Test one cardiac (CMO)

book and powerpoint

What is cardiomyopathy?

Disease that diffusely affects the myocardium and results in enlargement and/or ventricular dysfunction

What is the most common type of CMO

Dilated / congestive cardiomyopathy

What is dilated cardiomyopathy?

multi-chamber enlargement with decreased systolic and diastolic function

What are some causes of dilated CMO?

idiopathic, familial link, VHD, IHD/CAD, HTN, Arrhythmia

What are some signs and symptoms of dilated CMO?

HF, decreased CO, arrhythmia, regurgitant valves, ischemia, thrombus

What are some treatments for dilated CMO?

asymptomatic: no treatment

lifestyle changes

medical therapy

What is the goal of treatment for dilated CMO?

manage underlying issues

treat/control symptoms

prevent CMO from progressing

reduce sudden death risk

What are some 2D findings for dilated CMO?

dilation of the heart

decrease systolic and diastolic function

possible thrombus

smokey echo contrast

What are M mode findings for dilated CMO?

E point to septal seperation

What does hypertrophic CMO (HCMO)?

hypertrophic, hyperdynamic, non-dilated LV that is frequently associated with LVOTO

What does hypertrophic mean?

thickening

What does hyperdynamic mean

high force squeeze

What are 3 types of HCMO?

HOCM

Provocable HOCM

Non-obstructive HCMO

What does HOCM stand for?

Hypertrophic Obstructive Cardiomyopathy

What is HOCM?

Asymmetric / concentric / mid ventricular LVH with LVOTO

What does IHSS stand for?

Classic idiopathic hypertrophic subaortic stenosis

What is IHSS?

classic HOCM

ASH and SAM

contribute to LVOTO

What are the 3 types of HOCM?

IHSS

HOCM w/ concentric (entire walls) LVH + SAM that leads to LVOTO

HOCM with mid ventricular LVH that leads to LVOTO

What is ASH?

asymmetric septal hypertrophy

What is SAM?

systolic anterior motion of the mitral valve

What is provocable HOCM?

LVH with LVOTO but only when provoked with exercise, coughing, valsalva maneuver

What is non-constructive HOCM

apical / other LVH without LVOTO

What are some signs and symptoms of HCMO?

DOE, orthopnea, CP, arrythmias, pulmonary edema

What are complications for HCMO?

embolus, HF, IE/veg, sudden death

What are diagnostic tests for HCMO?

Echocardiogram, EKG, genetic testing, MRI

What is a surgical septal myectopy?

surgically remove part of a thickened septum

What is alcohol septal ablation?

Cath lab procedure, injecting alcohol to reduce septal thickness

What kind of HOCM is this image showing?

Classic IHSS

Does this image have ASH or SAM?

Both

What is the normal IVS/PWT ratio?

1 / 1

What is the IVS / PWT ratio with ASH?

Greater than or equal to 1.3 / 1.0

What kind of of HOCM is this?

HOCM concentric LVH

Does this image have ASH or SAM?

SAM

Can HOCM concentric LVH lead to LVOTO

Yes

What kind of HOCM is this?

Midventriuclar LVH

Does this image contain SAM or ASH?

neither

Which one does not lead to LVOTO

-classic IHSS

-concentric LVH

-midventricular LVH

-non obstructive HCMO?

non obstructive

What kind of HCMO is this?

non obstructive HCMO (apical / other LVH)

What shape does the non obstructive HCMO usually have

spade like shape

What does hyperdynamic wall motion mean?

the heart muscle is contracting with excessive force and squeezing more vigorously than normal

True or false, MVP and MAC are not possible for IHSS and Concentric LVH

False

On M-mode will the MV E-point to septal contact increase or decrease?

decrease

What is the shape and sound of a LVOTO using doppler?

dagger shape

sponge being wrung out

When during the cycle does the LVOTO peak appear?

late systole

Does LVOTO using doppler appear above or below the baseline?

below

Is the MR peak or LVOTO peak bigger?

MR

When dopplering LVOTO should you use CW or PW?

PW, switch to CW if greater than 2 m/s

What does doing a valsalva menuever rule out?

provocable LVOTO

What is a restrictive / infiltrative CMO?