A Quiz On Cardiomyopathy For Pros

A cardiomyopathy is a disease that diffusely affects the myocardium, resulting in enlargement and/or ventricular dysfunction. The myocardium is the middle layer of the heart wall and is responsible for the contraction of the heart muscle. When the myocardium is affected by a cardiomyopathy, it can lead to the enlargement of the heart chambers and impair the heart's ability to pump blood effectively. Therefore, the correct answer is myocardium.

In right heart failure, the right side of the heart is unable to effectively pump blood, leading to a buildup of fluid in the body. Lower extremity edema is a classic sign of right heart failure because the fluid tends to accumulate in the legs and ankles due to gravity. This can cause swelling and discomfort in the lower limbs. The other options, such as hemoptysis (coughing up blood), atrial fibrillation, and TS (which is not defined in the question), are not typically associated with right heart failure.

Patients with congestive cardio have dilated and poorly contracting left ventricles. This means that the left ventricle of the heart is enlarged and not functioning effectively, resulting in reduced pumping ability. This can lead to symptoms such as fatigue, shortness of breath, and fluid retention. The dilation and poor contraction of the left ventricle are characteristic features of congestive cardio, indicating a weakened heart muscle.

Restrictive (infiltrative) cardiomyopathy is a condition in which the heart muscle becomes stiff and less able to relax and fill with blood. This can be caused by various diseases that infiltrate the heart muscle, such as sarcoidosis, endomyocardial fibrosis, amyloidosis, and hemochromatosis. However, renal failure is not typically considered an etiology for restrictive cardiomyopathy. Renal failure primarily affects the kidneys and can lead to fluid overload and high blood pressure, but it does not directly infiltrate or stiffen the heart muscle.

Dyspnea is a common symptom experienced by patients with dilated cardiomyopathy. It refers to difficulty or discomfort in breathing. This symptom occurs due to the weakened heart's inability to pump blood effectively, leading to fluid accumulation in the lungs. As a result, patients may feel short of breath, especially during physical exertion or when lying flat. Therefore, dyspnea is a characteristic symptom of dilated cardiomyopathy.

If a systolic, high velocity, and late peaking jet is obtained in the left ventricular outflow tract (LVOT) by continuous wave Doppler from the apex, the likely diagnosis is hypertrophic obstructive cardiomyopathy (HOCM). HOCM is characterized by the thickening of the heart muscle, particularly in the left ventricle, which can lead to obstruction of blood flow out of the heart. This obstruction causes a turbulent blood flow, resulting in the specific Doppler pattern described in the question. TR (tricuspid regurgitation), valvular stenosis, and MR (mitral regurgitation) are not associated with this specific Doppler pattern.

The restrictive transmitral filling pattern is characterized by a rapid early filling phase followed by a reduced late filling phase. This pattern is most commonly seen in conditions with elevated left atrial (LA) pressures and increased ventricular stiffness. Elevated LA pressures can occur due to conditions such as left ventricular hypertrophy, diastolic dysfunction, or mitral valve disease. Increased ventricular stiffness can be caused by conditions such as myocardial fibrosis or infiltrative diseases. Together, these physiological parameters contribute to the restrictive transmitral filling pattern.

Asymmetric septal hypertrophy is present when the interventricular septum to posterior wall ratio is greater than 1:3:1. This means that the thickness of the interventricular septum is significantly greater than the thickness of the posterior wall of the heart. This abnormality can be indicative of certain heart conditions, such as hypertrophic cardiomyopathy, where the heart muscle becomes abnormally thick and stiff.

Hemochromatosis is most commonly associated with infiltrative cardiomyopathy. Infiltrative cardiomyopathy refers to a condition where abnormal substances, such as iron in the case of hemochromatosis, accumulate in the heart muscle, causing damage and impairing its function. This can lead to symptoms such as fatigue, shortness of breath, and heart failure. Infiltrative cardiomyopathy is different from other types of cardiomyopathies like dilated, congestive, and hypertrophic, which have different underlying causes and characteristics.

SAM (systolic anterior motion) of the MV (mitral valve) and asymmetric septal hypertrophy are typically associated with IHSS (idiopathic hypertrophic subaortic stenosis). SAM refers to the abnormal movement of the mitral valve during systole where the valve moves towards the septum, obstructing the left ventricular outflow tract. Asymmetric septal hypertrophy refers to the thickening of the interventricular septum in a non-uniform manner. These findings are characteristic of IHSS, a condition where the left ventricle becomes abnormally thickened, leading to obstruction of blood flow out of the heart.

