Cardiomyopathy

Cardiomyopathy 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 Cardiomyopathy

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

1PLAX LV DIL.wmv
 Dilated Cardiomyopathy
 The physiology of Dilated Cardiomyopathy is
characterized predominantly by:

Impaired left ventricular contractility

Reduced cardiac output
Elevated left ventricular end diastolic
pressures
Hypertrophic
CARDIOMYOPATHY
Basic Principles
Hypertrophic
Cardiomyopathy is an
autosomal dominant
inherited disease of the
myocardium
Anatomic Features
Predominant features of this disease are:

Asymmetric hypertrophy of the LV

Normal ventricular systolic function
Impaired diastolic LV function
Subaortic dynamic obstruction in some
individuals
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
Sub-aortic Obstruction
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 fixed
◦ Occurs only on mid to late systole
◦ The presence and severity can be altered by loading
conditions
Dynamic outflow obstruction
◦ Has a pattern of onset in mid-systole
◦ Maximum gradient of LV/Ao pressure in late systole
Restrictive Cardiomyopathy
HYPERTENSIVE
HEART DISEASE
Restrictive cardiomyopathy
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.
Etiology
Infiltrative processes
◦ Amyloidosis
◦ Hemochromatosis
◦ Glycogen storage diseases

Inflammatory diseases
◦ Sarcoidosis
◦ Hypereosinophylic syndrome
Diastolic filling in early stages
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
 Late disease diastolic filling

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.
Two-dimensional (2D) echocardiographic image (parasternal long-axis view) from a
patient 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 patient’s 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. Dilated cardiomyopathy
B. Abnormal myocardial relaxation
C. Restrictive cardiomyopathy
D. Normal diastolic function
1
The Doppler waveform of a patient’s 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. Dilated cardiomyopathy
B. Abnormal myocardial relaxation
C. Restrictive cardiomyopathy
D. Normal diastolic function
The Doppler waveform of a patient’s 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.

Diffuse hypertrophy of the left ventricle, with

B.
normal contractility.

Right and left ventricular hypertrophy and

C.
hyperkinetic wall motion.

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.

diffuse hypertrophy of the left ventricle, with

B.
normal contractility.

right and left ventricular hypertrophy and

C.
hyperkinetic wall motion.

D. enlarged left and right ventricles and generalized

hypokinesis of the ventricular walls.
Typical echocardiographic features of the dilated cardiomyopathies include
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
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

C. Heredity

D. Smoking
8 The common secondary cause of dilated cardiomyopathy
is:

A. Alcohol

B. Post-partum

C. Heredity

D. Smoking
Drinking alcohol is the most common
secondary cause for a dilated
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?

A. Pulmonic stenosis.

B. Mitral regurgitation.

C. Tricuspid regurgitation.

D. Pulmonic regurgitation.
10 Which of the following is not probable Doppler
finding with a dilated cardiomyopathy?

A. Pulmonic 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
tracing often seen in patients with a dilated
cardiomyopathy may indicate:

A. Mitral regurgitation.

B. Systolic anterior motion.

C. Mitral stenosis.

D. Elevated LV end-diastolic pressure.

12 A “B” bump on a Mitral valve M-mode
tracing often seen in patients with a dilated
cardiomyopathy may indicate:

A. Mitral regurgitation.

B. Systolic anterior motion.

C. Mitral stenosis.

D. Elevated LV end-diastolic pressure.

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. False

Latent 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.

B. Restrictive cardiomyopathy.

C. Infiltrative cardiomyopathy.

D. Hypertrophy obstructive cardiomyopathy.

14 Gradual closure of aortic valve suggesting
decrease in cardiac output is often associated with
this abnormality:

A. Dilated cardiomyopathy.

B. Restrictive cardiomyopathy.

C. Infiltrative cardiomyopathy.

D. Hypertrophy obstructive cardiomyopathy.

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

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

 
A. True
 
B. False

CW 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?

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?

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?

A. Decreased cardiac output.

B. Increased cardiac output.

C. Elevated LV end-diastolic pressure.

D. Mitral regurgitation.
18 Which of the following is not a finding of dilated
cardiomyopathy?

A. Decreased cardiac output.

B. Increased cardiac output.

C. Elevated LV end-diastolic pressure.

D. Mitral regurgitation.
19 Decreased acceleration of the Doppler waveform is
a feature of PA flow in pulmonary hypertension and
aortic flow in hypertrophic 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.
 
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.

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.

B. Atrial tachycardia.

C. Conduction defects.

D. Heart blocks.
21 Loffler’s syndrome is a type of hypertrophic cardiomyopathy.
 
A. True
 
 
B. False
 
 
 
 
 
21 Loffler’s syndrome is a type of hypertrophic
cardiomyopathy.
 
A. True
 
 
B. False

Loffler’s syndrome is a type of restrictive 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.

