Cardiomyopathy Assignment

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CHEM101L

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Apr 3, 2024

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Cardiomyopathy Assignment Please fill in the blanks: 1. A cardiomyopathy is a disease that diffusely affects the myocardium, resulting in enlargement and/or ventricular dysfunction. 2. Dilated cardiomyopathy is when the heart chambers enlarge and lose their ability to contract. It often starts in the left ventricle. As the disease worsens, it may spread to the right ventricle and to the atria. 3. When evaluating a dilated cardiomyopathy with Doppler, regurgitation is probable due to dilation of the chambers. 4. Acute heart failure due to sudden intense emotional or physical stress is called a Tako tsubo . Broken- heart syndrome is a classic finding in this disease process. 5. Diastolic dysfunction AND Systolic heart failure occurs in patients with dilated cardiomyopathy. 6. How do we evaluate diastolic dysfunction? Using E/A inflow PW doppler. 7. What breathing technique can be used to evaluate for a left ventricular outflow tract obstruction? Valsalva Maneuver 8. Hypertrophy cardiomyopathy is an autosomal dominant inherited disease where the myocardium is thickened, impairing diastolic function.

9. “Rigid ventricular” or “stiff ” appearance of the myocardium will be seen in Restrictive/Infiltrative CMO. 10. Although any part of the LV can hypertrophy, the basal portion of the IVS is the most commonly affected. 11. Systolic anterior motion ( SAM) is the displacement of the distal portion of the anterior leaflet of the mitral valve toward the left ventricular outflow area. 12. Restrictive / Infiltrative involves the infiltration of the myocardium that results in stiff, rigid ventricular walls that impede diastolic filling of the LV. 13. Explain what Apical Hypertrophy is and what can be used to help diagnose it. Apical hypertrophy is a rare form of hypertrophic cardiomyopathy and it involves thickening of the apex of the left ventricle. Color or Pw Doppler can be used to help diagnose the absence of blood flow in the apical region. 14. When evaluating an LVOTO, it can easily be mistaken for mitral regurgitation. List the three tips that can help with the differentiation of the two. 1. Angulation is vital . The transducer must be as parallel to the flow as possible. 2. The LVOT waveform is a late peaking systolic jet ( dagger shape) that sounds like a sponge being wrung out.

3. The MR wave form is wider than the LVOTO waveform because it encompasses the isovolumic relaxtion time. In addition, the MR peak velocity is typically greater than the LVOTO peak velocity. 15. In hypertensive patients or hypovolemic patients with a hyperdynamic LV the site of the late peaking, high velocity systolic jet is closer to the apex and is NOT subaortic therefore, not causing a LVOTO. 16. Left ventricular outflow tract obstructions are increased by: 1. A reduction in preload 2. An increase in contractility 3. A decrease in afterload 17. A thickening in the basal portion of the interventricular measuring 3 cm or less, most common in the elderly, and is a consequence of hypertensive heart disease and NOT hypertrophic CMO. We call this Sigmoid septum. 18. Describe what a provocable or latent hypertrophic cardiomyopathy is: A hypertrophic cardiomyopathy that is nonobstructive at rest but is obstructive when provoked with exercise of the Valsalva maneuver. 19. PLAX view is the best opportunity to visualize the difference in size between the LV posterior wall and the

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ventricular septal wall of the outflow tract when evaluating LV asymmetrical hypertrophy. 20. A disease that is marked by abnormal inflammatory masses (granulomas) that infiltrate various organs is called Sarcoidosis . 21. When evaluating an LVOTO with PW Doppler, if there is a significant increase in the velocity ( >2 m/s), you should switch to CW Doppler. 22. Hypertrophic Cardiomyopathy is the leading cause of heart-related sudden death in people under the age of 30. 23. An obstructive hypertrophic cardiomyopathy includes an obstruction of blood flow through the LVOT – if the gradient at rest is > 30 mmHg. 24. A biopsy may be necessary to diagnose Restrictive CMO. 25. Describe what EPSS (E point septal separation) in M- mode is: The distance from the mitral valve level “E” point to the interventricular septum. 26. Restrictive / Infiltrative CMO involves the infiltration of the myocardium that results in stiff, rigid ventricular walls that impede diastolic filling of the LV.

27. Name at least 3 methods that help when evaluating for a left ventricular apical thrombus: 1. A higher frequency transducer 2. Color flow to see if color flow fills in the apex or travels around thrombus. 3. Various windows to examine apex from different angles 28. Amyloidosis is the most common cause of Restrictive CMO. 29. When the septum is not thickened symmetrically it is called Asymmetric septal hypertrophy ( ASM) 30. Dynamic outflow obstruction usually is associated with a posterior mitral regurgitant jet because the systolic anterior motion of the leaflets disrupts proper closure of the MV. Bonus: What is an LVAD device and what is it used for? (The answer to this is not in the power point slides – do some research to find the answer.) Please do not leave this blank or I will take points off. A Left ventricular assist device LAD is a pump that we use for patients who have reached end stage heart failure. This device is surgically implanted , it is battery operated and is also a

mechanical pump as well which helps the left ventricle ( main pumping chamber of heart ) pump blood to the rest of body.

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