The peak gradient in Hypertrophic Obstructive Cardiomyopathy (HOCM) is calculated using the simplified Bernoulli equation, which states that the pressure difference across a stenotic valve is equal to 4 times the square of the velocity of blood flow. In this case, the resting outflow velocity is given as 3 m/sec. Plugging this value into the equation, we get (4 * 3^2) = 36 mmHg. Therefore, the peak gradient is 36 mmHg.

In patients with restrictive cardiomyopathy, there is impaired relaxation and filling of the ventricles. This leads to a large early E wave on Doppler echocardiography, indicating rapid early filling. However, due to the impaired relaxation, there is a short deceleration time of the E wave, meaning that it quickly decelerates after reaching its peak. Additionally, there is a small A wave, which represents atrial contraction, because the impaired relaxation limits the amount of blood that can be ejected from the atria into the ventricles.

The ratio of early transmitral (E) to atrial (A) Doppler filling velocities is influenced by patient's age, left ventricular preload, and delayed left ventricular relaxation. However, the transducer frequency does not have an impact on this ratio. The transducer frequency determines the depth and resolution of the ultrasound image, but it does not affect the E/A ratio.

In patients with asymmetric septal hypertrophy, the septal to posterior wall ratio is 1:3:1. This means that the thickness of the septum is 1 unit, while the thickness of the posterior wall is 3 units. This ratio indicates an abnormal thickening of the septum compared to the posterior wall, which is characteristic of asymmetric septal hypertrophy.

The correct answer is Dagger shaped. This term is used to describe the shape of a systolic, high velocity, and late peaking jet in the left ventricular outflow tract (LVOT) as observed by continuous wave (CW) Doppler from the apex. The term "Dagger shaped" implies that the jet has a sharp and pointed appearance, resembling the shape of a dagger. This description helps in identifying and characterizing the flow pattern in the LVOT.

Patients with IHSS (idiopathic hypertrophic subaortic stenosis) and a high resting outflow gradient may be offered surgical septal myectomy as a treatment option. This procedure involves the surgical removal of a portion of the thickened septum in the heart, which helps to relieve the obstruction of blood flow and improve symptoms. Other treatment options such as contrast septal ablation, Lipitor medical therapy, and sublingual nitroglycerin may not be as effective in reducing the outflow gradient and improving symptoms in these patients.

The correct answer is "Increased LV wall thickness." In dilated cardio, there is usually a thinning of the LV wall rather than an increase in thickness. Dilated cardio refers to the enlargement of the atrial and ventricular cavities, which is one of the common echo findings. Additionally, there is diffusely reduced ventricular contractility, meaning that the heart muscles are not contracting properly. Low Doppler velocity in the LVOT (left ventricular outflow tract) may also be observed.

The shape of the LV as it remodels in patients with a dilated cardio is spherical. In dilated cardiomyopathy, the left ventricle becomes enlarged and weakened, leading to a spherical shape. This change in shape is due to the stretching and thinning of the ventricular walls. The spherical shape is a characteristic feature of dilated cardiomyopathy and can be visualized through imaging techniques such as echocardiography.

Ischemic cardiomyopathy is specifically related to heart damage caused by myocardial ischemia, typically from coronary artery disease and heart attacks, leading to the heart muscle becoming weakened and dilated. This is different from congestive (dilated) cardiomyopathy, which can have various etiologies such as viral infections, metabolic disorders, hemochromatosis (iron overload), and it can occur peripartum (around the time of childbirth).

Amyloid cardiomyopathy is a type of restrictive cardiomyopathy. It is characterized by the deposition of abnormal proteins called amyloids in the heart muscle, which can lead to stiffening of the heart walls and impaired heart function.

In a patient with IHSS (idiopathic hypertrophic subaortic stenosis), M-mode findings may include asymmetric septal hypertrophy, systolic anterior motion of the MV (mitral valve), and mid-systolic closure of the AV (aortic valve). However, MV prolapse is not typically seen in IHSS.

