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Echo Conference

Echo Conference

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Echo Conference

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  1. Echo Conference Cardiology Cardiomyopathy

  2. Cardiomyopathy • Echo Evaluation of Cardiomyopathies • Dilated CM-dilation and reduced contractility of LV/RV • Hypertrophic CM- Hypertrophy of the LV • Restrictive CM-Restrictive diastolic filling and dec diastolic volume • Arrhythmogenic RV CM (AVRC/AVRD)-Fibrofatty replacement of the RV myocardium • Non-compaction-Extensive trabeculation of the ventricular wall • Takasubo-stress induced • Ischemic CM-2/2 CAD

  3. Cardiomyopathy • Dilated Cardiomyopathy • Normal LV diastolic diameter is less than 5.6cm • Incidence of dilated CM • 5 to 8 cases per 100,000 • Prevalence of 36 per 100,000 • Up to 14 percent of adults may have asymptomatic • Common causes • Viral, HIV, Chagas, Lyme, alcohol, Cocaine, Meds, Peripartum, Tachycardia-mediated, Sarcoid, ESRD, Autoimmune, OSA

  4. Cardiomyopathy • Dilated Cardiomyopathy • 1) dilated LV cavity • Sphericity index – nml >1.5 (100/86=1.16) • 2) decreased global systolic function

  5. Cardiomyopathy • Dilated CM – Diastolic Dysfunction-pseudonormal

  6. Cardiomyopathy • Hypertrophic Cardiomyopathy • Genetic disorder – 10 genes • 1 in 500 phenotypic expression • Asymmetric septal – most common • Concentric, Apical, or free wall LV hypertrophy • Sudden death cummulative • 19mm – 0% • 30mm – 40% • 2D echo

  7. Cardiomyopathy • Hypertrophic Cardiomyopathy

  8. Cardiomyopathy • Hypertrophic CM – Myocyte disarray

  9. Cardiomyopathy • Hypertrophic CM – Long Axis – LVOT obstruction

  10. Cardiomyopathy • Hypertrophic CM – Short Axis

  11. Cardiomyopathy • Hypertrophic CM – Systolic Anterior Motion – M-mode

  12. Cardiomyopathy • Hypertrophic CM – Doppler • LVOT gradient >30mmHg

  13. Cardiomyopathy • Athlete’s Heart vs Hypertrophic • 1) More symmetrical • 2) Rarely more than 17mm • 3) LV dimenstion is increased vs decreased • 4) Diastolic function nml (E’ > 7cm/s) • 5) Tissue doppler and strain normal

  14. Cardiomyopathy • Apical Hypertrophic Cardiomyopathy

  15. Cardiomyopathy • Restrictive Cardiomyopathy • Restricted ventricular filling 2/2 nonhypertrophiednondilated myocardial abnormality • Stiffening fibrosis • Decreased compliance • Nml EF, nml LV cavities, nml wall thickness, w/ BAE • Restrictive filling pattern grade 3 or 4 • Dip-and-plateau or square root in diastolic pressure trace

  16. Cardiomyopathy • Restrictive Cardiomyopathy • Causes include • Infiltrative-amyloidosis, sarcoidosis • Non-infiltrative-familial, idiopathic • Storage diseases-hemochromatosis, Fabry • Endomyocardial diseases-endomyocardial fibrosis, hypereosinophilic syndrome (scarring) • Radiation or drug toxicity (anthracycline)

  17. Cardiomyopathy • Restrictive CM – 3 Doppler features • 1) Mitral and Tricuspid inflow • Inc E velocity: >1 m/s • Dec A velocity: <0.5 m/s • Ratio E/A >2.0 • Short DT <160 and Decreased IVRT <70

  18. Cardiomyopathy • Restrictive CM – 3 Doppler features • 2) Pulmonary and hepatic vein flow • Systolic velocity less than diastolic velocity • Increased hepatic diastolic flow reversal in inspiration • Increased pulmonary vein atrial flow reversal velocity

  19. Cardiomyopathy • Restrictive CM – 3 Doppler features • 3) Tissue Doppler • Decreased systolic velocity: s’ < 5cm • Decreased early diastolic velocity: E’ < 7cm/s

  20. Cardiomyopathy • Right Ventricular Dysplasia/Cardiomyopathy • ARVD • Progressive replacement of the RV myocardium by fatty and fibrous tissue • Present with LBBB, CHF, murmur, or sudden death • In Europe, MCC cardiac death young pt (1/3) • Autosomal dominant • EKG epsilon wave V1-3

  21. Cardiomyopathy • Right Ventricular Dysplasia/Cardiomyopathy • Echo findings • RVOT diameter >25mm, best PLAX RVOT >30mm • Abnml RV function • RV regional wall motion abnormalities (apex and ant) • RV travecular derangements, hyperreflective moderator band

  22. Cardiomyopathy

  23. Cardiomyopathy • Non-compaction Cardiomyopathy • Embryonic arrest of compaction • Segmental thickening of LV wall with two layers • Ratio greater than 2 • LV cavity enlarged • LV ejection fraction decreased • c/b heart failure, thrombosis, VT, and sudden death

  24. Cardiomyopathy • Non-compaction Cardiomyopathy • Ratio 2:1

  25. Cardiomyopathy • Takosubo Cardiomyopathy • Stress-induced CM • Apical ballooning syndrome • Broken heart syndrome • Mimics MI but no evidene of obstructive CAD • Octopus trap • Triggers – medical illness, emotional, physical stress • Etiology – unclear, • postulate catecholamine excess • Coronary spasm • Microvascular dysfunction

  26. Cardiomyopathy • Takosubo Cardiomyopathy

  27. Cardiomyopathy • Ischemic Cardiomyopathy • Significant impaired left ventricular function <35-40% • 2/2 coronary artery disease • Most common cause of heart failure in developed world • Management of ischemic cardiomyopathy • Evaluation of the coronary artery disease • Medical management similary to nonischemic CM • Also device related strategies

  28. Questions

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