What are the three main classifications of Cardiomyopathies?
- 1.) Hypertrophic Obstructive Cardiomyopathy
- 2.) Restrictive or infiltrative cardiomyopathy
- 3.) Dilated or congestive cardiomyopathy
What will happen with the EF with Hypertrophic Cardiomyopathy?
Will first increase EF and than will later decrease EF
What type of Cardiomyopathies will have thin walls?
Dilated or congestive cardiomyopathy
What will happen to the EF with REstrictive or infiltrative cardiomyopathy?
will decrease right away
Which type of the three cardiomyopathies is a filling problem?
Restrictive or infiltrative cardiomyopathy
What will the valsalva or standing up do to the LV volume and pressure?
will decrease LV volume but increase LV pressure and velocity
What will the valsalva or standing up do to SAM?
Physiology of Partial midsystolic closure of AV (3)
- 1.) MV moves up during systole = obstruction
- 2.) AO loss of pressure so AV closes.
- 3.) MV closes in end-systole so AV opens up and finishes.
If you have an increase in LV volume what will happen to the gradient?
decrease the gradient
If you have an decrease in LV volume what will happen to the gradient?
increase the gradient
Restrictive or Infiltrative Cardiomyopathy is considered what type of disorder?
A filling problem causes the squezzing problem or cardiac muscle disease.
What type of Restrictive Cardiomyopathies will have an distinct appearance on echo?
What is it?
spectral ground glass appearance
What is Libman-Sachs Endocarditis?
endocarditis not caused by bacteria and usually has an ASD associated with it.
Systemic Lupus Erythematosus (SLE)
What are the two most common types of Restrictive Cardiomyopathy?
- 1.) Amyloidosis
- 2.) Idiopathic
What will also be present with an inflammatory disease?
fluid around the heart or pericardial effusion
What is an doppler finding that is seen with Restrictive Cardiomyopathy that is not seen with any other pathology?
Diastolic MR (still below baseline)
Can we treat a filling problem?
What is the most common type of Dilated Cardiomyopathy worldwide?
What is the most common type of Dilated Cardiomyopathy in the United States?
Infections such as HIV, viral, bacterial, parasitic (Chages)
What is ARVD?
a type of dilated cardiomyopathy that causes sudden death among young athletes due to arrhythmias.
What is Uhls?
a type of dilated cardiomyopathy that is congenital in which there is partial or total loss of myocardial muscle in the RV.
What Japanese term is a type of cardiomyopathy?
What is it?
Can it go away?
Takotsubo or Broken Heart Syndrome
Caused by emotional stress that causes a slight increase in cardiac enzymes and LV has a distinct ballooning appearance.
Yes can resolve in 2 to 4 weeks
What are 3 things that may come with Dilated Cardiomyopathies?
- 1.) tachyarrhythmias
- 2.) MR -100% of the time
- 3.) mural thrombi
How to tell difference between primary congestive cardiomyopathy and ischemic heart disease?
Dilated cardiomyopathy the whole thing will become dilated and hypokinesis.
Ischemic heart disease only specific areas will have wall motion abnormalities.
Why are pacemakers usually used as a treatment for Hypertrophic Cardiomyopathy?
can help increase the EF
What does ASH stand for?
asymmetrical septal hypertrophy
What does SAM stand for?
systolic anterior motion of the mitral valve
What can we have the patient do to bring out an Latent-Obstruction (SAM)?
Stand up or valsalva
Is there Coronary Artery disease with Hypertrophic Cardiomyopathy?
Why does partical midsystolic closure of the AV happen with hypertrophic cardiomyopathy? (4)
- 1.) because with SAM.
- 2.) MV moves up during systole causing an obstruction.
- 3.) AO has a loss of pressure so AV closes
- 4.) MV moves down at end-systole so AV opens up and finishes.
What are the 3 types of Hypertrophic Cardiomyopathy?
- 1.) Non-obstructive: ASH without SAM
- 2.) Latent- obstructive: ASH with hidden at rest SAM
- 3.) Obstructive: ASH with SAM present at rest
What are 4 M-Mode findings of hypertrophic cardiomyopathy?
- 1.) SAM
- 2.) Partial midsystolic closure of AV
- 3.) Decreased E-F slope
- 4.) Small LV cavity
What are 3 2D and Doppler findings of hypertrophic cardiomyopathy?
- 1.) Almost always has MR b/c of SAM
- 2.) Increased LA size b/c of MR
- 3.) decreased rapid filling in early diastole
What are some treatments of hypertrophic cardiomyopathy? (6)
- 1.) Myomectomy
- 2.) Myotomy
- 3.) Drugs
- 4.) Pacemaker
- 5.) Alcohol ablation
- 6.) Heart transplant
What type of Restrictive Cardiomyopathies is an inflammatory disease?
What type of Restrictive Cardiomyopathy can affect many tissues including the lungs, liver, spleen, and nodes?
What type of Restricitive Cardiomyopathy has fibrous extracellular protein deposited into the organs/heart?
How does this affect the heart?
Produces stiffening of the heart that prevents complete filling.
What type of Restrictive Cardiomyopathy can affect many tissues including liver, spleen, kidneys and heart?
What types of Restrictive Cardiomyopathies will have possible Pericardial Effusions? (3)
- 1.) Sarcoidosis
- 2.) Amyloidosis
- 3.) Systemic Lupus Erythematosus
What type of Restrictive Cardiomyopathy will mimic Constrictive pericarditis?
What type of REstrictive Cardiomyopathy will have an enlarged LA common?
