CardiomyopathyCardiomyopathy is defined as a primary disease of the myocardium excluding myocardial dysfunction due to ischemic heart disease.

Cardiomyopathy The

three basic physiologic categories of cardiomyopathy are:

Dilated Hypertrophic Restrictive

Dilated CardiomyopathyDilated

Cardiomyopathy is charaterized by four chamber enlargement with impaired systolic function of both ventricles

Dilated CardiomyopathyThe physiology of Dilated Cardiomyopathy is characterized predominantly by: left ventricular contractility y Reduced cardiac output y Elevated left ventricular end diastolic pressuresy Impaired

HypertrophicCARDIOMYOPATHY

Basic Principlesy Hypertrophic

Cardiomyopathy is an autosomal dominant inherited disease of the myocardium

Anatomic FeaturesPredominant features of this disease are: Asymmetric hypertrophy of the LV y Normal ventricular systolic function y Impaired diastolic LV function y Subaortic dynamic obstruction in some individualsy

Systolic Anterior Motion (SAM) of the Mitral leaflet

M-Mode in a patient with hypertrophic cardiomyopathy demonstrates systolic anterior motion of the mitral valve.

ASYMETRICAL SEPTAL HYPERTROPHY

SubSub-aortic Obstructiony

y

In patients with sub-aortic obstruction, contact of the anterior leaflet of the Mitral Valve against the Hypertrophied Interventricular septum is seen in systole This obstruction is dynamic rather than fixedOccurs only on mid to late systole The presence and severity can be altered by loading conditions

y

Dynamic outflow obstructionHas a pattern of onset in mid-systole Maximum gradient of LV/Ao pressure in late systole

Restrictive Cardiomyopathy HYPERTENSIVE HEART DISEASE

Restrictive cardiomyopathyy

Restrictive cardiomyopathy (RCM) is a form of cardiomyopathy in which the walls are rigid, and the heart is restricted from stretching and filling with blood properly. It is the least common cardiomyopathy In the pure forms of restrictive cardiomyopathy, systolic function is preserved and heart failure symptoms are due to diastolic dysfunction. The classic restrictive cardiomyopathy is infiltrative in nature as typified by cardiac amyloidosis.

y y

y

Etiologyy

Infiltrative processesAmyloidosis Hemochromatosis Glycogen storage diseases

y

Inflammatory diseasesSarcoidosis Hypereosinophylic syndrome

Diastolic filling in early stagesy

Impaired diastolic relaxation of the LV results in impaired early diastolic filling LV inflow shows a reduced E velocity, Pulmonary vein flow shows a reduced diastolic filling phase

y

Late disease diastolic fillingy

Restrictive pattern of LV filling:Increased E velocity and reduced A velocity Steep early diastolic deceleration slope Reduced IVRT

Example of restrictive mitral inflow pattern by Doppler echocardiography

Figure 3 Parasternal long axis transthoracic echocardiography showing diffused hypertrophic and hypokinetic left ventricle.

TwoTwo-dimensional (2D) echocardiographic image (parasternal long-axis view) from a (parasternal longpatient with AL cardiac amyloidosis showing normal biventricular dimensions, granular "sparkling" ventricular wall appearance, concentric left ventricular wall thickening, and thickened mitral valve leaflets suggesting infiltration

REVIEW

1

The Doppler waveform of a patients mitral valve has an E/A ratio of 1.6, the deceleration time is rapid and the isovolumic relaxation time is reduced. These findings are most consistent with:

A. B. C. D.

Dilated cardiomyopathy Abnormal myocardial relaxation Restrictive cardiomyopathy Normal diastolic function

1

The Doppler waveform of a patients mitral valve has an E/A ratio of 1.6, the deceleration time is rapid and the isovolumic relaxation time is reduced. These findings are most consistent with:

A. B. C. D.

Dilated cardiomyopathy Abnormal myocardial relaxation Restrictive cardiomyopathy Normal diastolic function

The Doppler waveform of a patients mitral valve has an E/A ratio of 1.6, the deceleration time is rapid and the isovolumic relaxation time is reduced.These findings are most consistent with restrictive cardiomyopathy.

