Cardiomyopathies and Heart Transplant Overview
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Questions and Answers

What is the gold standard for evaluating transplant rejection?

  • Coronary angiogram
  • Echocardiography
  • Dobutamine stress echocardiography
  • Endomyocardial biopsy (correct)

Which of the following is a common finding on ECG in patients with dilated cardiomyopathy?

  • Lateral ST segment elevation
  • Double 'P' wave (correct)
  • Right axis deviation
  • Bifid P waves

What is the typical timeframe of highest rejection risk after a heart transplant?

  • 1 month
  • 1 year
  • 6 months
  • 3 months (correct)

Which finding is considered an early sign of transplant rejection?

<p>Increased wall thickness (B)</p> Signup and view all the answers

What is a potential complication associated with heart transplant patients?

<p>Accelerated coronary atherosclerosis (C)</p> Signup and view all the answers

Which anatomical change occurs in the bicaval anastomosis heart transplant technique?

<p>Entire right atrium removed (D)</p> Signup and view all the answers

What abnormality is typically observed in diastolic function in transplant patients?

<p>Diastolic dysfunction (A)</p> Signup and view all the answers

What does the term 'noncompaction' refer to in cardiomyopathy?

<p>Alteration in endomyocardial trabeculations (A)</p> Signup and view all the answers

What is a common procedure performed annually in a heart transplant patient after the first year?

<p>Coronary angiogram (C)</p> Signup and view all the answers

What are the structural components of noncompaction cardiomyopathy?

<p>Two layers: thin compact myocardium and thicker noncompacted layer (B)</p> Signup and view all the answers

What is the primary area affected by noncompaction?

<p>Mid-lateral and apical areas (A)</p> Signup and view all the answers

What is a characteristic feature of hypertrophic cardiomyopathy?

<p>Hypertrophied myofibrils in chaotic disarray (D)</p> Signup and view all the answers

Which imaging method can assist in diagnosing noncompaction?

<p>Color Doppler and contrast echo (D)</p> Signup and view all the answers

How is hypertrophic cardiomyopathy (HCM) related to sudden cardiac death in young people?

<p>It is the most common cause of sudden cardiac death in young athletes. (D)</p> Signup and view all the answers

Which statement correctly describes asymmetrical hypertrophy in hypertrophic cardiomyopathy?

<p>The septum is thicker than other walls. (C)</p> Signup and view all the answers

What is the primary treatment for heart failure due to noncompaction?

<p>Treatment for congestive heart failure (A)</p> Signup and view all the answers

Which best describes the function of M-mode echocardiography in diagnosing asymmetric septal hypertrophy?

<p>It documents the thickness ratio of the septum to the posterior wall. (D)</p> Signup and view all the answers

Why can hypertrophic cardiomyopathy lead to obstruction of blood outflow?

<p>Thickened walls at specific locations (D)</p> Signup and view all the answers

What does an end-systolic ratio of NC/C layers greater than 2 indicate in noncompaction?

<p>Presence of noncompacted myocardium (B)</p> Signup and view all the answers

In which type of hypertrophic cardiomyopathy is obstruction due to anterior motion of the mitral valve most likely?

<p>Hypertrophic obstructive cardiomyopathy (HOCM) (D)</p> Signup and view all the answers

What condition can lead to the formation of whorled structures in myocardium?

<p>Hypertrophic myofibrils in chaotic disarray (B)</p> Signup and view all the answers

What factor contributes to ventricular fibrillation in patients with hypertrophic cardiomyopathy?

<p>Electrically unstable myocardium (B)</p> Signup and view all the answers

What is a possible result of the Venturi effect in hypertrophic cardiomyopathy?

<p>Low pressure zones that draw the mitral valve apparatus forward (D)</p> Signup and view all the answers

What is the primary indicator of hypertrophic obstructive cardiomyopathy (HOCM)?

<p>LVOT gradient of at least 30 mmHg (C)</p> Signup and view all the answers

What happens during the Valsalva maneuver?

<p>Momentary stop of venous return (B)</p> Signup and view all the answers

What effect do maneuvers that increase contractility have on HOCM?

<p>They can unmask a hidden gradient. (C)</p> Signup and view all the answers

What distinguishes dynamic obstruction in HOCM from fixed obstruction?

