The Common Vein

Hi Ashwin

Sorry for the delay

We should distinguish pathologically between  biventricular infiltration and hypertrophy

Biventricular hypertrophy is  really rare event
Biventricular thickening /infiltration is also uncommon but should be what we think about when both ventricles are thick

• So first question to address
  • Normal thickness of LV in diastole (number to remember is 1.2  but upper limits 1.4cms)
  • Normal thickness of RV in diastole (hard to measure but 3-5mms)
• next question
  • What are the infiltrative cardiomyopathies that can cause biventricular infiltration
  • Most important to remember are
    • amyloidosis
    • sarcoidosis
    • Less commonly
      • Hemochromatosis
      • Fabry disease,
      • Danon disease, and
      • Friedreich?s ataxia.
  • How do they affect function
    • primarily affect diastolic function and
    • less commonly systolic function

Examples of  Biventricular Thickening/Infiltration?

Our case with SLE, Sjogrens Raynauds

Two other more common causes of biventricular infiltration and thickening

• • Amyloidosis of the heart
  • Sarcoidosis of the heart

 

• Amyloid Cardiomyopathy

Left Ventricular Septal and Free Wall Thickening Atrial Septal Thickening

CARDIAC AMYLOIDOSIS with LV THICKENING – INFILTRATION VS LVH

Non gated axial CT through the opening of the mitral valve suggests early diastole confirms concentric thickening. The septum measures 24.1mms while the free wall measures 19.7mms. Upper limits normal is 14mms.

Cardiac Amyloidosis with Right Ventricular InfiltrationCARDIAC AMYLOIDOSIS

Non gated sagittal CT through the RVOT shows RVH (right ventricular thickening) wall measuring between 6-7mm  involving both the RV inflow as well as the outflow See Case 006

Delayed gadolinium in Short Axis Shows Diffuse Dominantly Subendocardial and Myocardial LGE in both LV and RV

• Key Issues for Cardiac Amyloid
  • The hallmark of CA
    • increased left ventricular thickness
    • but can be LV and RV and
    • BIatrial dilatation
    • Subendocardial LGE
    • Apical sparing
• Difficult to null

Sarcoid Cardiomyopathy with Thickening of Both Ventricles Due to Biventricular Infiltration and Subepicardial LGE

 

Key Issues  for Sarcoidosis

• Similar affinity for lymphatics as in sarcoid of the lungs
  • Lymphatics of the heart are subepicardial
    • LGE characteristically subepicardial
  • Also patchy, multifocal  nodular mid myocardial
  • most characteristic
    • free wall and
    • medial basal septum (conduction abnormalities)

25-30% cardiac involvement

 

• Other Infiltrative Disease with Biventricular Infiltration and Thickening

  • • hemochromatosis
    • Less commonly
      • Fabry disease,
      • Danon disease, and
      • Friedreich?s ataxia.

AD will discuss the following diagrams

“A” is for congo red Amyloid

Re Other Chamber Involvement with Wall Thickening and Enlargement

and Sarcoidosis

Disease Location and Form

 

Next John Lee,  Diastolic Heart Failure aka HF with Preserved EF