2 Systolic anterior motion of the mitral valve associated with abnormal aortic valve motion is suggestive of

A. Systemic hypertension.

B. Decreased compliance of the left ventricle.

C. Left ventricular outflow tract obstruction.

D. Dilated cardiomyopathy

2 Systolic anterior motion of the mitral valve associated with abnormal aortic valve motion is suggestive of

A. systemic hypertension.

B. Decreased compliance of the left ventricle.

C. Left ventricular outflow tract obstruction.

D. Dilated cardiomyopathy

Systolic anterior motion of the mitral valve associated with abnormal aortic valve motion is suggestive of left ventricular outflow tract obstruction.

3

What are two conditions, other than cardiomyopathy that result in concentric hypertrophy of the walls and which must be differentiated from a primary cardiomyopathy? A. Systemic hypertension; aortic stenosis B. Aortic regurgitation; systemic hypertension C. Systemic hypertension; pulmonary hypertension D. Mitral stenosis; aortic regurgitation

3

What are two conditions, other than cardiomyopathy that result in concentric hypertrophy of the walls and which must be differentiated from a primary cardiomyopathy? A. Systemic hypertension; aortic stenosis B. Aortic regurgitation; systemic hypertension C. Systemic hypertension; pulmonary hypertension D. Mitral stenosis; aortic regurgitation

Systemic hypertension and aortic stenosis both result in increased afterload forcing the ventricle to generate higher pressures and resulting in hypertrophy.

Typical echocardiographic features of dilated 4 cardiomyopathy include: A.

Right and left ventricular enlargement, and hyperkinetic motion of the ventricular walls.

B.

Diffuse hypertrophy of the left ventricle, with normal contractility. Right and left ventricular hypertrophy and hyperkinetic wall motion.

C.

D.

Enlarged left and right ventricles and generalized hypokinesis of the ventricular walls.

Typical echocardiographic features of dilated 4 cardiomyopathy include: A.

right and left ventricular enlargement, and hyperkinetic motion of the ventricular walls.

B.

diffuse hypertrophy of the left ventricle, with normal contractility. right and left ventricular hypertrophy and hyperkinetic wall motion.

C.

D.

enlarged left and right ventricles and generalized hypokinesis of the ventricular walls.

5

What is the physiologic basis of the LVOT obstruction seen in hypertrophic cardiomyopathy?

A. Thickened myocardial wall B. Aortic valve thickening C. Systolic anterior motion of anterior mitral leaflet D Sigmoid septum Systolic anterior motion (SAM) of the mitral valve causes the LVOT obstruction.

6 Fabry disease is a secondary cause of restrictive cardiomyopathy. A. True B. False

6

Fabry disease is a secondary cause of restrictive cardiomyopathy.

A. True

B. False

Fabry disease is a secondary cause of hypertrophic cardiomyopathy. Fabry disease is an inherited genetic disorder caused by a defective gene. The disease causes fatty deposits in several organs of the body.

7 E point to septal separation(EPSS) will decrease in patients with dilated cardiomyopathy. A. True

B. False

7 E point to septal separation(EPSS) will decrease in patients with dilated cardiomyopathy. A. True

B. False

E point to septal separation(EPSS) will increase in patients with dilated cardiomyopathy.

8 The common secondary cause of dilated cardiomyopathy is: A. Alcohol B. Post-partum PostC. Heredity D. Smoking

8 The common secondary cause of dilated cardiomyopathy is: A. Alcohol B. Post-partum PostC. Heredity D. Smoking

Drinking alcohol is the most common secondary cause for a dilated cardiomyopathy. cardiomyopathy. Alcohol kills the heart tissue and causes the chambers to dilate.

9 In dilated cardiomyopathy left ventricular function: A. Increases. B. Decreases. C. Becomes hypertrophied. D. Becomes hyperkinetic.

9 In dilated cardiomyopathy left ventricular function: A. Increases. B. Decreases. C. Becomes hypertrophied. D. Becomes hyperkinetic.

