Adult Echo 2 Final

A connective tissue disorder that often affects the elderly causes swelling and loss of mobility in the body's joints.

rheumatoid arthritis

Non primary cardiac tumors are how many more times as likely to occur than primary cardiac tumors?

20 times

Amyloidosis involves improperly folded _________ that infiltrate the myocardium.

proteins

Secondary metastatic tumors, frequently travel:

• To the pericardium, myocardium and then to the endocardium

• From the IVC to the right atrium and then to the right ventricle 

• From the pulmonary veins into the left atrium

• All of the above

All of the Above

A skin lesion that develops in late stage AIDS infections is called

 Kaposi's sarcoma

A dumb-bell shaped configuration of the inter-atrial septum often mistaken as cardiac mass is associated with:

 

Lipomatous hypertrophy

A common cardiomyopathy that develops in patients with chronic HIV infections is:

 

Dilated cardiomyopathy

Kawasaki's disease is an inflammatory illness that affects children.  A cardiac manifestation of Kawasaki's disease is:

• Dilated coronary arteries

• Dilated ventricular chambers

• Cardiac thrombus formation

• Mitral regurgitation

Dilated coronary arteries

The most common primary malignant intracardiac tumor in adults is which of the following?

• Myxoma

• Papillary fibroelastoma

• Angiosarcoma

• Fibroma

Angiosarcoma

A cardiac manifestation of carcinoid is

• Restricted TV leaflet motion

• Restricted MV leaflet motion

• PHTN

• Aortic stenosis

Restricted TV leaflet motion

A well-encapsulated, small tumor composed of fat cells is named____________.

Lipoma

The following is true of rhabdomyomas:

• Found in the ventricular walls

• Most common cardiac tumor in children

• Often obstruct the conduction pathways in the myocardium

• All of the above

All of the above

The improper retention and storage of iron particles in the body is called:

Hemochromatosis

An arteritis that presents with intimal thickening of the aorta and it's major branches is called:

Takayasu’s Arteritis

The TEE image of the left atrial appendage revealed:

A LAA clot

Normal velocity in the LAA?

>4m/s

The mass in the IVC on the image above is most likely consistent with which of the following diagnoses?

• Rhabdomyosarcoma

• Myxoma

• Infiltrative renal cell carcinoma

• Angiosarcoma

Infiltrative renal cell carcinoma

A patient is referred to the echo lab because of symptoms of TIA's.  The patient had an echo previously which showed a small patent foramen ovale.  A TEE is performed and reveals the above diagnosis.

• Normal inter-atrial septum

• Catheter protruding through the intra-atrial septum

• A large clot lodged in the patent foramen ovale

• An ASD closure device

A large clot lodged in the patent foramen ovale

In cases of secondary metastatic tumors in the heart, a common echocardiographic finding is 

• Pericardial effusion

• Well-circumscribed mass with definitive borders

• Thickening of the interatrial borders

• Cystic space in the pericardium

Pericardial effusion

The image above demonstrates a benign primary cardiac tumor.  The most likely diagnosis is which of the following?

• right atrial myxoma

• left atrial myxoma

• right atrial hemangioma

• left atrial hemangioma

left atrial myxoma

This was taken on a patient who has been diagnosed with postpartum cardiomyopathy and who currently has an ejection fraction of 20%.  What is the most likely diagnosis?

• left atrial myxoma

• left mitral valve vegetation

• left ventricular thrombus

• right atrial myxoma

left ventricular thrombus

Most common benign cardiac Tumor:

Myxoma

Most common malignant cardiac tumor:

Angiosarcoma

Traits of Papillary Fibroelastomas:

• Primary benign cardiac tumor

• common on valves (AoV) & papillary muscles

• Usually on arterial side of AoV

• Small, mobile, pedunculated

• May appear like Lambl’s excrescences

• Largest concern is embolism

Traits of Fibromas

• primary benign cardiac tumor

• Bulky, made of fibrin tissue

• Embedded in the myocardium of any chamber

  • Usually ventricular

  • Makes it difficult to remove, typically leads to transplant

• Usually intramural

• Usually solitary

• Age range: 2 - 5

Angiosarcomas mostly occur in which cardiac chamber?

