Please enable JavaScript.
Coggle requires JavaScript to display documents.
Cardiomyopathies (Restrictive (Ultrasound findings (Echocardiographic…
Cardiomyopathies
Restrictive
A non-compliant LV associated with elevated diastolic pressures. Systolic function usually preserved with impaired diastolic function
Two types
Infiltrative
Entire myocardium is infiltrated by an abnormal surface
Non-infiltrative
Endocardium and sub endocardium are fibrosed
Cause: Idiopathic
Ultrasound findings
2-D
: LVH with bright, shiny echogenic appearance, apical obliteration, normal systolic function with impaired diastolic function, bilateral enlargement
Doppler:
MR/TR often moderate to severe, pulmonary HTN, LVOT gradient may be present, diastolic dysfunction needs to be assessed
Pericardial effusion often present
Echocardiographic features
LV: thick walls, not dilated, normal systolic fx, abnormal diastolic fx
RV: free wall thickening
Atria: biatrial enlargement, elevated RA pressure
Pulmonary hypertension
Signs and Symptoms
Peripheral edema, ascites, atrial arrhythmia, biatrial enlargement, MT/TR, dyspnea, palpitation, fatigue, poor exercise tolerance, anorexia
Treatment
Treat symptoms, ACE inhibitors, calcium channel blockers, diuretics, anticoagulation therapy, pacemaker, cardiac transplatation
Clues to etiology
Amyloidosis: leaflet thickening, affects conduction system and coronary vasculature
Hemochromatosis: Conduction disease and DC or RC
Ferby's disease: hyper echoic endocardium, symmetric or asymmetric ventricular hypertrophy, conduction defects, aortic root dilation
Dilated
Characterized by 4 chamber dilation with ventricular systolic and diastolic dysfunction of unknown origin
Characterized by
Impaired LV contractility
Reduced cardiac output
Elevated LV EDP
Ultrasound approach
2D
: RV systolic function and LV systolic function
M-mode
: reduced AP aortic root motion, increased EPSS, delayed mitral valve closure
Doppler
: reduced aortic ejection velocity, reduced rate of rise in vent pressure, associated mitral regurgitation, diastolic dysfunction
Echo findings:
cardiomegaly, decreased global LV/RV systolic and diastolic function, valvular regurgitation due to annular dilation, often the LV and LA will be affected with a normal RV/RA
Etiology
Idiopathic, rarely hereditary
Signs and Symptoms
Signs: RV/LV failure, thromboembolic events, arrhythmia's, rales, decreased arterial pulse, tachycardia, murmurs, pulses alternans
Symptoms: dyspnea, orthopnea, nocturnal cough, fatigue, pedal edema, low BP, CP, palpitations, hemoptysis, syncope
Complications
Systemic embolization with neurological events from thrombus formed in the LV or LA
Sudden death
Treatment
Presence of myocardial inflammation
use immunosuppressive therapy
Hemodynamic state
after load reduction, heart rate control
Reduce risk of emboli
anticoagulant therapy
Reduce risk for ventricular arrhythmia's
Diuretics, O2 therapy, dietary modifications, reduce sodium intake, beta blockers, dual pacing pacemakers, implantable defibrillators, heart transplant
Hypertrophic Cardiomyopathies
Idiopathic, may or may not be asymmetric, thickening of a non-dilated ventricle
Two types
Obstructive: asymmetric
Non-obstructive: Concentric and apical hypertrophy
Hypertrophic Obstructive Cardiomyopathy
Autosomal dominant inherited disease of the myocardium related to abnormalities in genes coding for contractile proteins
Characterized by: asymmetric hypertrophy of the LV, normal ventricular systolic function, impaired diastolic function, sub-aortic dynamic obstruction
Classified as: non-obstructive if the outflow gradient at rest and with provocation is <30 mmHg, obstructive if the gradient at rest is > 30 mmHg, Provocable or latent if the resting gradient is <30 mmHg but obstruction occurs with exercise
Clinical features: High risk of sudden death, symptoms of angina, exercise intolerance, syncope, high presence of atrial fibrillation, systolic murmur on cardiac auscultation
Ultrasound findings
2-D:
systolic anterior motion of the MV leaflet, severity of obstruction varies with maneuvers
M-Mode:
Systolic anterior motion of the MV leaflet, mid-systolic closure of the aortic valve
Doppler
: late-peaking high-velocity flow in the outflow tract, LV inflow across the MV, LA inflow in the PV, TDI at MV annulus, IVRT
Echocardiac
features
: diastolic dysfunction due to stiffness of the ventricles, LV cavity obliteration, increased risk of arrhythmias, increased systolic function
Idiopathic Hypertrophic Sub Aortic Stenosis
Idiopathic, can be hereditary
Abnormal thickening of the IVS in a non-dilated LV with normal systolic function
Signs and symptoms
CP, Dyspnea, Orthopnea, syncope, murmur, fatigue, pulmonary edema
Complications
Sudden death, infective endocarditis, systemic embolism due to LA thrombus, CHF
Ultrasound findings
2-D
: Aov mid systolic notch, LAE, SAM, ASH
M-Mode
: Aov mid systolic notch, LAE, SAM, ASH
Doppler
: Find site of obstruction, determine diastolic dysfunction, classic dagger shaped flow profile present
Treatment
Decrease both ionotrophy and chronotrophy with beta blockers/calcium channel blockers, dual chamber pacing, possible to induce paradoxical septal motion to relieve outflow tract obstruction, septal myectomy, cardiac transplant