Congestive dilated cardio refers to a condition where the heart becomes enlarged and weakened, leading to poor blood circulation. Sinus tachycardia, edema, fatigue, and dyspnea are all physical symptoms commonly seen in patients with congestive dilated cardio. However, systemic hypertension, which is high blood pressure, is not typically associated with this condition. In fact, congestive dilated cardio often leads to low blood pressure rather than high blood pressure.

A patient with AIDS might experience congestive cardio, which refers to the condition where the heart is unable to pump enough blood to meet the body's needs. AIDS can lead to weakened immune system and opportunistic infections, such as viral or bacterial infections, which can affect the heart and cause inflammation or damage. This can result in congestive heart failure, where the heart becomes enlarged and weakened, leading to fluid buildup in the lungs and other parts of the body.

Patients with advanced symptoms from having a dilated cardio may benefit from interventions such as intra-aortic balloon pump, LV assist device, and heart transplant. However, mitral valve (MV) replacement may not be beneficial in this case. MV replacement involves replacing the damaged mitral valve with a prosthetic valve, which may not directly address the symptoms caused by dilated cardio. Other interventions mentioned are more suitable for managing the advanced symptoms and improving the patient's condition.

Patients with hypertrophic obstructive cardiomyopathy (HOCM) often have a "bright" myocardial appearance by echo due to myocardial fiber disarray. In HOCM, the myocardial fibers are disorganized and arranged in a haphazard manner, leading to abnormal thickening of the left ventricle. This results in increased echogenicity or brightness on the echocardiogram. The other options, such as amyloid deposits, using too high a gain setting, LVH (left ventricular hypertrophy), or small cavity size, are not the primary reasons for the bright myocardial appearance in HOCM.

Pericardial effusion is a common echo finding in patients with restrictive cardiomyopathy. Restrictive cardiomyopathy is characterized by impaired filling of the ventricles due to stiffening of the heart muscle. Pericardial effusion refers to the accumulation of fluid in the pericardial sac surrounding the heart. This can be seen on an echocardiogram as an abnormal collection of fluid around the heart. The other options, such as left ventricular dilation, asymmetric septal hypertrophy, right ventricular dilation, and normal left atrial size, are not typically associated with restrictive cardiomyopathy.

Patients with Chagas Disease might develop congestive cardio because Chagas Disease is a parasitic infection caused by the Trypanosoma cruzi parasite. This infection can lead to inflammation and damage to the heart muscle, resulting in congestive heart failure. Congestive heart failure occurs when the heart is unable to pump enough blood to meet the body's needs, leading to symptoms such as fluid retention, shortness of breath, and fatigue. Therefore, congestive cardio is a possible complication of Chagas Disease.

A higher frequency transducer should be used when looking for apical thrombi in the LV apex of patients with a dilated cardio. This is because a higher frequency transducer provides better resolution and allows for clearer imaging of small structures, such as thrombi, in the heart. Using a lower frequency transducer may not provide sufficient resolution to detect these small structures. Tissue harmonic imaging and saline contrast are not specifically mentioned as necessary for detecting apical thrombi in this context.

Amyl nitrite is a vasodilator that relaxes smooth muscles, including the muscles in the walls of blood vessels. When administered to a patient with hypertrophic obstructive cardiomyopathy, it can cause a decrease in systemic vascular resistance, leading to a decrease in left ventricular outflow tract (LVOT) obstruction. This decrease in obstruction can result in an increase in the systolic anterior motion (SAM) of the mitral valve (MV). SAM occurs when the anterior leaflet of the MV is pushed towards the LVOT during systole, potentially causing further obstruction and worsening symptoms. Therefore, the administration of amyl nitrite can increase the SAM of the MV in patients with hypertrophic obstructive cardiomyopathy.

In patients with restrictive cardiomyopathy, the correct Doppler finding is E-greater than A on mitral inflow. This means that the early diastolic filling velocity (E) is greater than the late diastolic filling velocity (A) on the mitral inflow waveform. This finding is characteristic of restrictive cardiomyopathy and is due to impaired ventricular relaxation and increased stiffness of the ventricular walls, leading to decreased compliance of the ventricles.

In patients with hypertrophic obstructive cardiomyopathy (HOCM), the outflow gradient typically increases with a valsalva maneuver due to increased obstruction. This is known as the "systolic anterior motion" (SAM) phenomenon. Therefore, the correct answer is "Outflow gradient that decreases with a valsalva maneuver" because it is not a Doppler finding seen in HOCM.

