【英文教学讲解课件】Echocardiography

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1、EchocardiographyCardiomyopathiesCardiomyopathiesDefinitionlPrimary disease of the myocardium,excluding myocardial dysfunction due to ischemia,chronic valvular disease,hypertensive heart disease and pulmonary heart disease.lDiagnosis by exclusion.Physiologic ClassificationlDilatedlHypertrophiclRestri

2、ctiveCardiomyopathiesCardiomyopathiesEchocardiographic EvaluationlConfirm the diagnoses and type.lDefine the physiologic consequences.Dilated CardiomyopathylCharacterized by four chamber enlargement.lImpaired systolic function of both ventriclesDilated CardiomyopathiesDilated CardiomyopathiesEtiolog

3、ylIdiopathiclToxinslMetaboliclPeripartumDilated CardiomyopathiesEtiologylInfectionslSystemic DiseaselInherited disordersDilated CardiomyopathiesToxinslAlcohollMedicationslCobaltlSnake biteDilated CardiomyopathiesMetaboliclThiamine deficiencylAcromegalyDilated CardiomyopathiesInfectionslChagas diseas

4、elPost viralDilated CardiomyopathiesPhysiologylImpaired contractility of the LVlReduced COlElevated LV-EDP.Dilated CardiomyopathiesSymptomslLow cardiac outputlPulmonary venous congestionlSystemic venous congestionDilated CardiomyopathiesDiastolic DysfunctionlLV diastolic dysfunction often coexists w

5、ith systolic dysfunction but typically is not the predominant feature.Dilated Cardiomyopathies2-D Echocardiographic FindingslEnlargement of the 4 chamberslGlobal decreased in wall motionDilated CardiomyopathiesDilated CardiomyopathiesM-mode findingslIncreased EPSSlReduced anteroposterior aortic root

6、 motionlB-bump on the AC shoulderDilated CardiomyopathiesDilated CardiomyopathiesDilated CardiomyopathiesDopplerlReduced aortic ejection velocitylReduced aortic VTIlA slow rate of rise in the velocity of the MR jet(reduced rate of rise in LV pressure in early systole)Dilated CardiomyopathiesDilated

7、CardiomyopathiesDilated CardiomyopathiesDilated CardiomyopathiesDopplerlMitral and tricupid regurgitationDilated CardiomyopathiesDilated CardiomyopathiesDiastolic Filling PatternEarly -Impaired RelaxationlProlonged IVRTlReduced ElIncreased ADilated CardiomyopathiesFurther deterioration in LV functio

8、nlIncreased E velocity(high LA pressure)lReduced A velocity(elevated LV-EDP)lPseudonormalizationDilated CardiomyopathiesLA Filling PatternlIncreased atrial reversal velocitylIncreased ratio of antegrade diastolic to systolic flow.Dilated CardiomyopathiesDilated CardiomyopathiesCardiomyopathiesHypert

9、rophic CardiomyopathyHypertrophic CardiomyopathiesHypertrophic CardiomyopathylAutosomal dominantlAbnormalities in the Beta myosin heavy chain.Predominant FeatureslAsymmetric hypertrophy of the LVlNormal ventricular systolic functionlImpaired LV diastolic functionl+/-Subaortic dynamic obstructionHype

10、rtrophic CardiomyopathiesClinical FeatureslHigh risk of sudden deathlSymptoms of anginalExercise intolerancelSyncopelSystolic murmurHypertrophic CardiomyopathiesType FeatureIHypertrophy confined to Anterior segment of the IVSIIHypertrophy confined to Anterior and Inferior segments of the IVSIIIExten

11、sive hypertrophy of LV with sparing of the basal segment of the posterior wall.IV Apical hypertrophyHypertrophic CardiomyopathiesHypertrophic CardiomyopathieslThe apical pattern of hypertrophy is associated with an inverted precordial T waves on the EKGHypertrophic Cardiomyopathies The common featur

12、e of all of these hypertrophy patterns is normal thickness of the basal posterior LV wall.Hypertrophic CardiomyopathiesSubaortic obstructionlCaused by apposition of AMVL against the hypertrophied septum.lDynamic obstructionlOccurs in mid late systoleHypertrophic CardiomyopathiesHypertrophic Cardiomy

13、opathiesSubaortic obstructionlMaximum LV to aortic pressure gradient occurring in late systole.lPresence and severity of obstruction depends on the loading conditions.Hypertrophic CardiomyopathiesThe obstruction can diminished by maneuvers that:1.Increase ventricular volume(increase in preload).2.De

14、crease contractility.3.Increase afterload.Hypertrophic CardiomyopathiesThe obstruction can be increased by maneuvers that:1.Decrease ventricular volume(decrease in preload)2.Increase contractility3.Decrease afterloadHypertrophic CardiomyopathiesHypertrophic CardiomyopathiesClinical useful maneuversl

15、Examination during a post premature contraction beat(Increased contraction).lValsalva(Decreased preload).lInhalation of amyl nitrate(Decreased afterload and preload)Hypertrophic CardiomyopathiesThese maneuvers lead tolIncreased degree of dynamic obstructionlLouder murmurlIncreased in Doppler velocit

16、y.Hypertrophic CardiomyopathiesMitral RegurgitationlThe SAM of the leaflets in systole disrupt the normal mitral valve coaptation.lResults in a posteriorly directed MR jet of mild to moderate severity.Hypertrophic CardiomyopathiesHypertrophic CardiomyopathiesHypertrophic CardiomyopathiesHypertrophic

17、 CardiomyopathiesHypertrophic CardiomyopathiesLV functionlNormal systolic function.lAbnormal diastolic function with impaired relaxation and decreased compliance.Hypertrophic CardiomyopathiesEchocardiographic Evaluation2-DlUse multiple views to define pattern of LV hypertrophy.lQualitative and quant

