ECHO 2013 / Systolic Heart Failure Review of Cardiomyopathy
.pdf
Myocardial viability (dobutamine response) guiding therapy in ischemic cardiomyopathy
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20% |
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18% |
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16% |
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14% |
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percent |
12% |
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mortality |
10% |
* |
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8% |
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6% |
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4% |
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2% |
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0% |
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I |
II |
III |
IV |
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V+ R+ |
V+ R- |
V- R+ V- R- |
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group |
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* p < 0.01 |
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Afridi et al JACC 1999;32:921-6 |
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Cardiomyopathy examples
HOCM classic echo findings
Restrictive Cardiomyopathy
impaired LV filling, increased LVEDP
•Infiltrative
•Sarcoidosis
•Amyloidosis
•Post irradiation therapy
•Storage disease
•Hemochromatosis
•Glycogen storage
disease
• Fabry’s disease
•Endocardial fibrosis
–Loeffler’s cardiomyopathy
–Non-eosiniophilic endomyocardial fibrosis
•Idiopathic restrictive cardiomyopathy
Echo features restrictive cardiomyopathy
•Biatrial enlargement
•Thickened ventricles
–Decreased compliance
•Small LV
–Evolves to dilated cmpty
•Normal to depressed LV systolic function
•Infiltrative processes most common etiologies
–Septal bounce, ventricular interdependence
•Less common – endocardial fibrosis (hypereosinophilic
syndrome)
– Apical depositions
64 y/o with long standing hypertension; 1 yr of increasing exertional dyspnea and pedal edema.
Initial W/U - ETT negative for ischemia. Echo “LVH with preserved function”. Pt treated aggressively for hypertension but symptoms increased.
Referred for 2nd opinion
Phys Exam: BP 112/70, HR 70, nl resp
JVP 15 cms H2O, prominent y descent. Lung-bibasilar crackles Cardiac: non-displaced LV impulse, nl hrt snds, 2/6 sys Ejection M at LSB no change with maneuvers.
Abd exam: ascites, nl liver size; Ext - pitting edema to the thighs
BUN 57, Cr 1.5, Hct 38.8, Bili 3.3, UA 2+ prtn