Amyl nitrite inhalation is a medication used to treat angina and cyanide poisoning. It works by relaxing blood vessels and increasing blood flow. Contraindications are conditions or factors that make it unsafe or inappropriate to use a particular treatment. In this case, the contraindications to amyl nitrite inhalation include allergies to nitrites, severe aortic stenosis, hemodynamic instability, and recent stroke. However, moderate mitral regurgitation is not listed as a contraindication, meaning that it is not a reason to avoid using amyl nitrite inhalation.

Patients with dilated cardiomyopathy often progress through different stages of diastolic dysfunction. In advanced stages, they may demonstrate a restrictive inflow pattern on Doppler echocardiography. This pattern is characterized by a high E wave and a low A wave, with a shortened deceleration time, indicating severe diastolic dysfunction and elevated left atrial pressures.

The given options list various features of amyloid heart disease. MVP, or mitral valve prolapse, is not typically associated with amyloid heart disease. This condition is characterized by the displacement of the mitral valve into the left atrium during systole, causing regurgitation. However, amyloid heart disease is known to cause multivalvular regurgitation, increased wall thickness, and pulmonary embolism (PE).

Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by the thickening of the heart muscle, particularly the left ventricle. Common echo findings in HOCM include left ventricular hypertrophy (LVH), systolic anterior motion of the mitral valve (SAM), midsystolic closure of the aortic valve, and a small left ventricular cavity size. However, decreased ejection fraction (EF) is not typically seen in HOCM. EF is a measure of how well the heart is pumping blood and is usually reduced in conditions such as heart failure, but it is not a characteristic finding in HOCM.

A common complication from a surgical septal myectomy procedure is the development of a ventricular septal defect (VSD). This refers to an abnormal hole in the septum, the wall that separates the left and right ventricles of the heart. This can occur due to the surgical manipulation of the septum during the myectomy, leading to a rupture or tear in the tissue. VSD can result in symptoms such as heart murmurs, shortness of breath, and fatigue, and may require additional interventions or surgical repair.

The proper technique for Dopplering the Mitral inflow looking for diastolic dysfunction is to use Apical 4ch view, pulsed Doppler, at mitral tips. This allows for the evaluation of the flow pattern across the mitral valve during diastole, which is important in assessing diastolic function. The Apical 4ch view provides a clear visualization of the mitral valve and the pulsed Doppler allows for the measurement of the E and A wave velocities, which are indicators of diastolic dysfunction. Dopplering at the mitral tips ensures accurate measurement of the flow across the valve.

Patients with hypertrophic cardiomyopathy usually have an EF (ejection fraction) in the range of 70-80%. EF is a measure of how well the heart is pumping blood. In hypertrophic cardiomyopathy, the walls of the heart become thickened, which can affect the heart's ability to pump blood effectively. However, in some cases, the EF may be preserved or even increased due to the increased contractility of the heart muscle. Therefore, a higher EF range of 70-80% is more commonly seen in patients with hypertrophic cardiomyopathy.

In a patient with IHSS (idiopathic hypertrophic subaortic stenosis), it is commonly observed that mitral regurgitation (MR) is often present. MR refers to the backward flow of blood from the left ventricle into the left atrium due to a faulty mitral valve. This is typically seen in IHSS patients, along with other symptoms such as a decrease in SAM (systolic anterior motion) of the mitral valve with a valsalva maneuver and a left ventricular posterior wall to septal ratio greater than 1.3. Additionally, IHSS does not directly affect the aortic valve, so mid-diastolic closure of the aortic valve is not expected.

Increased aortic root excursion is not typically associated with echo findings in patients with congestive (dilated) cardio. Echo findings commonly seen in these patients include reduced mitral valve excursion, global hypokinesis, dilated left ventricle, and left ventricular hypertrophy. Increased aortic root excursion is not a typical finding in this condition.

An echo finding in patients with DCM is the presence of a B-notch on the M-mode. This refers to a dip or notch in the systolic descent of the left ventricular posterior wall. It is often seen in dilated cardiomyopathy and is thought to be due to abnormal myocardial relaxation and early closure of the aortic valve. The B-notch is not a normal finding and can be indicative of impaired left ventricular function.