Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF + ++ Which one of the following primary cardiomyopathies is most common? + Dilated + Hypertrophic + Infiltrative + Restrictive + Download Section PDF + ++ Dilated cardiomyopathy can typically be distinguished from other primary cardiomyopathies by the presence of which one of the following? + Decreased ejection fraction + Impaired left ventricular relaxation + Decreased end-diastolic volume + Mitral regurgitation + Download Section PDF + ++ Which one of the following locations is the most common site for the development of thrombi in patients with dilated cardiomyopathy? + Main pulmonary artery + Left atrium + Left ventricular apex + Right atrial appendage + Download Section PDF + ++ All of the following factors are associated with decreased 5-year survival following the initial diagnosis of dilated cardiomyopathy except: + Biventricular dysfunction + Childhood onset + Delayed initiation of therapy + Increased extent of cardiac remodeling + Download Section PDF + ++ What percentage of patients with dilated cardiomyopathy will die within 2 years? + 20% to 25% + 45% to 50% + 70% to 75% + 90% to 95% + Download Section PDF + ++ What percentage of patients with dilated cardiomyopathy improve spontaneously? + 20% to 25% + 45% to 50% + 70% to 75% + 90% to 95% + Download Section PDF + ++ Idiopathic dilated cardiomyopathy can most commonly be distinguished from ischemic cardiomyopathy by which one of the following characteristics? + Absence of coronary artery disease + Angina + Improvement in regional ventricular wall motion following dobutamine + Symmetric and globally reduced ventricular wall motion + Download Section PDF + ++ Which one of the following echocardiographic findings pertaining to left ventricular dilatation in patients with dilated cardiomyopathy is correct? + Basal diameter exceeds midventricular diameter. + Decreased end-systolic diameter. + Diminished relative wall thickness. + Left ventricular dilatation is usually less than right ventricular dilatation. + Download Section PDF + ++ Which of the following echocardiographic findings is most consistent with a diagnosis of right ventricular dilatation? + Apex-forming right ventricle + Hepatic vein Doppler flow velocity reversal during systole + Right ventricular free wall akinesis + Tricuspid regurgitation + Download Section PDF + ++ Which of one the following echocardiographic findings is fundamental to the diagnosis of dilated cardiomyopathy? + Left ventricular end-systolic diameter less than 4 cm2 + Left ventricular ejection fraction less than 45% + Right ventricular dilatation + Severe mitral regurgitation + Download Section PDF + ++ Which one of the following echocardiographic findings is consistent with the greatest risk for systemic embolization of thrombus? + Dilated left atrium + Left atrial appendage laminated thrombus + Protuberant left ventricular apical thrombus + Spontaneous contrast in the left ventricle + Download Section PDF + ++ Diagnostic echocardiographic criteria for identifying a left ventricular thrombus in a patient with dilated cardiomyopathy include all of the following, except: + Demarcation by a clear thrombus-blood interface + Normal transmitral Doppler flow velocity profile + Usual location adjacent to but distinct from abnormally contracting myocardium + Visualization in at least two planes + Download Section PDF + ++ In patients with dilated cardiomyopathy, impaired left ventricular relaxation is indicated by which one of the following characteristics of the transmitral Doppler flow velocity profile? + Decreased A-wave velocity + Decreased isovolumic relaxation time + Increased deceleration time + Increased E-wave velocity + Download Section PDF + ++ In patients with dilated cardiomyopathy, impaired left ventricular relaxation is indicated by which one of the following characteristics of the pulmonary venous Doppler flow velocity profile? + Atrial reversal component duration exceeding the transmitral A-wave duration + Atrial reversal velocity greater than 35 cm/s + Peak diastolic velocity less than peak systolic velocity + Systolic flow reversal + Download Section PDF + ++ In patients with dilated cardiomyopathy, mitral regurgitation is most commonly due to which one of the following mechanisms? + Apical displacement of the coaptation point + Mitral annular calcification + Posterior leaflet prolapse + Systolic anterior motion + Download Section PDF + ++ All of the following echocardiographic findings have been correlated with a worse outcome in