10 Which of the following is not probable Doppler finding with a dilated cardiomyopathy? cardiomyopathy? A. Pulmonic stenosis. stenosis. B. Mitral regurgitation. C. Tricuspid regurgitation. D. Pulmonic regurgitation.

10 Which of the following is not probable Doppler finding with a dilated cardiomyopathy? cardiomyopathy? A. Pulmonic stenosis. stenosis. B. Mitral regurgitation. C. Tricuspid regurgitation. D. Pulmonic regurgitation.

11 Causes of dilated cardiomyopathy include alcohol, diabetes and ischemia. A. True B. False

11 Causes of dilated cardiomyopathy include alcohol, diabetes and ischemia. A. True B. False Causes of dilated cardiomyopathy include alcohol, diabetes and ischemia.

12 A B bump on a Mitral valve M-mode Mtracing often seen in patients with a dilated cardiomyopathy may indicate: A. Mitral regurgitation. B. Systolic anterior motion. C. Mitral stenosis. stenosis. D. Elevated LV end-diastolic pressure. end-

12 A B bump on a Mitral valve M-mode Mtracing often seen in patients with a dilated cardiomyopathy may indicate: A. Mitral regurgitation. B. Systolic anterior motion. C. Mitral stenosis. stenosis. D. Elevated LV end-diastolic pressure. end-

13 Latent obstruction can be provoked with a valsalva maneuver or amyl nitrate if hypertrophic cardiomyopathy is suspected. A. True B. False

13 Latent obstruction can be provoked with a valsalva maneuver or amyl nitrate if hypertrophic cardiomyopathy is suspected. A. True B. FalseLatent obstruction can be provoked with a valsalva maneuver or amyl nitrate if hypertrophic cardiomyopathy is suspected.

14 Gradual closure of aortic valve suggesting decrease in cardiac output is often associated with this abnormality: A. Dilated cardiomyopathy. cardiomyopathy. B. Restrictive cardiomyopathy. cardiomyopathy. C. Infiltrative cardiomyopathy. cardiomyopathy. D. Hypertrophy obstructive cardiomyopathy. cardiomyopathy.

14 Gradual closure of aortic valve suggesting decrease in cardiac output is often associated with this abnormality: A. Dilated cardiomyopathy. cardiomyopathy. B. Restrictive cardiomyopathy. cardiomyopathy. C. Infiltrative cardiomyopathy. cardiomyopathy. D. Hypertrophy obstructive cardiomyopathy. cardiomyopathy.

15 Continuous Wave Doppler is needed for assessment of the LVOT gradient in hypertrophic cardiomyopathy. cardiomyopathy.

A. True B. False

15 Continuous Wave Doppler is needed for assessment of the LVOT gradient in hypertrophic cardiomyopathy. cardiomyopathy.

A. True B. FalseCW Doppler is needed for assessment of the LVOT gradient in hypertrophic cardiomyopathy due to high velocities.

16 What is the finding with Chagas disease which helps identify it as the cause of a dilated cardiomyopathy? cardiomyopathy? A. Left ventricular apical aneurysm. B. Dilated right ventricle. C. Dilated left ventricle. D. Mitral regurgitation.

16 What is the finding with Chagas disease which helps identify it as the cause of a dilated cardiomyopathy? cardiomyopathy? A. Left ventricular apical aneurysm. B. Dilated right ventricle. C. Dilated left ventricle. D. Mitral regurgitation.

17 Restrictive cardiomyopathy refers to the restriction of LV outflow. A. True B. False

17 Restrictive cardiomyopathy refers to the restriction of LV outflow. A. True B. False Restrictive cardiomyopathy refers to the restriction of LV filling.

18 Which of the following is not a finding of dilated cardiomyopathy? cardiomyopathy? A. Decreased cardiac output. B. Increased cardiac output. C. Elevated LV end-diastolic pressure. endD. Mitral regurgitation.

