Thread by @DavidWienerMD

#FITSurvivalGuide on Restrictive Cardiomyopathy (RCM) vs Constrictive Pericarditis (CP).

In both:

💠Diastolic RV & LV impaired; systolic function preserved
💠HFpEF phenotype, predominant “R sided” signs (­JVP, edema, ascites)

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@dr_chirumamilla @Pooh_Velagapudi @bcostelloMD

🔑 to understanding different filling:
RCM = myocardial disorder
CP = pericardial disorder.

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@majazayeri @fawazalenezi55 @SanChris999 @GuruKowlgi @Nidhi_Madan9 @sabeedak1 @noshreza @SaggerMawri @nsivcd @DrManiCardio @khandelwalMD @drjohnm @heartdoc45 @zainasadEP @docaward

RCM

💠Stiff myocardium➡️early diastolic ⏫­­LV and RV pressure w/small vol ∆
💠 Echo: early diastolic abnormalities
💠High initial flow (= E wave; so E/A >2); ends abruptly (⬇️E decel time)

⚠️Restrictive pattern also in stage 3 HFrEF w/abnl early diastole

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Etiologies and evaluation of RCM

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@KevinShahMD @sairasamani @sarahhudsonuk @avolgman @rahatheart1 @DavidWienerMD @sunnyvmd @monsangh @feelingthepulse @achoiheart @akshitsharmaMD @adcaTicTocDoc @rezaemaminia @MartyTamMD @true_EP @onco_cardiology @sheelakrishmd @skilicmd

CP

💠Pericardial shell ➡️dissociation between intrathoracic pressure (PCWP) and intracardiac (ICP) ∆s
💠Inspiration: PCWP outside the sac &⬇️; ICP inside the sac and ≠ ⬇️
💠⬇️driving gradient & LV doesn’t fill as well.

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@ekgpdx @chadialraies @mirvatalasnag

Echo in CP: exaggerated ventricular interdependence:

💠Inspiration (⬇️LV filling)
💠⬇️ MV flow
💠Septum shifts left (“bounce’ on echo)
💠RV fills better, ⬆️TV flow
💠Expiration = opposite; & HV late diastolic flow reversal (due to ⬇️RV filling)

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Other #EchoFirst stuff in CP

💠To dx V interdependence: turn on respirometer on machine (ask a sonographer!)
💠Other D/O also have V interdependence (tamponade)
💠Annulus reversus (lateral e’ < septal – opposite of usual). Lateral not septal
myocardium bound by pericardium
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Etiologies of CP vary geographically; include

💠Idiopathic
💠Post-surgical
💠Post radiation therapy
💠Connective tissue disease
💠Neoplasia
💠Uremia
💠TB (developing countries)

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@venkmurthy @fischman_david @drtoniyasingh @drmarthagulati @vietheartPA @regadenoson

Advanced imaging helps distinguish; and helps establish etiologies (details in chart; images here!)

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@cardiojaydoc02 @mark_kaeppler @mmamas1973 @CMichaelGibson @DocSavageTJU @rajivxgulati @SVRaoMD @MinnowWalsh @DrKevinCampbell @krishmd @cardiodee @DrLaxmiMehta

Cath

💠Both: early rapid filling, square root sign.
💠“Classic” criteria to distinguish (= pressures,­ ⬆️RVSP, LVEDP>RVEDP) are < specific than thought

🔑 for CP: RV vs LV filling varies with respiration. PCWP-LVP gradient varies by >5 mm with respiration

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References and Summary Table:

JACC 2016;68:2329–47
JACC 2016;67:2061–76
Circ Res 2017;121:819-837
J Am Coll Cardiol 2018;71:1149–66
Am Coll Cardiol 2018;71:1130–48

Cath and multimodality colleagues: input invited! 😉

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@ash71us @purviparwani @gina_lundberg

@iamritu @pamelasdouglas @SharonneHayes @EilidhPinkChic @JelaniAini @DrAnneAlbers @biljana_parapid @DavidLBrownMD @willsuh76 @mswami001 @DrSheilaSahni @DrFerNunez @HeartOTXHeartMD @keaglemd @DrQuinnCapers4 @narrowQRS @dr_danMD @yogitar

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