patients with dilated cardiomyopathy, except: + Decreased left ventricular end-systolic volumes following dobutamine + Increased tricuspid regurgitation peak Doppler flow velocity + Restrictive transmitral Doppler flow velocity profile + Severe mitral regurgitation + Download Section PDF + ++ In patients with dilated cardiomyopathy, decreased right ventricular compliance is indicated by which one of the following echocardiographic findings? + Increased transtricuspid E-wave deceleration time + Inferior vena cava diameter less than 1.5 cm2 + Decreased transtricuspid peak E-wave velocity + Predominant hepatic vein V- and A-wave reversals during spontaneous inspiration + Download Section PDF + ++ In patients with dilated cardiomyopathy, which one of the following most likely accounts for the relative increased incidence of thrombi found in the left ventricle compared to the left atrium? + Atrial fibrillation + Concurrent left ventricular apical myocardial infarction + Decreased left atrial compliance + Protective effect of mitral regurgitation + Download Section PDF + ++ All of the following echocardiographic findings are commonly associated with dilated cardiomyopathy, except: + Dilated left atrium + Impaired left ventricular relaxation + Focal regional wall motion abnormalities + Mitral regurgitation + Download Section PDF + ++ Etiologies for the development of dilated cardiomyopathy include all of the following, except: + Familial linkage + Autoimmunity + Systemic hypertension + Viral myocarditis + Download Section PDF + ++ Primary cardiomyopathies: + Can be associated with coronary artery narrowing + Are associated with systemic disease + Are commonly found in the general population + Always involve all four chambers + Are always associated with diastolic dysfunction + Download Section PDF + ++ True statements regarding primary cardiomyopathies include all of the following, except: + They overlap with each other with respect to clinical symptoms. + All may have diastolic dysfunction. + All may have systolic dysfunction. + They are associated with a systemic disease. + The incidence in the general population is less than 1%. + Download Section PDF + ++ All patients with hypertrophic cardiomyopathy have a globally hypertrophied ventricle. + True + False + Download Section PDF + ++ Approximately 25% of patients with hypertrophic cardiomyopathy have left ventricular outflow tract obstruction. + True + False + Download Section PDF + ++ All of the following contribute to systolic anterior motion and left ventricular outflow tract obstruction, except: + Posterior mitral annular calcification + Septal hypertrophy + Elongated mitral leaflets + Direction of ventricular inflow + Posterior shift of papillary muscle + Download Section PDF + ++ The incidence of HCM/HOCM in the general population is: + Less than 1% + Less than restrictive/infiltrative cardiomyopathy + Greater than 10% + Between 1% and 10% + Greater than for dilated cardiomyopathy + Download Section PDF + ++ Genetic testing for patients with HCM/HOCM: + Has found abnormalities on only one gene + Is performed in all patients + Has found mutations on at least nine genes + Has not revealed any genetic abnormalities + Is routinely performed in all family members of patients with HCM/HOCM + Download Section PDF + ++ All patients with ventricular hypertrophy: + Have a primary cardiomyopathy + Have an asymmetric pattern of hypertrophy + Have aortic stenosis and/or systemic hypertension + Have involvement of the interatrial septum + Are more likely to have echocardiographic evidence of diastolic dysfunction + Download Section PDF + ++ All of the following are true except: + Hypertrophic cardiomyopathy may be symptomatic or asymptomatic. + Diastolic dysfunction is found in the majority of patients with ventricular hypertrophy. + Systolic outflow obstruction can be dynamic and episodic. + Restrictive filling is found only in restrictive cardiomyopathy. + Varying degrees of diastolic dysfunction are found in patients with hypertrophy. + Download Section PDF + ++ Hypertrophic cardiomyopathy: + Incidence is greatest in the elderly patient + Incidence is greatest in patients under 10 years old + Can occur only after the second decade + Is more commonly discovered between the 2nd and 5th decades + Does not predict risk of complications + Download Section PDF + ++ Risk factors for sudden death in hypertrophic cardiomyopathy include all of the following, except: + Personal or family history of syncope + Presence of left ventricular outflow tract obstruction + Young patients + Severe left ventricular hypertrophy (>20-mm thickness) + A reduction in blood pressure with exercise + Download Section PDF + ++ Relationships between the mitral coaptation point and the left ventricular outflow tract that predispose to outflow tract obstruction include: + Distance between the mitral coaptation point and the ventricular septum 25 mm or less + Mitral inflow/aortic outflow angle of less than 30° + Relative lengths of the anterior and posterior leaflets of greater than 2.0:1.0 + Distance between the mitral annulus and septum less than 25 mm + Posterior displacement of the coaptation point + Download Section PDF + ++ For hypertrophic cardiomyopathies, coronary ischemia may be due to all of the following, except: + Hypertrophy of the coronary arteries + Elevated intraventricular pressures + Coronary artery aneurysm and thrombosis + Coronary atheromatous disease + Reduced coronary vasodilatory reserve + Download Section PDF + ++ Which of the following is least likely to be performed as a primary treatment in patients with hypertrophic cardiomyopathy? + Mitral valve replacement with a bioprosthetic valve + Placement of an internal cardiac defibrillator + Mitral valve repair + Surgical resection of the hypertrophic ventricular septum + Administration of antibiotic prophylaxis + Download Section PDF + ++ True statements regarding hypereosinophilic syndrome include all of the following, except: + It is also known as Loffler endocarditis. + It is continuous with endomyocardial fibrosis (ie, same disease). + It is known to cause endocardial thickening of the mitral and tricuspid annuli. + It is associated with significant systolic dysfunction. + Endocardial thickening is associated with obliteration of the ventricular apex. + Download Section PDF + ++ Differential diagnosis of restrictive filling defect include all of the following, except: + Myocardial ischemia/infarct + Cardiac amyloidosis + Mitral regurgitation + Hypereosinophilic syndrome + End-stage aortic stenosis + Download Section PDF + ++ Histologic examination of hypertrophic cardiomyopathy may include all of the following, except: + Myocardial disarray + Myocardial fibrosis + Myocardial hypertrophy + Amyloid infiltration + Asymmetric distribution of hypertrophy + Download Section PDF + ++ Doppler data suggestive of restrictive filling pattern include all except: + Transmitral deceleration time less than 150 milliseconds + Isovolumic relaxation time less than 80 milliseconds + Transmitral early to late filling fraction ratio (E/A) less than 0.70 + Pulmonary venous systolic to diastolic inflow ratio (E/A) of less than 0.5 + Pulmonary venous atrial reversal (Arev) velocity greater than 35 cm/s + Download Section PDF + ++ Which of the following statements is true regarding patients with hypertrophic cardiomyopathy? + Hypertrophy is frequently found in the right ventricle. + Hypertrophy is not found in the inferolateral wall. + Hypertrophy is typically asymmetric with greater involvement of the septum. + Hypertrophy typically involves the interatrial septum. + Download Section PDF + ++ Which of the following statements is true regarding patients with hypertrophic cardiomyopathy? + Coronary arteries may exhibit abnormal concentric thickening. + Always coexists with pulmonary hypertension. + It is inherited as an autosomal recessive trait with variable expression. + Diastolic dysfunction occurs in 25% of patients. + Download Section PDF + ++ In patients with hypertrophic cardiomyopathy, ventricular hypertrophy can involve: + Basilar septum + Inferolateral wall + Mid-cavity + Apex + All of the above + Download Section PDF + ++ Which of the following echocardiogarphic findings is most likely associated with hypertrophic cardiomyopathy? + Increased intracavitary dimensions + Decreased systolic function + Symmetric ventricular hypertrophy + Systolic anterior motion of the mitral valve + Download Section PDF + ++ Which of the following statements is true regarding echocardiographic evidence of left ventricular outflow tract obstruction? + M-mode demonstrates late closure of the aortic valve. + M-mode demonstrates premature opening of the aortic valve. + M-mode demonstrates late opening of the aortic valve. + M-mode demonstrates premature closure of the aortic valve. + Download Section PDF + ++ Which of the following statement is true regarding patients with hypertrophic cardiomyopathy? + Ventricular dysrhythmias are the main cause of death. + Left ventricular outflow obstruction has been directly related the