18 Which of the following is not a finding of dilated cardiomyopathy? cardiomyopathy? A. Decreased cardiac output. B. Increased cardiac output. C. Elevated LV end-diastolic pressure. endD. Mitral regurgitation.

19 Decreased acceleration of the Doppler waveform is a feature of PA flow in pulmonary hypertension and aortic flow in hypertrophic cardiomyopathy. cardiomyopathy. A. True B. False

19 Decreased acceleration of the Doppler waveform is a feature of PA flow in pulmonary hypertension and aortic flow in hypertrophic cardiomyopathy. cardiomyopathy. A. True B. False Decreased acceleration of the Doppler waveform is a feature of Pulmonic Artery flow in pulmonary hypertension. Acceleration is increased in aortic flow in hypertrophic cardiomyopathy giving a late systolic peak.

20 A common electrical abnormality seen in patients with a dilated cardiomyopathy is: A. Sinus bradycardia. bradycardia. B. Atrial tachycardia. C. Conduction defects. D. Heart blocks.

20 A common electrical abnormality seen in patients with a dilated cardiomyopathy is: A. Sinus bradycardia. bradycardia. B. Atrial tachycardia. C. Conduction defects. D. Heart blocks.

21 Lofflers syndrome is a type of hypertrophic cardiomyopathy. cardiomyopathy. A. True

B. False

21 Lofflers syndrome is a type of hypertrophic cardiomyopathy. cardiomyopathy. A. True

B. False

Lofflers syndrome is a type of restrictive cardiomyopathy. cardiomyopathy.

22 The most common cause for decreased cardiac output in patient with dilated cardiomyopathy is: A. Outflow tract obstruction. B. Significant decrease in LV diastolic function. C. Significant decrease in LV systolic function. D. Pericardial effusion.

22 The most common cause for decreased cardiac output in patient with dilated cardiomyopathy is: A. Outflow tract obstruction. B. Significant decrease in LV diastolic function. C. Significant decrease in LV systolic function. D. Pericardial effusion.

23 The most common color abnormality in a dilated cardiomyopathy is: A. Pulmonic regurgitation. B. Mitral regurgitation. C. Aortic regurgitation. D. Tricuspid regurgitation.

23 The most common color abnormality in a dilated cardiomyopathy is: A. Pulmonic regurgitation. B. Mitral regurgitation. C. Aortic regurgitation. D. Tricuspid regurgitation.

24 Doppler velocities of the left and right ventricular outflow tracts will _________ in patients with a dilated cardiomyopathy. cardiomyopathy.

A. Increase.

B. Decrease.

24 Doppler velocities of the left and right ventricular outflow tracts will _________ in patients with a dilated cardiomyopathy. cardiomyopathy.

A. Increase.

B. Decrease.

25 A complication of a hypertrophic cardiomyopathy: cardiomyopathy: A. Myocardial infarction. B. Sudden death. C. Mitral valve prolapse. prolapse. D. Infective endocarditis. endocarditis.

25 A complication of a hypertrophic cardiomyopathy: cardiomyopathy: A. Myocardial infarction. B. Sudden death. C. Mitral valve prolapse. prolapse. D. Infective endocarditis. endocarditis.

26 With a hypertrophic cardiomyopathy you would see: A. Left ventricular pressure overload. B. Left atrial pressure overlaod. overlaod. C. Left ventricular volume overload. D. Left atrial volume overload.

26 With a hypertrophic cardiomyopathy you would see: A. Left ventricular pressure overload. B. Left atrial pressure overlaod. overlaod. C. Left ventricular volume overload. D. Left atrial volume overload.

27 Which of the following cardiomyopathy is caused by genetics? A. Restricitive cardiomyopathy. cardiomyopathy. B. Infiltrative cardiomyopathy. cardiomyopathy. C. Dilated cardiomyopathy. cardiomyopathy. D. Hypertrophic cardiomyopathy. cardiomyopathy.

27 Which of the following cardiomyopathy is caused by genetics? A. Restricitive cardiomyopathy. cardiomyopathy. B. Infiltrative cardiomyopathy. cardiomyopathy. C. Dilated cardiomyopathy. cardiomyopathy. D. Hypertrophic cardiomyopathy. cardiomyopathy.

