or less

What genetically inherited cardiomyopathy causes high incidences of deadly ventricular arrhythmias?

Arrhythmogenic Right Ventricular Dysplasia

The RV is dilated and contracts/functions very poorly

An infant arrived from a tropical climate and findings showed LVH, fibrotic aortic and mitral valve leaflets, Mural thrombi, a dilated LV and bilateral enlargement.  What condition does this infant suffer from, what is the tx and what is the prognosis?

Endomyocardial Fibroelastosis

steriods

extremely poor prognosis/death

A cardiomyopathy in which only the apex is thickened.  Give both the names this rare condition.

Apical Hypertrophic CMP

Yamaguchi's

(spade-shaped heart)

DCM

drifting closure of aortic cusps

flat aortic root d/t poor LVF

enlarged LA

LBBB on EKG

Congestive Cardiomyopathy

enlarged LV

systolic doming - MV cusps fail to coapt (MR)

LAE

[image]Evaluate this image

DCM 

Enlarged spherical LV

LVE > 5.6 cm

systolic thickening < 30 % in IVS, LVPW

little/no change between diastolic and systolic size

widened EKG = BBB

DCM

LV thrombus

I.H.S.S.

Huge IVS / speckled

S.A.M.

obstructs LVOT