sudden death. + Left ventricular outflow obstruction is directly related to arrhythmias. + The annual mortality rate ranges from 0.5% to 1%. + Download Section PDF + ++ Which of the following increases the risk of sudden death in patients with hypertrophic cardiomyopathy? + LVOT gradient of 35 mm Hg + Reduction in blood pressure during exercise + LV hypertrophy of 20 mm + Old age + Download Section PDF + ++ With regard to systolic anterior motion of the mitral valve and outflow tract obstruction: + It is found in approximately 70% of patients with hypertrophic cardiomyopathy. + It has different mechanisms across different populations. + It is related, in part, to abnormalities of the mitral apparatus. + The Bernoulli effect is responsible for outflow tract obstruction. + Download Section PDF + ++ M-mode echocardiography is useful for the evaluation of hypertrophic cardiomyopathy by detecting or measuring: + Ventricular diastolic function + Ventricular wall thickness + Mitral insufficiency when combined with color Doppler + Aortic insufficiency when combined with color Doppler evaluation of the left ventricular outflow tract + Download Section PDF + ++ True statements regarding diastolic dysfunction include: + It occurs in all patients with hypertrophic cardiomyopathy. + Doppler assessment is often affected by changes in loading conditions. + It is always associated with systolic dysfunction. + It occurs in 25% of patients with restrictive cardiomyopathy. + Download Section PDF + ++ Which of the following is associated with a restrictive cardiomyopathy? + Myocarditis + Friedreich ataxia + Lead poisoning + Cardiac hemochromatosis + Download Section PDF + ++ Typical echocardiographic features in patients with restrictive cardiomyopathy include: + Left ventricular free-wall thickening + Right ventricular free-wall thickening + Decreased LV systolic function + Normal right and left atrial size + Download Section PDF + ++ The typical mitral inflow velocity in patients with restrictive cardiomyopathy includes: + Short IVRT, tall E wave, short DT + Short IVRT, short E wave, short DT + Short IVRT, tall E wave, long DT + Short IVRT, short E wave, long DT + Download Section PDF + ++ The prognosis for patients with cardiac amyloidosis is: + Poor for patients with a pulmonary venous systolic/ diastolic inflow ratio less than 0.5 + Poor for patients with LV wall thickness in diastole greater than 15 mm + Poor for patients with a transmitral deceleration time less than 140 milliseconds + All of the above + Download Section PDF + ++ When differentiating cardiac amyloidosis from other causes of restrictive patterns: + Speckling or a “starry-skied” appearance of the myocardium is found only in patients with amyloidosis. + Left ventricular systolic dysfunction is more likely to be present in amyloidosis. + Involvement of the interatrial septum is strongly suggestive of amyloid infiltration. + Dilation of the atria is diagnostic of amyloidosis. + Download Section PDF + ++ In patients with amyloid infiltration of the heart: + The incidence of left ventricular systolic dysfunction is not related to wall thickness. + Left ventricular systolic dysfunction is present in 70% of cases. + Left ventricular dilation is present in less than 10% of cases with systolic dysfunction. + Biventricular dilation is an end-stage event. + Download Section PDF + ++ Cardiac involvement in hemochromatosis: + Commonly presents with restrictive pathophysiology + Is commonly seen without other organ system involvement + Uncommonly contributes to mortality + Is associated with systolic dysfunction and chamber enlargement + Download Section PDF + ++ Which of the following statements is correct regarding constrictive pericarditis and restrictive cardiomyopathy? + Both have a similar clinical presentation. + Both have decreased LV systolic function. + Both have the same pattern of impaired diastolic filling. + Both are associated with pulmonary hypertension. + Download Section PDF + ++ Echocardiographic data that differentiate constrictive pericarditis from restrictive cardiomyopathy include: + Respiratory variation of transmitral and pulmonary venous flows + Presence of a thickened and/or calcified pericardium + Normal-appearing interatrial septum + All of the above + Download Section PDF + ++ Intracardiac thrombi may occur: + With all three categories of cardiomyopathy + With abnormalities of the endocardium due to infiltrative diseases + In the dilated and dysfunctional atrium + In areas of low flow velocity (<25 cm/s) + All of the above