28 Idiopathic hypertrophic subaortic stenosis(IHSS) stenosis(IHSS) is also referred to as: A. Hypertrophic non-obstructive cardiomyopathy. noncardiomyopathy. B. Restrictive cardiomyopathy. cardiomyopathy. C. Congestive cardiomyopathy. cardiomyopathy. D. Hypertrophic obstructive cardiomyopathy. cardiomyopathy.

28 Idiopathic hypertrophic subaortic stenosis(IHSS) stenosis(IHSS) is also referred to as: A. Hypertrophic non-obstructive cardiomyopathy. noncardiomyopathy. B. Restrictive cardiomyopathy. cardiomyopathy. C. Congestive cardiomyopathy. cardiomyopathy. D. Hypertrophic obstructive cardiomyopathy. cardiomyopathy.

29 Inhaling amyl nitrite will increase LVOT obstruction, but also increases this abnormality: A. Tricuspid regurgitation. B. Mitral stenosis. stenosis. C. Aortic stenosis. stenosis. D. Mitral regurgitation.

29 Inhaling amyl nitrite will increase LVOT obstruction, but also increases this abnormality: A. Tricuspid regurgitation. B. Mitral stenosis. stenosis. C. Aortic stenosis. stenosis. D. Mitral regurgitation.

30 Symptoms that may only be experienced during exercise best describe this type of cardiomyopathy? cardiomyopathy? A. Congestive. B. Hypertrophic. C. Dilated. D. Infiltrative.

30 Symptoms that may only be experienced during exercise best describe this type of cardiomyopathy? cardiomyopathy? A. Congestive. B. Hypertrophic. C. Dilated. D. Infiltrative.

31 Patients with restrictive cardiomyopathy have a fixed stroke volume. In order for these patients to increase their cardiac output: A. B. They must be given drugs to induce bradycardia. C. Their left ventricle will hypertrophy. D. Their ventricle will dilate.

Their heart rate must increase.

31 Patients with restrictive cardiomyopathy have a fixed stroke volume. In order for these patients to increase their cardiac output: A. B. They must be given drugs to induce bradycardia. C. Their left ventricle will hypertrophy. D. Their ventricle will dilate.

Their heart rate must increase.

Patients with restrictive cardiomyopathy have a fixed stroke volume. In order for these patients to increase their cardiac output, their heart rate must increase. Cardiac output is equal to stroke volume multiplied by heart rate. If stroke volume is fixed, then the only way that cardiac output may be increased is by increasing the heart rate.

Remember:

Co= SV x HR

32 Which of the following is a classic finding in hypertrophic obstructive cardiomyopathy? cardiomyopathy? A. Mitral valve prolapse. prolapse. B. Biatrial enlargement. C. Concentric left ventricular hypertrophy. D. Systolic anterior motion.

32 Which of the following is a classic finding in hypertrophic obstructive cardiomyopathy? cardiomyopathy? A. Mitral valve prolapse. prolapse. B. Biatrial enlargement. C. Concentric left ventricular hypertrophy. D. Systolic anterior motion.

33 When obtaining a peak gradient on a patient with hypertrophic obstructive cardiomyopathy the Doppler should be directed: A. Distal to the aortic valve. B. Into the left ventricular outflow tract. C. Into the left ventricular inflow tract. D. Into the RVOT(Infundibulum). RVOT(Infundibulum).

33 When obtaining a peak gradient on a patient with hypertrophic obstructive cardiomyopathy the Doppler should be directed: A. Distal to the aortic valve. B. Into the left ventricular outflow tract. C. Into the left ventricular inflow tract. D. Into the RVOT(Infundibulum). RVOT(Infundibulum).

34 The speckling or increase in echogenicity of the interventricular septum in the hypertrophic cardiomyopathy may also be referred to as a ___________ appearance. A. Hockey stick. B. Crushed ice. C. Ground glass. D. Water ballon. ballon.

