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Questions and Answers
What ejection fraction (EF) percentage indicates impaired ventricular function typically seen in DCM?
What Ejection Fraction (EF) range indicates severely reduced heart function?
Which abnormal finding on myocardial biopsy is commonly associated with dilated cardiomyopathy (DCM)?
Which ECG finding indicates a past myocardial injury or hypertrophy?
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Which condition is suggested by the inability to increase blood pressure during stress testing?
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What is the significance of high ventricular filling pressures in cardiac catheterization?
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What measurement is considered normal for Pulmonary Capillary Wedge Pressure (PCWP)?
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What classification of heart failure is indicated by BNP levels greater than 300 pg/mL?
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Which chest X-ray finding is a common indication of advanced heart failure?
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What cardiac output range is considered normal in hemodynamic studies?
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Which of the following indicates electrical instability in ambulatory ECG monitoring?
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What is the normal range for left ventricular wall thickness, above which left ventricular hypertrophy (LVH) is suggested?
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What indicates a right-sided heart failure based on right atrial pressure measurements?
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Study Notes
Echocardiography
- Ejection Fraction (EF)
- Normal: 55–70%
- Mildly Reduced: 41–55%
- Moderately Reduced: 30–40%
- Severely Reduced: < 30% (seen in advanced DCM or HF)
- Left Ventricular Hypertrophy (LVH)
- Wall thickness > 12 mm suggests HCM
- Ventricular Dilation
- Enlarged left ventricular dimensions (end-diastolic diameter > 60 mm) indicate DCM
Electrocardiography (ECG)
- Normal Sinus Rhythm: Regular rhythm at 60-100 bpm
- Left Ventricular Hypertrophy (LVH)
- High QRS voltage, particularly in leads V1-V6
- Abnormal Q Waves
- Indicates past myocardial injury or hypertrophy, common in HCM
- Atrial Fibrillation or Flutter
- Irregular rhythm, may indicate HF or advanced cardiomyopathy
- Ventricular Tachycardia (VT)
- Wide complex tachycardia often found in ARVD and severe DCM
- Low Voltage QRS Complexes
- Seen in ATTR-CM due to amyloid infiltration
Ambulatory ECG Monitoring (Holter Monitor)
- Normal Findings: Stable heart rate without significant arrhythmias
- Abnormal Findings: Episodes of ventricular tachycardia, atrial fibrillation, or other arrhythmias, often associated with ARVD and advanced cardiomyopathy
Chest X-ray
- Heart Size (Cardiomegaly)
- Normal Cardiothoracic Ratio: < 50% of the chest width
- Cardiomegaly: Cardiothoracic ratio > 50%, commonly seen in DCM and advanced HF
- Pulmonary Congestion
- Fluid in lung bases or pleural effusions indicate left-sided HF
Hemodynamic Studies (Right Heart Catheterization)
- Pulmonary Capillary Wedge Pressure (PCWP)
- Normal: 6-12 mmHg
- Elevated: > 18 mmHg indicates left-sided HF or fluid overload
- Right Atrial Pressure
- Normal: 0-8 mmHg
- Elevated: > 8 mmHg suggests right-sided HF
- Cardiac Output (CO)
- Normal: 4-8 L/min
- Low CO: Common in advanced cardiomyopathy and indicates reduced heart function
Cardiac Stress Testing
- Normal Response: Gradual increase in heart rate and BP with exertion, absence of ischemic changes
- Abnormal Findings
- Ischemic changes on ECG (ST depression) during stress indicating reduced coronary perfusion, often seen in HCM
- Inability to increase BP suggesting limited cardiac reserve in advanced HF
Radionuclear Scans (e.g., MUGA Scan)
- Normal Ejection Fraction (EF)
- 55-70% in both ventricles
- Reduced EF
- < 50% indicates impaired ventricular function, typical in DCM
Cardiac Catheterization and Coronary Angiography
- Normal Coronary Arteries: No significant blockages
- Coronary Blockages: Stenosis in coronary arteries, indicating underlying coronary artery disease
- Ventricular Pressures
- High ventricular filling pressures suggest restrictive filling in RCM
- Ventricular Dilation: Common in DCM, with enlarged chamber sizes
Myocardial Biopsy
- Normal Findings: Healthy cardiac muscle cells without abnormal deposits or fibrosis
- Abnormal Findings
- Fibrosis: Common in DCM and RCM
- Amyloid Deposits: Seen in ATTR-CM
- Inflammatory Cells: Indicate myocarditis, which can be a cause of DCM
Genetic Testing
- Normal Findings: No mutations linked to cardiomyopathy
- Abnormal Findings
- Sarcomere mutations for HCM
- Desmosomal mutations for ARVD
- Transthyretin gene mutations for hereditary ATTR-CM
Brain Natriuretic Peptide (BNP) or NT-proBNP
- Normal BNP Levels: < 100 pg/mL
- Mild Heart Failure: 100-300 pg/mL
- Moderate to Severe Heart Failure: > 300 pg/mL in BNP or > 900 pg/mL for NT-proBNP indicating severe HF and is commonly seen in advanced cardiomyopathy
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Description
Test your knowledge of echocardiography and electrocardiography concepts, including ejection fractions, left ventricular hypertrophy, and ambulatory ECG monitoring. This quiz covers key indicators and abnormalities significant in diagnosing cardiac conditions such as heart failure and cardiomyopathy.