18、itation evaluation of LV systolic function.Hypertrophic CardiomyopathiesLV Diastolic FunctionlDoppler inflow velocity curve recorded at the mitral valve leaflet tipslMeasure E velocity,A velocity,E/A ratio,IVRT and deceleration slopeHypertrophic CardiomyopathiesFindingslProlonged IVRTlReduced E velo

19、citylIncreased A velocityHypertrophic Cardiomyopathies2-D and M-mode FindingslSAM of the AMVLlApposition of AMVL and septum in late systole.lContact lesion on the IVS at point of AMVL impingementHypertrophic CardiomyopathiesHypertrophic CardiomyopathieslAortic valve show normal leaflet opening in ea

20、rly systole,followed by mid-systolic abrupt partial closure with coarse fluttering of the AV leaflets in late systole.Hypertrophic CardiomyopathiesHypertrophic CardiomyopathiesDoppler EvaluationlPresence of obstructionlLocation of obstruction(Pulsed Doppler Stepwise evaluationlSeverity of obstructio

21、nHypertrophic CardiomyopathiesHigh Velocity Systolic flowHigh intracavitary gradient.1.Apical hypertrophy.2.Opposition of the papillary with the septum.Hypertrophic CardiomyopathiesHypertensive heart disease/hypovolemia lLVHlHyperdynamic systolic functionlMid ventricular obstruction in late systolel

22、Late-peaking high velocity systolic waveform.Hypertrophic CardiomyopathiesHypertrophic CardiomyopathiesHypertrophic CardiomyopathiesHypertrophic CardiomyopathiesHypertrophic CardiomyopathiesNo evidence of outflow obstruction at rest.ManeuverslSpontaneous PVC results in an increased LV contraction on

23、 the post PVC beat.lValsalva maneuverlAmyl nitrateHypertrophic CardiomyopathiesMitral valve abnormalitieslIncreased length and surface area of MV especially the AMVL.lExcessive degree of coaptation with the coaptation place displaced posteriorly.lAnomalous papillary muscle anatomy with direction ins

24、ertion of the papillary muscle into the leaflet.Hypertrophic CardiomyopathiesDifferential DiagnosislHypertension with hyper dynamic concentrically hypertrophy of the ventricle.Hypertrophic CardiomyopathiesCardiomyopathiesRestrictive CardiomyopathiesRestrictive CardiomyopathiesRestrictive Cardiomyopa

25、thylNormal LV systolic function.lImpaired diastolic function due to a stiff,hypertrophied LVRestrictive CardiomyopathiesSymptoms of heart FailurelDue to elevated LV-EDPlInability to increase CO due to impaired diastolic fillingRestrictive CardiomyopathiesHeart FailurelInability to maintain a normal

26、CO.OrlMaintenance of a normal CO only with an elevated LV-EDP.Restrictive CardiomyopathiesDisease ProgressionlRestrictive PatternlSome features of dilated cardiomyopathylFeatures indistinguishable from dilated cardiomyopathy.Restrictive CardiomyopathiesEtiologylAmyloidosislHemochromatosislSarcoidosi

27、slHyperesinophilic SyndromelGlycogen storage diseasesRestrictive CardiomyopathiesHypereosinophilic SyndromelHypereosinophilia involving the lungs,bone marrow,brain and heart.lCardiac involvement -LV apical thrombus with gradual obliteration of the apex and thrombus formation under the PMVL with adhe

28、rence of the PMVL to the endocardium.Restrictive CardiomyopathiesEcho findingslNon dilated,thick-walled LVlNormal systolic functionlAbnormal diastolic functionlThick RV free walllBiatrial enlargementRestrictive CardiomyopathiesRestrictive CardiomyopathiesRestrictive CardiomyopathiesDoppler Evaluatio

29、nlModerate Pulmonary hypertension a.TR jet b.PR jet c.Time to peak velocity of the RVOT velocity.d.IVC evaluationRestrictive CardiomyopathiesPulmonary HypertensionPulmonary HypertensionPattern of Diastolic FillingEarly in the diseaselImpaired relaxationa.Prolonged IVRTb.Reduced Ec.Increased A Restri

30、ctive CardiomyopathiesDiastolic DysfunctionPattern of Diastolic Fillingd.Decreased early diastolic deceleration slopee.Reduced diastolic filling in the LA filling curve.Restrictive CardiomyopathiesLater in the DiseaselLA pressure rises Increased Atrial to ventricle pressure gradient.lReduced diastol

31、ic compliancea.Increased E waveb.Rapid deceleration slopec.Reduced A wave(Increased LV-EDP and reduced atrial contraction.This results in pseudonormalization.Restrictive CardiomyopathiesDiastolic DysfunctionDiastolic DysfunctionDiastolic DysfunctionPseudonormalizationlDistinguished from normal by th

32、e pattern of LA filling.lIncreased atrial reversal flowlReduced systolic phaselIncreased diastolic phaseRestrictive CardiomyopathiesLater stagelVentricular compliance severely compromised.lHigh E velocitylReduced A velocitylSteep deceleration slopelReduced IVRT.Restrictive CardiomyopathiesDiastolic

33、DysfunctionDiastolic DysfunctionDiastolic DysfunctionDifferential DiagnosisConstrictive PericarditislSimilar clinical presentationlImpaired diastolic functionlNormal systolic functionlDistinguished by the pattern of atrial and ventricular fillingRestrictive CardiomyopathiesDistinguished by thelPattern of atrial and ventricular filling.lAbsence of pericardial thickening.lDegree of associated pulmonary hypertension.Restrictive Cardiomyopathies