<p>Dynamic obstruction has variability in gradients. (D)</p> Signup and view all the answers

What is a common finding associated with HOCM?

<p>Obstructive mitral valve systolic anterior motion (SAM) (C)</p> Signup and view all the answers

How can the severity of mitral regurgitation (MR) in HOCM be assessed?

<p>Based on the anterior leaflet SAM degree (A)</p> Signup and view all the answers

Which method may not effectively demonstrate dynamic gradients in HOCM?

<p>Resting echocardiography (D)</p> Signup and view all the answers

What is a potential long-term risk associated with alcohol septal ablation?

<p>Development of arrhythmias (D)</p> Signup and view all the answers

What is the primary therapeutic approach for severe symptoms in HOCM patients not responding to medications?

<p>Surgical myectomy (A)</p> Signup and view all the answers

Which statement is true regarding the distinction between obstructive and nonobstructive forms of HCM?

<p>The presence of an LV outflow gradient is critical for differentiation. (B)</p> Signup and view all the answers

What physical characteristic is commonly noted in patients with apical hypertrophy?

<p>Markedly diminished apical cavity with spade-shaped configuration (B)</p> Signup and view all the answers

What is the role of beta blockers in the treatment of HOCM?

<p>They reduce the force of contraction. (A)</p> Signup and view all the answers

Which diagnostic method is most effective for tracking ejection velocities and obstruction location in HOCM?

<p>Echo Doppler studies (B)</p> Signup and view all the answers

In HOCM, what does the term 'hyperdynamic function' refer to?

<p>Increased ejection fraction despite heart failure symptoms (A)</p> Signup and view all the answers

What is the outcome of using dual-chamber pacing in the management of HOCM?

<p>Limited evidence of improved hemodynamics (C)</p> Signup and view all the answers

Flashcards

Dilated Cardiomyopathy

A condition where the heart muscle is weakened and enlarged, leading to difficulty pumping blood effectively.

Heart Transplant

A surgical procedure where a healthy heart from a deceased donor is transplanted into a recipient.

Transplant Rejection

A major complication after heart transplant, where the body's immune system attacks the new heart.

Endomyocardial Biopsy

A test used to diagnose transplant rejection, involving taking a small sample of heart muscle for analysis.

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First 3 Months Post-transplant

The highest risk period for heart transplant rejection, occurring within the first few months after surgery.

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Accelerated Coronary Atherosclerosis

A narrowing or blockage of the coronary arteries, which can occur at a faster rate in heart transplant recipients.

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Ventricular Noncompaction

A condition characterized by abnormal thickening and trabeculations in the heart's inner lining, affecting its ability to pump effectively.

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Epicardial Side

A thin, compacted layer of heart muscle found on the outside of the heart in patients with ventricular noncompaction.

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Endocardial Layer

A thicker, noncompacted layer of heart muscle found on the inside of the heart in patients with ventricular noncompaction.

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Unclassified Cardiomyopathy

A group of heart conditions that don't fit into other specific categories, often associated with abnormal heart muscle structure and function.

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Hypertrophic Cardiomyopathy (HCM)

A heart condition characterized by thickened heart muscle in the absence of increased afterload.

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HCM - Obstructive vs. Non-obstructive

HCM can either obstruct blood flow out of the heart or not.

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HCM Hereditary Transmission

HCM is often seen in families, suggesting a genetic cause.

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HCM and Sudden Death

The most common cause of sudden cardiac death in young people, especially athletes.

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HCM - Asymmetrical Hypertrophy

The thickened heart muscle in HCM often shows an uneven pattern of enlargement.

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Asymmetric Septal Hypertrophy (ASH)

The septum (wall dividing the heart chambers) is thicker than other heart walls.

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Obstructive HCM

ASH is a form of HCM where the thickening causes a dynamic obstruction to blood flow out of the heart.

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Mitral Valve Systolic Anterior Motion (SAM)

The mitral valve (heart valve between the left atrium and ventricle) moves abnormally towards the septum during contraction, blocking blood flow.

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SAM - Dynamic Obstruction

The obstruction caused by SAM is dynamic and can change based on factors like heart rate and blood pressure.

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SAM - Duration of Contact

The amount of obstruction caused by SAM depends on how long the mitral valve contacts the septum.

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HCM - Doppler Quantification

The degree of obstruction in obstructive HCM is measured using Doppler echocardiography.

