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Chapter 61: Restrictive Heart Diseases

Which of the following echocardiographic findings are associated with restrictive physiology?

A. An increased ratio of early diastolic filling to atrial filling (≥ 2)

B. Decreased E-deceleration time (< 160 ms)

C. Increased isovolumetric relaxation time

D. A and B

E. B and C

The answer is D. (Hurst’s The Heart, 14th Edition, Chap. 61) Restrictive physiology describes a pattern of ventricular filling in which increased myocardial stiffness causes a precipitous elevation of ventricular pressure matched by a limited increase in volume; the resultant diastolic dysfunction is characterized by a pattern of mitral inflow Doppler velocities with an increased ratio of early diastolic filling to atrial filling (≥ 2) (option A), decreased E-deceleration time (< 160 ms) (option B), and decreased isovolumetric relaxation time (option C).

Which of the following features are consistent with the European Society of Cardiology and American Heart Association definitions of restrictive cardiomyopathy?

A. Normal or reduced diastolic volumes of one or both ventricles

B. Increased ventricular wall thickness

C. Normal or reduced systolic volumes of one or both ventricles

D. A and B

E. A and C

The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 61) According to the definition of the European Society of Cardiology (ESC), “Restrictive cardiomyopathies are defined as restrictive ventricular physiology in the presence of normal or reduced diastolic volumes of one or both ventricles, normal or reduced systolic volumes, and normal ventricular wall thickness.”1 According to the definition of the American Heart Association (AHA), “Primary restrictive non-hypertrophied cardiomyopathy is a rare form of heart muscle disease and a cause of heart failure that is characterized by normal or decreased volume of both ventricles associated with biatrial enlargement, normal left ventricular (LV) wall thickness and atrioventricular (AV) valves, impaired ventricular filling with restrictive physiology, and normal (or near normal) systolic function.”2 Both definitions emphasize restrictive ventricular physiology, normal or reduced volume of one or both ventricles, and normal wall thickness.

A 43-year-old woman is admitted to your care for acute decompensated heart failure with preserved ejection fraction. The family history is notable for restrictive cardiomyopathy. She has experienced a nearly 25-pound weight gain, is orthopneic, and is short of breath at rest. Which of the following would you not expect to observe during her physical examination?

A. Prominent jugular venous pulse and X and Y descents

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