RA

Common primary benign cardiac tumors:

• Myxoma

• papillary fibroelastoma

• Lipoma

• Rhabdomyoma

• Fibroma

Primary malignant cardiac tumors

• angiosarcoma

• Rhabdomyosarcoma

• Other (rare) ones: fibrosarcoma, lymphoma, sarcoma, mesothelioma

Where is cardiac thrombus most often located?

• LV

• LAA

• IVC/RA

Different LAA shapes:

Treatments for cardiac thrombus:

• anti-coagulation

  • NOAC/DOAC: apixiban

  • Heparin

• Thrombolysis

  • EKOS: Ultrasound assisted catheter-delivered thrombolysis. Thrombus “opens up” d/t ultrasound and allows more medication into the thrombus

  • Oral

• Thrombectomy

  • Angiovac

  • Surgical

What are some indications to use EKOS?

When should it be turned off/not used?

• most commonly used for pulmonary embolisms

• Can be used for critical DVTs

• MUST be turned off during echocardiograms

What is the Ridge of Coumadin?

a part of the left atrium that lies between the left atrial appendage

Echo features of amyloidosis:

• Ground Glass, Granular, “Sparkling” myocardium

• Apical Sparing (strain pattern)

• Ventricular hypertrophy

• Atrial Dilatation

• Pericardial/pleural effusion

• Diastolic Dysfunction

• thickened valves w/ regurgitation

• thickened IAS

• thickened papillary muscles

What is the typical strain pattern for amyloidosis? Is it specific for this disease?

• Apical Sparing: a preservation of contractility in the apical segments, with a decrease in the basal & mid segments

• It is NOT specific for amyloidosis

Traits of Myxomas

• Primary benign cardiac tumor

• Usually pedunculated on/near the IAS

• Most common in the LA

• Gelatinous Texture

Traits of Lipomas

• Primary benign cardiac tumor

• Encapsulated

• Most commonly in LV, RA, or IAS

• Can occur in any heart layer

• Mostly sessile (NOT pedunculated/attached by a stalk)

• Typically asymptomatic

Traits of Hemangiomas

• primary & benign

• comprised of blood vessels & tissue

• Most commonly in the ventricles

What disease is associated with rhabdomyomas?

tuberous sclerosis

Rhabomyomas are most commonly found in which age group?

in children

Traits of Rhabdomyomas

• primary benign cardiac tumor

• Most common tumor in children

• Yellowish-gray color

  • made of muscle cells

• Invades ventricular myocardium

• May cause arrhythmias

• Associated w/ tuberous sclerosis

Traits of Angiosarcomas

• primary malignant cardiac tumor

• Most common primary malignant tumor

• Mostly occur in the RA

• Large, mural mass

  • May extend into the pericardium

Traits of Carcinoid tumors

• secondary & malignant

• often originate in the digestive system

  • metastasize to the liver & releases serotonin

• Mostly affects right heart valves

Traits of rhabdomyosarcomas

• primary & malignant

• often embedded in ventricular myocardium

Traits of Osteosarcomas (in the heart)

• Secondary & Malignant

• originates in bone

  • rarely mets to the heart

Traits of Fibrosarcomas

• Primary & malignant

• infiltrates the entire heart

Traits of melanoma (in the heart)

• secondary & malignant

• skin cancer

• commonly mets to the brain and heart

Traits of Lymphoma (in the heart)

• secondary & malignant

• commonly in the RA

• assocaited with pericardial effusion

Traits of squamous cell carcinoma (in the heart)

• secondary & malignant

• typically originates int he lungs

• can travel via the pulmonary veins or pericardium

Connective tissue disorder caused by a defect in the synthesis of collagen causing loose joints, hyper-elastic skin and easily damaged blood vessels—there are treatments but no cure.

