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what is cardiomyopathie
diseases of the myocardium that are associated with cardiac dysfunction
How many classification is there of cardiomyopathies ?
Name all three classification of cardiomyopathies.
- Arrhythmogenic right ventricular
Hypertrophic Cardiomyopathy AKA's
- Idiopathic Hypertrophic Subaortic Stenosis (IHSS)
- Hypertrophic Obstructive Cardiomyopathies (HOCM)
- Asymmetric Septal Hypertrophy (ASH)
- Muscular Subaortic Stenosis (MSS)
- Apical Asymmetric Hypertropthy (AAH)
Hypertrophic cardiomyopathy symptoms may vary depending on the severity or stage of the disease symptoms may be:
- Chest pain
- Dyspnea on exertion
- Systolic ejection murmur may be heard on auscultation
- *Symptoms may occur only upon exertion, including sudden death.*
The three major 2D finding of hypertrophic cardiomyopathy is :
- Hypertrophic LV
- Impaired diastolic LV function
- Hyperdynamic or preserved systolic ventricular function
- *Depending on the area of the septal hypertrophy, sub-aortic stenosis may be present *
Hypertrophic cardiomyopathy 3 categories
- Hypertrophic Obstructive (HOCM)
- Provocable Hypertrophic Obstructive
- Hypertrophic Non Obstructive
4 types of hypertrophic cardiomyopathies
- Type 1 - hypertrophy is only in the anterior IVS
- Type 2 -involves anterior and posterior IVS
- Type 3 - Extensive LVH, except basal posterior walls
- Type - the apical region is hypertrophied *least common*
What is Concentric Hypertrophy ?
Involves equal hypertrophy of all the LV walls; this may contribute to a LVOTO
What is Midventricular Hypertrophy ?
involves hypertrophy and LVOTO at the level of the papillary muscles (this form does not involve SAM of the MV).
What is Provocable Hypertrophic CMO ?
A LVOTO is provoked with the use of exercise, drugs, or Valsalva maneuver.
*** The Valsalva maneuver decreased preload, which results in decreased filling of the left ventricle. An under filled LV results in an increased in LVOTO
What is Hypertrophic Non-Obstructive CMO?
Apical hypertrophy, or another form of hypertrophy, that does not produce a LVOTO.
What causes the "ground glass" appearance of the IVS?
A abnormal cellular disarray known as "myocellular disarray"
M-mode patterns with HOCM:
- Asymmetrical septal hypertrophy (ASH)
- Increased echogenicity of the IVS
- Systolic anterior motion (SAM) of the mitral valve
- Mid-systolic notching or closure of the aortic valve (caused by change in chamber pressure from obstruction).
Doppler exam and evaluating HOCM:
LVOT obstruction Doppler waveform is typically a late-peaking high velocity monophasic signal and has a "dagger-shaped" appearance.
significantly impaired myocardial relaxation may occur. An abnormal reduced E and increased A velocity might be present.
Hypertrophic cardiomyopathy complications
- Embolus (most likely due to LA thrombus)
- Sudden death (especially with exertion
Hypertrophic Cardiomyopathy treatment option
Surgical myectomy - involves removal of a portion of the septum and a MV repair or replacement if necessary.
Some Possible Causes for Dilated Cardiomyopathy:
- Pre and post partum
- Inherited disease (sickle cell anemia,Muscular dystrophy)
- Infections (viral, Chagas disease)
- Toxic (alcohol, medications, radiation)
Dilated Cardiomyopathy patients may present with :
- Chest Pain
- Peripheral Edema
Dilated Cardiomyopathy AKA
Restrictive Cardiomyopathy AKA
What are normal m-mode finding associated with restrictive cardiomyopathy?
- Normal to small LV and RV
- Dilated atria
- RV hypertrophy
Restrictive cardiomyopathy doppler findings....
- Mild to moderate MV and TV regurgitation
- pulmanary hypertension
- in an advanced stage E velocity becomes much higher than the A
Arrhythmogenic right ventricular cardiomyopathy is AKA?
Clinical indacations of arrthmogenic right ventricular cardiomyopathy are:
- Heart murmur
- Sudden death
What causes Rv dyslpasia?
Replacment of myocardium in the RV with fatty and fibrous tissue.
which one of the following cardiomyopathy is often a result of an autosomal dominant inherited disease?
a) dilated cardiomyopathy
b) congestive cardiomyopathy
c) hypertrophic cardiomyopathy
d) restrictive cardiomyopathy
C: hypertrophic cardiomyopathy
The one finding thatall types of hypertrophic cardiomyopathies have in common is :
A) sub-aortic stenosis
B) systolic anterior motion
C) normal thickness of basal posterior Lv wall
D) asymmetrical septal hypertrophy
D: asymmetric septal hypertrophy
A simple clue to help identify restrictive cardiomyopathy is.....
Bi atrial enlargement with relatively normal ventricle size.
The speckling or increased in echogenicity osf the iVS in the hypertrophic cardiomyopathy may also be referred to as:
A) "hockey stick" appearance
B) "crushed ice" appearance
C) "ground glass" appearance
D) "water balloon" appearance
C: ground glass appearance
When hypertrophic cardiomyopathy is present, the outflow obstruction is consisdered to be:
d) none of the above
When diastolic dysfunction is present the doppler inflow tracing will reveal:
a) reduced E velocity
b) increased A velocity
c) prolonged IVRT and deceleration time
d) al the above
D: all the above
Which of the following causes of a dilated or congestive cardiomyopathy can be detected on echo?
a) chagas' disease
b) alcoholic cardiomyopathy
c) diabetic cardiomyopathy
d) postpartum cardiomyopathy
A: chagas disease
Which of the following is NOT a probable finding with a restrictive cardiomyopathy?
a) bilateral atrial enlargement
b) small to moderate pericardial effusion
c) normal diastolic function
d) right ventricular hypertrophy
C: normal diastolic function
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