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Cardiomyopathy (Dilated Cardiomyopathy (Definition: Characterized by 4…
Cardiomyopathy
Dilated Cardiomyopathy
Definition: Characterized by 4 chamber dilation with ventricular systolic/diastolic dysfunction of unknown origin. Can sometimes be caused by chemotherapy, viral infection, AIDS, and bacterial infections. Usually idiopathic or familial transmission.
Treatment: If there is myocardial inflammation use immunosuppressive therapy. Anticoagulant to prevent emboli. Reduce risk for arrhythmias. Lasix, beta blockers, heart transplant. Treat etiology if known. bed rest. Ace inhibitors.
2D findings: four chamber dilation. Decreased EF. Spherical configuration of LV. Decreased LV wall thickening. Slow moving red blood cells. Thrombus in LV. IVC dilation.
M-Mode Findings: Increased EPSS of MV. B bump/notch of MV indicates increased LVEDP. Decreased D-E excursion of MV. Decreased AoR excursion. Gradual closure of AV.
Doppler findings: MR, TR, PI, AI. Decreased LVOT/AV velocities. Decreased RVOT velocities. Diastolic dysfunction.
Restrictive Cardiomyopathy
Infiltrative
Entire myocardium is infiltrated by an abnormal substance. Causes: Amyloidosis, sarcoidosis, gaucher disease, fatty infiltration
Non-Infiltrative
Endocardium and sub endocardium are fibrosed. Causes: Idiopathis cardiomyopathy, familial cardiomyopathy, hypertrophic cardiomyopathy, scleroderma
non-compliant LV associated with elevated diastolic pressures. Systolic function usually preserved with impaired diastolic function. Increased resistance to ventricular filling due to increased myocardial stiffness associated with elevated ventricular diastolic pressure, increased atrial pressure. Treat etiology, diuresis, Ace inhibitors, pacemaker, cardiac transplant
2D Findings: Rigid, non-compliant ventricular walls. Atrial enlargement. LVH with echogenic appearance. Apical obliteration. RV free wall thickening. Dilated IVC.
M-Mode: Thick walls. No septal shift. Atrial enlargement.
Doppler:Diastolic Dysfunction. MR/TR. Pulmonary HTN
Hypertrophic Cardiomyopathy
Definition: Symmetric or asymmetric thickening of non dilated ventricle.
HCM = hypertrophic cardiomyopathy = non obstructive. Autosomal dominant trait, idiopathic. Non dilated LV. Concentric LVH. Same treatment as obstructive, other than myectomy.
IHSS/HOCM: Idiopathic Hypertrophic sub-aortic stenosis / Hypertrophic obstructive cardiomyopathy.
Asymmetric hypertrophy of heart with greatest buildup at septum. Autosomal dominant trait. Non dilated LV. Treatment may include beta blockers, ICD, septal myectomy.
2D Findings: ASH, wall thickening, SAM, small hypercontractile LV, thickened and elongated MV leaflets, MAC, dilated left atrium, ground glass appearance of IVS
M-Mode Findings: Thickened walls/ASH, SAM, B bump of mitral valve, mid systolic notching of aortic valve
Doppler Findings: Use PW to find the site of obstruction, TDI may indicate increased filling pressures, use CW to find dagger shaped spectral tracing, mid systolic drop in waveform. If pressure gradient over 30=significant.
2D Findings: donut shaped heart, all walls thickened.
M-mode: concentric thickened walls, may still have SAM or mid systolic closure of aortic valve
Doppler findings: Diastolic dysfunction