34 The speckling or increase in echogenicity of the interventricular septum in the hypertrophic cardiomyopathy may also be referred to as a ___________ appearance. A. Hockey stick. B. Crushed ice. C. Ground glass. D. Water ballon. ballon.

35 In patients with hypertrophy cardiomyopathy, the cardiomyopathy, M-mode of the aortic valve may show: A. Eccentric line of closure. B. Decreased Aortic opening. C. Mid-systolic notching. MidD. Gradual closure of aortic valve.

35 In patients with hypertrophy cardiomyopathy, the cardiomyopathy, M-mode of the aortic valve may show: A. Eccentric line of closure. B. Decreased Aortic opening. C. Mid-systolic notching. MidD. Gradual closure of aortic valve.

36 A daggered shaped aortic waveform best describes this abnormality: A. Aortic stenosis. stenosis. B. Restrictive cardiomyopathy. cardiomyopathy. C. Aortic regurgitation. D. Hypertrophic cardiomyopathy. cardiomyopathy.

36 A daggered shaped aortic waveform best describes this abnormality: A. Aortic stenosis. stenosis. B. Restrictive cardiomyopathy. cardiomyopathy. C. Aortic regurgitation. D. Hypertrophic cardiomyopathy. cardiomyopathy.

37 Asymmetrical septal hypertrophy can occur besides a Hypertrophic Cardiomyopathy. Cardiomyopathy. A. True. B. False.

37 Asymmetrical septal hypertrophy can occur besides a Hypertrophic Cardiomyopathy. Cardiomyopathy. A. True. B. False.

38 The Doppler of the mitral valve inflow in patients with restrictive cardiomyopathy and wall thickness greater than 15 mm will display: A. Normal E/e. B. E/A wave reversal. C. Pseudonormalization. Pseudonormalization. D. Restrictive pattern.

38 The Doppler of the mitral valve inflow in patients with restrictive cardiomyopathy and wall thickness greater than 15 mm will display: A. Normal E/e. B. E/A wave reversal. C. Pseudonormalization. Pseudonormalization. D. Restrictive pattern.

39 Ventricular filling resistance increases, ventricular diastolic pressure and atrial pressure increases along with preserved systolic function best describes: A. Dilated cardiomyopathy. cardiomyopathy. B. Hypertrophic cardiomyopathy. cardiomyopathy. C. Restrictive cardiomyopathy. cardiomyopathy. D. Congestive cardiomyopathy. cardiomyopathy.

39 Ventricular filling resistance increases, ventricular diastolic pressure and atrial pressure increases along with preserved systolic function best describes: A. Dilated cardiomyopathy. cardiomyopathy. B. Hypertrophic cardiomyopathy. cardiomyopathy. C. Restrictive cardiomyopathy. cardiomyopathy. D. Congestive cardiomyopathy. cardiomyopathy.

40 The apical four chamber view demonstrates dilatation of the: A. Left atrium and left ventricle. B. Left and right ventricle. C. Left and right atria. D. Right atrium and right ventricle.

40 The apical four chamber view demonstrates dilatation of the: A. Left atrium and left ventricle. B. Left and right ventricle. C. Left and right atria. D. Right atrium and right ventricle. Biatrial enlargement is normal finding in restrictive cardiomyopathy. cardiomyopathy.

41 The most common 2D finding(s) in patients with amyloidosis is : A. Biventricular hypertrophy. B. Ground glass appearance. C. Biatrial enlargement. D. All of the above.

41 The most common 2D finding(s) in patients with amyloidosis is : A. Biventricular hypertrophy. B. Ground glass appearance. C. Biatrial enlargement. D. All of the above.

42 The most common cause of restrictive cardiomyopathy due to the infiltrative process is: A. Hurlers syndrome. B. Sarcoidosis. Sarcoidosis. C. Amyloidosis. Amyloidosis. D. Hemachromatosis. Hemachromatosis.

42 The most common cause of restrictive cardiomyopathy due to the infiltrative process is: A. Hurlers syndrome. B. Sarcoidosis. Sarcoidosis. C. Amyloidosis. Amyloidosis. D. Hemachromatosis. Hemachromatosis.