Ehler’s-Danlos

A rare neuro-developmental disorder characterized by a distinctive, "elfin" facial appearance along with a low nasal bridge,an unusually cheerful demeanor and ease with strangers. Cardiovascular problems include: supravalvular AS, hypercalcemia

William’s Syndrome

Also known as brittle bone disease. Abnormal collagen formation

Osteogenesis imperfecta

An inherited disease of the nervous system: Heart disorders include atrial fibrillation, tachycardia and hypertrophic cardiomyopathy

Friedrich' ataxia

An inherited disease of the nervous system: Heart disorders include atrial fibrillation, tachycardia and hypertrophic cardiomyopathy

Friedrich' ataxia

Enlargment of the RV as a response to increased resistance or high blood pressure in the lungs.
Results in pulmonary hypertension, RVH, RV dilatation

Cor Pulmonale

A genetic disorder of the connective tissues. Heart disorders include MVP and dilated aorta

Marfan’s Syndrome

A set of four cardiac defects: Supravalvular mitral membrane, parachute mitral valve, subaortic stenosis and coarctation of the aorta.

Shone’s complex

The reversal of any congenital shunt from left to right to right to
left secondary to PHTN. It is a cyanotic heart defect consisting of VSD,
dextroposition of the aorta, pulmonary hypertension and RVH

Eisenmenger’s Syndrome

It is a very rare congenital heart disease with a partial or total loss of the myocardial muscle in the RV

Uhl’s

A disorder marked by the deposition of amyloid in various organs and tissues of the body. It may be associated with a chronic disease, such as rheumatoid arthritis, TB, or multiple myeloma

Amyloidosis

A disease in which eosinophils accumulate in the lung in response
to a parasitic infection. Cardiac damage caused by the damaging effects
of eosinophil granule proteins is known as Loeffler endocarditis

Loeffler’s

Hereditary disease which causes an overload of iron in the body

Hemochromatosis

A disease in which abnormal collections of chronic inflammatory
cells (granulomas) form as nodules in multiple organs. Cause is
unknown

Sarcoidosis

Tumor of the adrenal gland affecting heart rate and blood pressure

Pheochromocytoma

A rare multi-system genetic disease that causes non-malignant
tumors to grow in the brain and on other vital organs such as the
kidneys, heart, eyes, lungs and skin

Tuberous sclerosis

A form of pericarditis that is also known as the post-myocardial
infarction syndrome. It occurs 6-8 weeks after an infarction and is
characterized by chest pain and pericardial effusion

Dressler’s

A relatively common autosomal dominant congenital disorder considered to by a type of dwarfism. Heart disorders: PS, ASD, HOCM

Noonan’s

Chromosomal abnormality in which all or part of the sex chromosomes are absent. Cardiac problems include: Biscupid AV, coarctation of the aorta and anomolous venous drainage.

Turner’s Syndrome

Also known as "aortic arch syndrome" is a form of large vessel granulomatous vasculitis and massive intimal fibrosis. Mainly affects the aorta and pulmonary arteries.

Takayasu's arteritis

A congenital malformation of the tricuspid valve in which one,
two or all three leaflets are displaced downward from the annulus with
RV atrialization

Ebstein’s Anomaly

A disease characterized by a persistently elevated eosinophil count with involvement of the heart, nervous system or bone marrow. Causes endomyocardial fibrosis

Hypereosinophilia

A form of congenital heart disease consisting of an ASD and
mitral stenosis

Lutembacker’s

Abnormal accumulation of glycolipids in blood vessels, tissues and various organs causing impaired function

Fabry’s

Type of nonischemic cardiomyopathy that involves primarily the RV. It is characterized by hypokinetic areas involving the free wall of the RV, with fibrofatty replacement of the RV myocardium with associated arrhythmias.

Arrhythomogenic RV dysplasia

Parasite which can lead to cardiomyopathy

Chagas

A disease which damages muscle and nerve cells throughout the body. It is caused by an accumulation of glycogen. Can result in LVH, tumor like appearance of the papillary muscles and poor global ventricular systolic function

Pompe's

A genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, lungs, liver and brain. Also associated with pulmonary arteriovenous fistulas

Osler-Weber-Rendu

A chronic form of spondylitis in males marked by arrhythogenic RV dysplasia caused by abnormal protein formation.

Ankylosing spondylitis

A form of nonbacterial endocarditis that is seen in systemic lupus erythematosus.