What is the cause of Hemochromotosis?
Usually unknown but is common in anemic patients who have had multiple blood transfusions.
What type of Restrictive Cardiomyopathy will have excessive amounts of iron deposited into the tissue and can change the skin pigment to a bronze color?
How does it affect the heart?
Iron may be deposited in the myocardium where it will impair LV function, resulting in heart failure.
What type of Restrictive Cardiomyopathy that can result in liver disease and diabetes?
What type of Restrictive Cardiomyopathy is caused from an excessive glycogen in tissues?
What happens to the heart?
Glycogen storage or Pompe's disease
- Heart becomes enlarged and globular. And thickening of RV, LV and IVS.
- VERY THICK HEART
What type of Restrictive cardiomyopathy is hereditary and occurs early in life and has an high mortality rate>?
Glycogen storage disease or Pompe's disease
Is there any treatments for Glycogen storage or Pompe's disease?
No Treatment and high mortality rate.
What type of Restrictive cardiomyopathy has endomyocardial disease where the fibrotic tissue lines the myocardium?
What happens to the heart?
Endomyocardial fibrotic thickening results in decreased LV function.
What are the two causes of Loffler's Syndrome?
- 1.) Parasite -- most common
- 2.) Primary
What Restrictive Cardiomyopathy is characterized by eosinophilia?
What type of Restrictive Cardiomyopathy is prone to mural thrombi?
Areas of focal necrosis is prone to mural thrombi.
What type of Restrictive Cardiomyopathy is an inherited degenerative disease with sclerosis of the dorsal and lateral columns of the spinal cord?
What type of Restrictive Cardiomyopathy has a sign as swaying movements when walking?
What type of Restrictive Cardiomyopathy has findings similar to HYpertrophic Cardiomyopathy except with no LVOT obstruction?
What is the cause of Friedreich's Ataxia?
inherited or genetic
What type of Restrictive Cardiomyopathy is associated with Libman-Sachs endocarditis?
Systemic Lupus Erythematous (SLE)
What type of Restrictive Cardiomyopathy has an constrictive pathology?
Systemic Lupus Erythematous (SLE)
What are some signs and symptoms of Restrictive Cardiomyopathy? (8)
- 1.) Congestive heart failure-- most common
- 2.) Arrhythmias
- 3.) chest discomfort
- 4.) Syncope
- 5.) Prominent jugular venous pressure with jugular vein distention.
- 6.) Sudden death
- 7.) EKG
- 8.) Normal EKG
What are some causes of Hypertrophic Cardiomyopathy? (9)
- 1.) unknown or idiopathic
- 2.) HTN
- 3.) AS
- 4.) Tumor
- 5.) RV pressure overload
- 6.) Newborns of diabetics
- 7.) Newborns up to 6 months
- 8.) Congenital
- 9.) Patients undergoing hemodialysis
What are some signs and symptoms of hypertrophic cardiomyopathy? (7)
- 1.) Dyspnea
- 2.) Angina
- 3.) Fatique
- 4.) Palpitations
- 5.) Light headedness
- 6.) Syncope
- 7.) Arrhythmias
What are some 2D findings of Restrictive Cardiomyopathy? (6)
- 1.) thickened LV myocardium
- 2.) Some LV cavity
- 3.) RV and RA may be dilated
- 4.) LA enlargement
- 5.) Hyprokinesia of all cardiac walls
- 6.) Pericardial effusion
M-Mode finding of Restrictive Cardiomyopathy? (2)
- 1.) Dilated LA
- 2.) Small A wave on MV
What is the treatment of Restrictive Cardiomyopathy? (2)
- 1.) NO treatment and prognosis is poor.
- 2.) Can't reverse or slow down the process.
Causes of Dilated Cardiomyopathy (10)
- 1.) Idiopathic-- World wide
- 2.) Infections-- United States
- 3.) Ischemic
- 4.) Alcohol and toxins
- 5.) Immune
- 6,) Genetic
- 7.) Post-Partum
- 8.) Stress-Related
- 9.) Physical agents
- 10.) Drugs
Signs and symptoms of Dilated Cardiomyopathy (9)
- 1.) Arrhythmias
- 2.) BP normal or low
- 3.) Dyspnea
- 4.) CHF
- 5.) Edema
- 6.) Fatique and weakness
- 7.) Angina
- 8.) Increased venous pressure
- 9.) Abdominal pain due to hepatic congestion
What pathology will the patient have MR and TR and likely tachyarrhythmias?
What is a high risk with Dilated Cardiomyopathy?
What are some 2D findings of Dilated Cardiomyopathy? (4)
- 1.) Dilated LV, RV, LA and RA
- 2.) Low EF usually under 30%
- 3.) Normal or thinned wall thickness
- 4.) Spontaneous echo contrast (smoke)
What are some M-Mode Findings of Dilated Cardiomyopathy? (4)
- 1.) Increased E-point septal separation
- 2.) Early closure of AV due to decreased LVF
- 3.) Dilated cardiac chamber
- 4.) May have a B bump on the MV indicating high end diastolic pressure
What does a B bump on the MV mean?
High end diastolic pressure
What are the Doppler Findings of Dilated Cardiomyopathy? (3)
- 1.) Diastolic dysfunction (1st impaired then restrictive pattern)
- 2.) MR and TR
- 3.) Likely AI and PI
What are some treatments for Dilated Cardiomyopathy? (5)
- 1.) Drugs-- Common
- 2.) Transplant
- 3.) Dual-chamber pacemaker
- 4.) Acorn Procedure
- 5.) Bridge to transplant