43 M-mode findings associated with hypertrophic Mcardiomyopathy include all of the following except: A. Asymmetric septal hypertrophy. B. Mid-systolic notching of the aortic valve. MidC. Mid-systolic notching of the pulmonic valve. MidD. Systolic anterior motion of the mitral valve.

43 M-mode findings associated with hypertrophic Mcardiomyopathy include all of the following except: A. Asymmetric septal hypertrophy. B. Mid-systolic notching of the aortic valve. MidC. Mid-systolic notching of the pulmonic valve. MidD. Systolic anterior motion of the mitral valve.

Additional M-mode echocardiographic findings in Mpatiens with hypertrophic cardiomyopathy include: -Decreased systolic septal thickening. -Decreased systolic septal excursion. -Decreased E-F slope of MV valve. E-E-point septal contact of the MV . -Anterior displacement of the MV. -B notch of the MV. -Small left ventricular cavity.

44 The Doppler mitral flow pattern most often associated with hypertrophic obstructive cardiomyopathy is stage: A. I B. II C. III D. IV

44 The Doppler mitral flow pattern most often associated with hypertrophic obstructive cardiomyopathy is stage: A. I B. II C. III D. IV

The maximum velocity during the initial diastolic flow (E) is reduced , and the velocity following atrial kick (A) is significantly increased. Abnormal left ventricular filling may be one of the fundamental problems in this condition. No stage IV exists.

45 Characteristic findings in patients with idiopathic dilated cardiomyopathy include all of the following except: A. Asymmetric septal hypertrophy. B. Dilated, poorly contracting left ventricle. C. Low cardiac output. D. High intracardiac pressures.

45 Characteristic findings in patients with idiopathic dilated cardiomyopathy include all of the following except: A. Asymmetric septal hypertrophy. B. Dilated, poorly contracting left ventricle. C. Low cardiac output. D. High intracardiac pressures.

The left ventricle is dilated and little difference is noted between diastole and systole. All the systolic indices, whether one measures fractional shortening, fractional area changes or ejection fraction, are reduced. Wall thickness remains normal, and global dysfunction is fairly generalized.

46 Early in the disease stage, the usual Doppler mitral inflow pattern with dilated cardiomyopathy demonstrates: A. Abnormal compliance pattern. B. Abnormal relaxation pattern. C. Normal pattern. D. Pseudonormal pattern.

46 Early in the disease stage, the usual Doppler mitral inflow pattern with dilated cardiomyopathy demonstrates: A. Abnormal compliance pattern. B. Abnormal relaxation pattern. C. Normal pattern. D. Pseudonormal pattern.

Mitral inflow is invariably abnormal in patients with severe myocardial dysfunction. The usual pattern, especially early in the disease state, is abnormal relaxation. As mitral regurgitation or elevated left ventricular diastolic pressures occur, however, the abnormal relaxation pattern may progress toward stage III, with a tall E wave and a small A wave, which usually carries a poor prognosis. During this progression, one may recognize a pattern of pseudonormalization. pseudonormalization.

47 A common mitral valve finding of dilated cardiomyopathy in two-dimensional echocardiography twois: A. Decreased E septal separation. B. Reserve diastolic doming. C. Incomplete closure of the mitral valve. D. Premature closure of the mitral valve.

47 A common mitral valve finding of dilated cardiomyopathy in two-dimensional echocardiography twois: A. Decreased E septal separation. B. Reserve diastolic doming. C. Incomplete closure of the mitral valve. D. Premature closure of the mitral valve.

A common finding with dilated cardiomyopathy is incomplete closure of the mitral valve or papillary muscle dysfunction. This is also referred to as tenting of the mitral valve, which is best seen in the apical four chamber view. Incomplete closure of the mitral valve is a possible explanation for the common finding of mitral regurgitation.

4848- The most common regurgitation found in patients with dilated cardiomyopathynis: cardiomyopathynis: A. Aortic insufficiency. B. Mitral regurgitation. C. Pulmonary insufficiency. D. Tricuspid regurgitation.