Libman-Sack's

An autoimmune condition that develops in response to an
infection in another part of the body. Inflammatory arthritis

Reiter's

Congenital heart defect which is classically understood to involve four anatomical abnormalities. It is the most common cyanotic heart defect and the most common cause of blue baby syndrome—consists of PS, VSD, deviation of the aorta, RVH

Tetralogy of Fallot

Autoimmume disease where the body's immune system becomes
hyperactive and attacks normal, healthy tissue. Resulting symptoms
include inflammation, swelling, damage to joints, skin, kidneys, blood,
heart and lungs.

Lupus

A 34 year old man with lymphoma presents with a 3 week history of decreased exercise tolerance.  Physical exam reveals a diaphoretic man with a BP of 90/60, HR of 120 and respiratory rate of 24/min.  Lungs are clear, heart sounds are distant.  Echo reveals a large, circumferential pericardial effusion with RV diastolic collapse.  The most appropriate next step in treating this patient is which of the following?

• Evaluate for RA systolic collapse

• Record Doppler filling velocities with a respirometer

• Insert a Swan-Ganz catheter

• Perform a pericardiocentesis

Evaluate for RA systolic collapse

Etiological possibilities for the development of constrictive pericarditis include which of the following?

• cardiac surgery

• viral

• bacterial

• all of the above

all of the above

When evaluating a patient for cardiac tamponade, the echo helps determine the size, location and hemodynamic effects of the pericardial effusion on the heart.  Cardiac tamponade is a diagnosis made by which of the following?

• Cardiac catheterization

• Electrocardiogram

• Tamponade is a clinical diagnosis

• Thoracotomy

Tamponade is a clinical diagnosis

Classic clinical signs and symptoms of constrictive pericarditis include which of the following?

• pericardial knock

• murmur

• none of the above

• Ewart's Sign

 pericardial knock

the physiologic severity of a pericardial effusion largely depends on which of the following?

• volume and rate of fluid accumulation

• volume and presence or absence of loculations in the fluid

• rate of accumulation and fluid composition

• fluid composition

 volume and rate of fluid accumulation

A small posterior echo-free space is detected during the systolic phase only by M-mode/2D echo.  This is considered a:

• Cardiac tamponade

• Normal finding

• Moderate pericardial effusion

• Large pericardial effusion

 Normal finding

In order to be considered full blown tamponade physiology, which of the following must be present?

•  right ventricular systolic collapse and right atrial diastolic collapse

• right ventricular diastolic collapse and right atrial systolic collapse

• left atrial systolic collapse and right ventricular diastolic collapse

• left ventricular collapse and right atrial collapse throughout systole and diastole

 right ventricular diastolic collapse and right atrial systolic collapse

A 10 mmHg decrease in systemic blood pressure with inspiration associated with cardiac tamponade is referred to as which of the following?

• Beck's triad

• precordium

• orthostatic hypotension

• pulsus paradoxus

 pulsus paradoxus

What are the components of Beck’s Triad?

• hypotension

• JVD

• Muffled heart sounds

What diagnosis can be made from this echo image?

• Normal parasternal long axis

• Pericardial effusion

• Pericardial and pleural effusion

• Pleural effusion

A 45-year old female presents to her doctor with complaints of increasing dyspnea on exertion for three months.  Her physical exam reveals jugular venous distention, ascites and a pericardial knock.  What is the most likely diagnosis?

Constrictive pericarditis

Constrictive pericarditis is best defined as which of the following?

• a condition in which a pericardial effusion results in tamponade physiology

• a condition in which the patient develops an outflow tract obstruction

• a condition in which the pericardium becomes thickened and fibrotic

• none of the above

 

a condition in which the pericardium becomes thickened and fibrotic

(T/F) The best way to differentiate constrictive pericarditis from restrictive cardiomyopathy is by determining if respiratory variation is present.

True

Which of the following does not present the possibility for development of constrictive pericarditis?

•  cardiac surgery

• Viral infection

• Bacterial infection

• Aortic dissection

aortic dissection

Pulsed-wave Doppler evidence of cardiac tamponade includes:

A 45 year old patient comes to the lab as a referral from his doctor.  He has had elevated blood pressure that has not responded to traditional medications.  When performing his echo, you attempt to CW the MV to evaluate for any MR.  You get the resulting waveform.  What do we see here?