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Echocardiography

Echocardiography

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Echocardiography

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  1. Echocardiography Cardiomyopathies

  2. Cardiomyopathies Definition • Primary disease of the myocardium, excluding myocardial dysfunction due to ischemia, chronic valvular disease, hypertensive heart disease and pulmonary heart disease. • Diagnosis by exclusion.

  3. Cardiomyopathies Physiologic Classification • Dilated • Hypertrophic • Restrictive

  4. Cardiomyopathies Echocardiographic Evaluation • Confirm the diagnoses and type. • Define the physiologic consequences.

  5. Dilated Cardiomyopathies Dilated Cardiomyopathy • Characterized by four chamber enlargement. • Impaired systolic function of both ventricles

  6. Dilated Cardiomyopathies

  7. Dilated Cardiomyopathies Etiology • Idiopathic • Toxins • Metabolic • Peripartum

  8. Dilated Cardiomyopathies Etiology • Infections • Systemic Disease • Inherited disorders

  9. Dilated Cardiomyopathies Toxins • Alcohol • Medications • Cobalt • Snake bite

  10. Dilated Cardiomyopathies Metabolic • Thiamine deficiency • Acromegaly

  11. Dilated Cardiomyopathies Infections • Chagas’ disease • Post viral

  12. Dilated Cardiomyopathies Physiology • Impaired contractility of the LV • Reduced CO • Elevated LV-EDP.

  13. Dilated Cardiomyopathies Symptoms • Low cardiac output • Pulmonary venous congestion • Systemic venous congestion

  14. Dilated Cardiomyopathies Diastolic Dysfunction • LV diastolic dysfunction often coexists with systolic dysfunction but typically is not the predominant feature.

  15. Dilated Cardiomyopathies 2-D Echocardiographic Findings • Enlargement of the 4 chambers • Global decreased in wall motion

  16. Dilated Cardiomyopathies

  17. Dilated Cardiomyopathies M-mode findings • Increased EPSS • Reduced anteroposterior aortic root motion • B-bump on the AC shoulder

  18. Dilated Cardiomyopathies

  19. Dilated Cardiomyopathies

  20. Dilated Cardiomyopathies Doppler • Reduced aortic ejection velocity • Reduced aortic VTI • A slow rate of rise in the velocity of the MR jet (reduced rate of rise in LV pressure in early systole)

  21. Dilated Cardiomyopathies

  22. Dilated Cardiomyopathies

  23. Dilated Cardiomyopathies

  24. Dilated Cardiomyopathies Doppler • Mitral and tricupid regurgitation

  25. Dilated Cardiomyopathies

  26. Dilated Cardiomyopathies Diastolic Filling Pattern Early - Impaired Relaxation • Prolonged IVRT • Reduced E • Increased A

  27. Dilated Cardiomyopathies Further deterioration in LV function • Increased E velocity (high LA pressure) • Reduced A velocity (elevated LV-EDP) • Pseudonormalization

  28. Dilated Cardiomyopathies LA Filling Pattern • Increased atrial reversal velocity • Increased ratio of antegrade diastolic to systolic flow.

  29. Dilated Cardiomyopathies

  30. Cardiomyopathies Hypertrophic Cardiomyopathy

  31. Hypertrophic Cardiomyopathies Hypertrophic Cardiomyopathy • Autosomal dominant • Abnormalities in the Beta myosin heavy chain.

  32. Hypertrophic Cardiomyopathies Predominant Features • Asymmetric hypertrophy of the LV • Normal ventricular systolic function • Impaired LV diastolic function • +/- Subaortic dynamic obstruction

  33. Hypertrophic Cardiomyopathies Clinical Features • High risk of sudden death • Symptoms of angina • Exercise intolerance • Syncope • Systolic murmur

  34. Hypertrophic Cardiomyopathies

  35. Hypertrophic Cardiomyopathies

  36. Hypertrophic Cardiomyopathies • The apical pattern of hypertrophy is associated with an inverted precordial T waves on the EKG

  37. Hypertrophic Cardiomyopathies The common feature of all of these hypertrophy patterns is normal thickness of the basal posterior LV wall.

  38. Hypertrophic Cardiomyopathies Subaortic obstruction • Caused by apposition of AMVL against the hypertrophied septum. • Dynamic obstruction • Occurs in mid – late systole

  39. Hypertrophic Cardiomyopathies

  40. Hypertrophic Cardiomyopathies Subaortic obstruction • Maximum LV to aortic pressure gradient occurring in late systole. • Presence and severity of obstruction depends on the loading conditions.

  41. Hypertrophic Cardiomyopathies The obstruction can diminished by maneuvers that: • Increase ventricular volume (increase in preload). • Decrease contractility. • Increase afterload.

  42. Hypertrophic Cardiomyopathies The obstruction can be increased by maneuvers that: • Decrease ventricular volume (decrease in preload) • Increase contractility • Decrease afterload

  43. Hypertrophic Cardiomyopathies

  44. Hypertrophic Cardiomyopathies Clinical useful maneuvers • Examination during a post premature contraction beat (Increased contraction). • Valsalva (Decreased preload). • Inhalation of amyl nitrate (Decreased afterload and preload)

  45. Hypertrophic Cardiomyopathies These maneuvers lead to • Increased degree of dynamic obstruction • Louder murmur • Increased in Doppler velocity.

  46. Hypertrophic Cardiomyopathies Mitral Regurgitation • The SAM of the leaflets in systole disrupt the normal mitral valve coaptation. • Results in a posteriorly directed MR jet of mild to moderate severity.

  47. Hypertrophic Cardiomyopathies

  48. Hypertrophic Cardiomyopathies

  49. Hypertrophic Cardiomyopathies

  50. Hypertrophic Cardiomyopathies