4848- The most common regurgitation found in patients with dilated cardiomyopathynis: cardiomyopathynis: A. Aortic insufficiency. B. Mitral regurgitation. C. Pulmonary insufficiency. D. Tricuspid regurgitation.

Mitral regurgitation is present in nearly 100% of patients with dilated cardiomyopathy. cardiomyopathy. Tricuspid regurgitation is present in nearly 90%, pulmonary insufficiency in 50%, and aortic insufficiency in 20%. Atrioventricular valves regurgitations results from enlargement of the circumference of the mitral or tricuspid annulus, and ventricular dilatation with resultant distortion of the geometry of the subvalvular apparatus.

49 Echocardiographic findings in dilated cardiomyopathy include all of the following except: A. Apical mural thrombus. B. Dilated ventricular cavities. C. Enlarged atrial cavities. D. Increased mitral valve leaflet excursion.

49 Echocardiographic findings in dilated cardiomyopathy include all of the following except: A. Apical mural thrombus. B. Dilated ventricular cavities. C. Enlarged atrial cavities. D. Increased mitral valve leaflet excursion.

Secondary features of dilated cardiomyopathy include dilated cavities, dilated mitral annulus, papillary muscle dysfunction with tenting of the mitral valve leaflets, evidence of low cardiac output( such as decreased excursion of the mitral valve), and valvular regurgitation.

50 The most common cause of primary dilated cardiomyopathy is: A. Adriamyacin toxicity. B. Coronary artery disease. C. Hemochromatosis. Hemochromatosis. D. Idiopathic.

50 The most common cause of primary dilated cardiomyopathy is: A. Adriamyacin toxicity. B. Coronary artery disease. C. Hemochromatosis. Hemochromatosis. D. Idiopathic.

Primary cardiomyopathy is defined as heart muscle disease of unknown cause. Specific heart muscle is of a know cause or is associated with disorders of other systems such as systemic hypertension, coronary artery disease, valvular heart disease, or congenital heart disease.

51 Cardiac involvement associated with acquired immunodeficiency syndrome (AIDS) is: A. Dilated cardiomyopathy. cardiomyopathy. B. Hypertrophic cardiomyopathy. cardiomyopathy. C. Infiltrative cardiomyopathy. cardiomyopathy. D. Restrictive cardiomyopathy. cardiomyopathy.

51 Cardiac involvement associated with acquired immunodeficiency syndrome (AIDS) is: A. Dilated cardiomyopathy. cardiomyopathy. B. Hypertrophic cardiomyopathy. cardiomyopathy. C. Infiltrative cardiomyopathy. cardiomyopathy. D. Restrictive cardiomyopathy. cardiomyopathy.

Other echocardiographic/Doppler findings echocardiographic/Doppler in AIDS patients include pericardial effusion, cardiac tamponade, endocarditis, tamponade, endocarditis, myocarditis, myocarditis, and metastatic cardiac neoplasm.

51 The following image demonstrates characteristics that relate to the dynamic nature of outflow obstruction, except: A. Late systolic peak of the aortic waveform in Hypertrophic Cardiomyopathy. Cardiomyopathy. B. The maximum gradient occurs in late systole. C. Pressure gradient develops mid to end systole. D. The maximun gradient occurs in early systole.

51 The following image demonstrates characteristics that relate to the dynamic nature of outflow obstruction, except: A. Late systolic peak of the aortic waveform in Hypertrophic Cardiomyopathy. Cardiomyopathy. B. The maximum gradient occurs in late systole. C. Pressure gradient develops mid to end systole. D. The maximun gradient occurs in early systole.

52 The most like EKG finding with restrictive cardiomyopathy would be: A. Elevated ST segment. B. Premature ventricular contraction. C. Decreased voltage. D. ST segment depression.

52 The most like EKG finding with restrictive cardiomyopathy would be: A. Elevated ST segment. B. Premature ventricular contraction. C. Decreased voltage. D. ST segment depression.