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Doppler Signal in Obstructive HCM

The Doppler signal peaks later in obstructive HCM patients due to the delayed blood flow caused by obstruction.

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Noncompaction Cardiomyopathy (NCC)

A rare heart condition where the heart muscle doesn't develop normally, resulting in abnormal thick muscle walls and pockets.

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NCC - Embryonic Origin

NCC is thought to be caused by an interruption in normal fetal heart development.

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NCC - Ventricles Affected

NCC affects the left ventricle most often, but can also involve both ventricles.

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LVOT Gradient

The maximal pressure difference between the left ventricle and the aorta, which is a measure of the severity of obstruction in HCM.

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Dynamic Obstruction in HCM

The phenomenon in HCM where the left ventricular outflow tract (LVOT) becomes more obstructed as systole progresses. This is due to reduced left ventricular volume bringing the obstruction components closer together.

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Valsalva Maneuver in HCM

A common maneuver used to assess for dynamic LVOT obstruction in HCM. Valsalva maneuver reduces blood flow, increases contractility, and worsens obstruction.

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Fixed Obstruction in HCM

HCM with a persistent, measurable LVOT gradient even at rest.

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Dynamic Obstruction in HCM

HCM with a variable LVOT gradient that can be made worse by certain maneuvers like Valsalva.

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PW Doppler in HCM

PW Doppler is used to visualize the flow pattern in the LVOT and identify the location of obstruction in HCM. The point of highest velocity indicates the point of greatest obstruction.

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Non-Obstructive HCM

HCM characterized by thickened walls and a restricted left ventricular cavity, but without significant obstruction in the outflow tract. It may present with subtle signs like a hyperdynamic LV contraction and prominent papillary muscles.

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Septum Myectomy-Myotomy in HCM

A surgical approach to treat HCM by removing a portion of the thickened septum, widening the LVOT, and reducing obstruction.

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Alcohol Septal Ablation in HCM

A procedure using alcohol injection into a specific septal artery supplying the thickened portion of the septum, causing a controlled myocardial infarction and reducing LVOT obstruction in HCM.

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Mitral Valve Replacement (MVR) in HCM

A heart valve replacement surgery for HCM patients with severe mitral valve regurgitation (MR) associated with SAM.

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Apical Hypertrophy in HCM

A type of HCM where the thickening of the heart muscle is concentrated at the apex of the left ventricle, giving it a spade-shaped appearance.

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Mid-Ventricular Obstruction in HCM

A type of HCM where the thickening of the heart muscle is concentrated in the mid-portion of the left ventricle, often leading to a dynamic obstruction.

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Study Notes

Dilated Cardiomyopathy

  • Heart transplant is a treatment option
  • Evaluation for rejection is crucial
  • 2D and Doppler echocardiography are used for assessment

Heart Transplant

  • Biatrial anastomosis is part of the procedure
  • Associated risks include arrhythmias, tricuspid valve dysfunction, and thrombus formation
  • Echo findings of rejection may include increased wall thickness
  • Annual coronary angiograms are common post-transplant
  • Echocardiograms are typically done every 6 months
  • Blood work every 2-3 months

Ventricular Noncompaction

  • Unclassified cardiomyopathy
  • Myocardial structure is altered, with two layers.
  • The compacted layer is thin, and the noncompacted layer is thick

Hypertrophic Cardiomyopathy

  • Heart muscle thickens without increased afterload
  • Can be obstructive or non-obstructive
  • Family history is significant, with recurrent syncope and sudden cardiac death potential
  • Younger individuals may have a more severe form
  • Often asymmetric, with the septum thicker than other walls
  • Obstructive myopathy is characterized by outflow obstruction, typically dynamic
  • Diagnosis involves echo, demonstrating thickening, and abnormal septal motion (SAM)
  • Treatment options include medical therapy, pacemakers, alcohol septal ablation, or myectomy. Key clinical signs and symptoms should be considered.

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Cardiomyopathies 2025 - Part 2 PDF

Description

This quiz covers various types of cardiomyopathies, including dilated, hypertrophic, and noncompaction types, as well as treatment options like heart transplant. Explore key diagnostic tools, management strategies, and complications associated with these conditions. Test your knowledge on echocardiography, surgical techniques, and patient care post-transplant.

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