A. Increase.

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

A. Increase.

B. Decrease.
25 A complication of a hypertrophic cardiomyopathy:

A. Myocardial infarction.

B. Sudden death.

C. Mitral valve prolapse.

D. Infective endocarditis.
25 A complication of a hypertrophic cardiomyopathy:

A. Myocardial infarction.

B. Sudden death.

C. Mitral valve prolapse.

D. Infective endocarditis.
26 With a hypertrophic cardiomyopathy you would
see:

A. Left ventricular pressure overload.

B. Left atrial pressure 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.

C. Left ventricular volume overload.

D. Left atrial volume overload.

27 Which of the following cardiomyopathy is caused
by genetics?

A. Restricitive cardiomyopathy.

B. Infiltrative cardiomyopathy.

C. Dilated cardiomyopathy.

D. Hypertrophic cardiomyopathy.
27 Which of the following cardiomyopathy is caused
by genetics?

A. Restricitive cardiomyopathy.

B. Infiltrative cardiomyopathy.

C. Dilated cardiomyopathy.

D. Hypertrophic cardiomyopathy.
28 Idiopathic hypertrophic subaortic stenosis(IHSS)
is also referred to as:

A. Hypertrophic non-obstructive cardiomyopathy.

B. Restrictive cardiomyopathy.

C. Congestive cardiomyopathy.

D. Hypertrophic obstructive cardiomyopathy.

28 Idiopathic hypertrophic subaortic stenosis(IHSS)
is also referred to as:

A. Hypertrophic non-obstructive cardiomyopathy.

B. Restrictive cardiomyopathy.

C. Congestive cardiomyopathy.

D. Hypertrophic obstructive cardiomyopathy.

29 Inhaling amyl nitrite will increase LVOT
obstruction, but also increases this abnormality:

A. Tricuspid regurgitation.

B. Mitral stenosis.

C. Aortic stenosis.

D. Mitral regurgitation.
29 Inhaling amyl nitrite will increase LVOT
obstruction, but also increases this abnormality:

A. Tricuspid regurgitation.

B. Mitral stenosis.

C. Aortic stenosis.

D. Mitral regurgitation.
30 Symptoms that may only be experienced during
exercise best describe this type of cardiomyopathy?

A. Congestive.

B. Hypertrophic.

C. Dilated.

D. Infiltrative.
30 Symptoms that may only be experienced during
exercise best describe this type of 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.
Their heart rate must increase.

B.
They must be given drugs to induce bradycardia.

C.
Their left ventricle will hypertrophy.

D.
Their ventricle will dilate.
31
Patients with restrictive cardiomyopathy have a fixed
stroke volume. In order for these patients to increase their
cardiac output:

A.
Their heart rate must increase.

B.
They must be given drugs to induce bradycardia.

C.
Their left ventricle will hypertrophy.

D.
Their ventricle will dilate.
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?

A. Mitral valve 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?

A. Mitral valve 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).

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).

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.
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.
35 In patients with hypertrophy cardiomyopathy, the
M-mode of the aortic valve may show:

A. Eccentric line of closure.

B. Decreased Aortic opening.

C. Mid-systolic notching.

D. Gradual closure of aortic valve.

35 In patients with hypertrophy cardiomyopathy, the
M-mode of the aortic valve may show:

A. Eccentric line of closure.

B. Decreased Aortic opening.

C. Mid-systolic notching.

D. Gradual closure of aortic valve.

36 A “daggered” shaped aortic waveform best
describes this abnormality:

A. Aortic stenosis.

B. Restrictive cardiomyopathy.

C. Aortic regurgitation.

D. Hypertrophic cardiomyopathy.
36 A “daggered” shaped aortic waveform best
describes this abnormality:

A. Aortic stenosis.

B. Restrictive cardiomyopathy.

C. Aortic regurgitation.

D. Hypertrophic cardiomyopathy.
37 Asymmetrical septal hypertrophy can occur
besides a Hypertrophic Cardiomyopathy.

A. True.

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

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.

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.

B. Hypertrophic cardiomyopathy.

C. Restrictive cardiomyopathy.

D. Congestive cardiomyopathy.
39 Ventricular filling resistance increases, ventricular
diastolic pressure and atrial pressure increases along
with preserved systolic function best describes:

A. Dilated cardiomyopathy.

B. Hypertrophic cardiomyopathy.

C. Restrictive cardiomyopathy.

D. Congestive 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.
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. Hurler’s syndrome.

B. Sarcoidosis.

C. Amyloidosis.

D. Hemachromatosis.
42 The most common cause of restrictive
cardiomyopathy due to the infiltrative process is:

A. Hurler’s syndrome.

B. Sarcoidosis.

C. Amyloidosis.

D. Hemachromatosis.
43 M-mode findings associated with hypertrophic
cardiomyopathy include all of the following except:

A. Asymmetric septal hypertrophy.

B. Mid-systolic notching of the aortic valve.

C. Mid-systolic notching of the pulmonic valve.

D. Systolic anterior motion of the mitral valve.

43 M-mode findings associated with hypertrophic
cardiomyopathy include all of the following except:

A. Asymmetric septal hypertrophy.

B. Mid-systolic notching of the aortic valve.

C. Mid-systolic notching of the pulmonic valve.

D. Systolic anterior motion of the mitral valve.

Additional M-mode echocardiographic findings in
patiens with hypertrophic cardiomyopathy include:

-Decreased systolic septal thickening.

-Decreased systolic septal excursion.
-Decreased E-F slope of MV valve.
-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.
47 A common mitral valve finding of dilated
cardiomyopathy in two-dimensional
echocardiography is:

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 is:

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.
48- The most common regurgitation found in patients
with dilated cardiomyopathynis:

A. Aortic insufficiency.

B. Mitral regurgitation.

C. Pulmonary insufficiency.

D. Tricuspid regurgitation.
48- The most common regurgitation found in patients
with dilated 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. 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.

D. Idiopathic.
50 The most common cause of primary dilated
cardiomyopathy is:

A. Adriamyacin toxicity.

B. Coronary artery disease.

C. 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.

B. Hypertrophic cardiomyopathy.

C. Infiltrative cardiomyopathy.

D. Restrictive cardiomyopathy.
51 Cardiac involvement associated with acquired
immunodeficiency syndrome (AIDS) is:

A. Dilated cardiomyopathy.

B. Hypertrophic cardiomyopathy.

C. Infiltrative cardiomyopathy.

D. Restrictive cardiomyopathy.
Other echocardiographic/Doppler findings
in AIDS patients include pericardial
effusion, cardiac tamponade, endocarditis,
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.

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.

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.