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Cardiology
Hemodynamic Assessment for Hypertrophic Cardiomyopathy, Restrictive Cardiomyopathy, Constric
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
6 sections · 135 slides
Role of invasive hemodynamic assessment
- Scope of this topic
- Historical development of these diagnoses
- The catheterization laboratory as tiebreaker
- Other indications beyond discrepant data
- Primary indications by disease
- Primary Indications for Invasive Hemodynamic Assessment
- Primary Indications for Invasive Hemodynamic Assessment (continued)
- Fundamentals common to every case
- Fundamentals of Detailed Invasive Hemodynamic Assessment
- Fundamentals of Detailed Invasive Hemodynamic Assessment (continued)
- Fundamentals of Detailed Invasive Hemodynamic Assessment (continued)
- Fundamentals of Detailed Invasive Hemodynamic Assessment (continued)
Hypertrophic cardiomyopathy
- Origins of the hypertrophic cardiomyopathy diagnosis
- Septal morphology in hypertrophic cardiomyopathy
- The obstruction debate and its resolution
- Sequence of events in dynamic obstruction
- Drag effect versus the Venturi hypothesis
- Role of the mitral apparatus
- Hemodynamic basis for symptoms
- Diastolic dysfunction after septal reduction therapy
- TEMPO trial: metoprolol and exercise hemodynamics
- Supply-demand ischemia and myocardial bridging
- Pulmonary hypertension in hypertrophic cardiomyopathy
- Dynamic right ventricular outflow obstruction
- Indications for invasive study in hypertrophic cardiomyopathy
- Catheter position for gradient assessment
- Antegrade and retrograde catheter approaches in hypertrophic cardiomyopathy
- Retrograde route when transseptal is not chosen
- Apical hypertrophic cardiomyopathy on catheter and echocardiography
- Preprocedural planning and sedation effects
- Variability of the resting gradient
- Simultaneous apex and aortic pressure recording
- Spike-and-dome versus the slurred aortic upstroke
- Fixed dynamic obstruction
- Left ventricular and aortic tracings in fixed and dynamic obstruction
- Valsalva maneuver as provocation
- Post-extrasystolic potentiation and its use
- Brockenbrough-Braunwald-Morrow sign
- Post-extrasystolic response: obstructive HCM versus aortic stenosis
- Provocation sequence for latent obstruction
- Isoproterenol provocation
- Exercise provocation and its limitations
- Left ventricular angiography in hypertrophic cardiomyopathy
- Spade-shaped ventricle in apical hypertrophic cardiomyopathy
- Limitations of invasive assessment in HCM
- Additional findings at catheterization in HCM
Restrictive cardiomyopathy
- Defining restrictive cardiomyopathy
- Diagnostic workup of restrictive cardiomyopathy
- Four groups of restrictive cardiomyopathy
- Classification of Restrictive Cardiomyopathies
- Hemodynamic hallmarks of restrictive cardiomyopathy
- Pulmonary hypertension and atrial fibrillation in restriction
- Fixed stroke volume and the dip-and-plateau
- Medical therapy in restrictive cardiomyopathy
- Cardiac amyloidosis as the prototype infiltrative disease
- When endomyocardial biopsy is indicated for amyloidosis
- Diagnostic algorithm for cardiac amyloidosis
- Indications for invasive assessment in restrictive cardiomyopathy
- Access for simultaneous filling pressure measurement
- Avoiding catheter whip artifact
- Technique of endomyocardial biopsy
- Targeting biopsy in patchy disease
- Classic invasive findings in restrictive cardiomyopathy
- Vasodilator challenge before transplantation
- Pitfalls of vasodilator testing in low output states
- Risk and consent for endomyocardial biopsy
- Limitations in restrictive cardiomyopathy assessment
- Radiation heart disease
Constrictive pericarditis
- Presentation and epidemiology of constrictive pericarditis
- Changing etiology of constrictive pericarditis
- Surgical and medical treatment considerations
- Pericardial anatomy relevant to hemodynamics
- Pericardial thickness in surgical constriction
- Chamber and annular changes after pericardiectomy
- Two hemodynamic underpinnings of constriction
- Ventricular interdependence over the respiratory cycle
- Evaluation for Constrictive Pericarditis by Diagnostic Modality
- Evaluation for Constrictive Pericarditis by Diagnostic Modality (continued)
- Physical examination findings in constriction
- Natriuretic peptides in constriction versus restriction
- Mayo Clinic echocardiographic criteria
- Supportive echocardiographic findings
- Cross-sectional imaging in constrictive pericarditis
- Classic catheterization criteria for constriction
- Intrathoracic-intracardiac dissociation
- Simultaneous ventricular pressures in constriction and restriction
- Indications for invasive assessment in constriction
- Access requirements for the constriction study
- Rhythm requirements for respirophasic assessment
- Options when mechanical prostheses block left heart access
- Classic hemodynamic profile and mixed disease
- Pulmonary hypertension in constrictive pericarditis
- Split beats and respiratory coaching
- Recognising split beats over the respiratory cycle
- Fluid challenge and exercise provocation in constriction
- Coronary fixation and fluoroscopic calcification
- Conditions that mimic constrictive hemodynamics
- Effusive-constrictive pericarditis
- Differentiation of Constrictive Pericarditis and Restrictive Cardiomyopathy
- Differentiation of Constrictive Pericarditis and Restrictive Cardiomyopathy (continued)
Cardiac tamponade
- Definition of cardiac tamponade
- Etiology of the effusion and its implications
- Transmural pressure and the hemodynamics of tamponade
- Examination and electrocardiography in tamponade
- Echocardiographic findings in cardiac tamponade
- Indications for invasive study and pericardiocentesis
- Access routes for echocardiographic-guided pericardiocentesis
- Access sites for echocardiographic-guided pericardiocentesis
- How to Perform Echocardiographic-Guided Pericardiocentesis
- Invasive findings in cardiac tamponade
- Right atrial waveforms across restriction, constriction, tamponade and tricuspid regurgitation
- Right atrial descents across the four diseases
- Effusive-constrictive physiology after pericardiocentesis
- Pericardial and right atrial pressures before and after drainage
Synthesis and references
- Separating the four diagnoses at the table
- Conclusions
- References
- References (continued)
- References (continued)
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- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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