Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Stage 3 > Cardiology: Cardiomyopathy + Aortic Dissection > Flashcards

Cardiology: Cardiomyopathy + Aortic Dissection Flashcards

1
Q

What is cardiomyopathy?

A

Structural and functional abnormality of the myocardium without CAD, HTN, valvular or congenital heart diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the four main types of cardiomyopathy?

A

1) Dilated
2) Hypertrophic (HOCM)
3) Restrictive
4) Arrhythmogenic right ventricular cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common type of cardiomyopathy?

A

Dilated cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When do most patients present with dilated cardiomyopathy?

A

Between age 20-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes of dilated cardiomyopathy?

A

1) Ischaemic changes over time can manifest as dilated cardiomyopathy esp. post MI
2) Hypertension
3) Genetic and congenital - familial dilated cardiomyopathy, sporadic gene mutations in idiopathic
4) Toxin-related i.e. drugs
5) Infiltrative - haemochromatosis, amyloidosis, sarcoidosis
6) Peripartum (rare)
7) Thyrotoxicosis
8) Infectious
9) Stress-induced cardiomyopathy (Takotsubo cardiomyopathy)
10) Idiopathic - when other potential causes have been ruled out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which drugs can cause dilated cardiomyopathy?

A

1) Excessive alcohol consumption - leads to myocardial dysfunction and subsequent DCM
2) Cocaine - ischaemia and DCM
3) Anthracycline chemotherapy (doxorubicin)
4) Cyclophosphamide
5) Antiretroviral drugs (zidovudine)
6) Chloroquine
7) Clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are infectious causes of dilated cardiomyopathy?

A

1) Secondary to myocarditis
2) Direct result of infection from HIV, Lyme disease and Chagas disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is stress induced cardiomyopathy (Takotsubo cardiomyopathy)?

A

Transient left ventricular ballooning precipitated by intense psychologic stress - almost all patients recover completely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the clinical features of dilated cardiomyopathy (see on echo)?

A

Dilation and poor contraction of the left ventricle or both ventricles (EF < 40%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the EF in dilated cardiomyopathy?

A

< 40% (of left or both ventricles, poor contraction + dilation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the symptoms of dilated cardiomyopathy?

A

Most common = heart failure symptoms:
1) Exertional dyspnoea
2) Orthopnoea
3) Paroxysmal nocturnal dyspnoea
4) Peripheral oedema
Consequences of cardiomyopathy:
5) Arrhythmia - AF or VT
6) Conduction disturbances
7) Sudden cardiac death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which arrhythmias can occur as a result of dilated cardiomyopathy?

A

AF or VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Symptoms and signs of which condition occur in dilated cardiomyopathy?

A

Heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the examination findings in dilated cardiomyopathy?

A

1) Displaced apex beat
2) S3 gallop rhythm (rapid ventricular filling)
3) Mitral regurgitation murmur (due to displacement of the valve leaflets)
4) Signs of heart failure - oedema, hepatomegaly, ascites, raised JVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which two signs are heard on auscultation in dilated cardiomyopathy?

A

1) S3 gallop rhythm
2) Mitral regurgitation murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What might you see on ECG in dilated cardiomyopathy?

A

Poor R wave progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the diagnostic investigation for dilated cardiomyopathy?

A

Echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is hypertrophic cardiomyopathy (HCM)?

A

A genetic condition characterised by left ventricular hypertrophy of varying degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes hypertrophic cardiomyopathy?

A

Mutation in one of several myocyte sarcomere genes e.g. myosin and troponin, causing myocyte hypertrophy and disarray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which gene is mutated in HCM?

A

One of several myocyte sarcomere genes e.g. myosin and troponin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the inheritance of HCM?

A

Autosomal dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What causes the genetic defect in HCM?

A

1) Autosomal dominant inheritance
2) 50% of cases due to sporadic mutations where the parents do not carry a disease-causing gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When does HCM develop?

A

1) Most of the hypertrophy develops during childhood and adolescence
2) Genetic variation means some late onset disease does not occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the consequences of HCM?

A

The abnormal morphology of the left ventricle can cause severe consequences:
1) Left ventricular outflow tract obstruction (LVOTO) - this is known as HOCM
2) Diastolic dysfunction
3) Ischaemia
4) Mitral regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the symptoms of HCM?

A

1) Many patients have little to no symptoms and the initial presenting conditions can sometimes be presyncope, syncope or sudden death
2) Exertional dyspnoea
3) Fatigue
4) Chest pain (anginal or atypical)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the signs of HCM?

A

Typical findings:
1) Jerky pulse
2) Double apex beat
3) Harsh ejection systolic murmur
4) Apical thrill
(physical examination can also be normal or non-specific)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the ECG findings in HCM?

A

1) Abnormal Q waves
2) Deeply inverted T waves
3) Left ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do you diagnose HCM?

A

Echo - shows an area of left ventricular wall thickness in the absence of any other cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is restrictive cardiomyopathy?

A

Non-dilated non-hypertrophied ventricles with impaired ventricular filling

30
Q

What are inherited genetic causes of restrictive cardiomyopathy?

A

Familial non-infiltrative cardiomyopathy (inherited genetic disorders)

31
Q

What are infiltrative causes of restrictive cardiomyopathy?

A

1) Amyloidosis
2) Sarcoidosis
3) Gaucher disease
4) Hurler syndrome
5) Fatty infiltration

32
Q

What are storage causes of restrictive cardiomyopathy?

A

1) Haemochromatosis
2) Fabry disease
3) Glycogen storage disorders

33
Q

What are other causes of restrictive cardiomyopathy?

A

1) Diabetic cardiomyopathy
2) Scleroderma
3) Hypereosinophilic syndrome (Löffler’s)
4) Radiation
5) Chemotherapy (anthracyclines e.g. doxorubicin and daunorubicin)

34
Q

How does restrictive cardiomyopathy present?

A

1) Often present as heart failure
2) Sometimes present similar to constrictive pericarditis
3) Up to 75% have associated AF

35
Q

How do you diagnose restrictive cardiomyopathy?

A

1) Echo (shows thickened ventricular walls and valves) AND
2) Cardiac MRI (useful for distinguishing between restrictive cardiomyopathy and constrictive pericarditis)

36
Q

What causes aortic dissection?

A

A tear in the tunica intima of the aorta creates a false lumen whereby blood can flow between the inner and outer layers of the walls of the aorta

37
Q

What are risk factors for aortic dissection?

A

1) Hypertension
2) Connective tissue disease e.g. Marfan’s syndrome
3) Valvular heart disease
4) Cocaine/amphetamine

38
Q

What classification is used to classify aortic dissections?

A

Stanford classification

39
Q

What is a Stanford Type A aortic dissection?

A

Involves the ascending aorta + arch of aorta

40
Q

What is a Stanford Type B aortic dissection?

A

Involves the descending aorta

41
Q

Which patients usually present with aortic dissection?

A

Men > 50

42
Q

How does aortic dissection present?

A

1) Sudden onset tearing chest pain or interscapular pain radiating to the back
2) Depending on how far the dissection extends it can also present with bowel/limb ischaemia, renal failure and syncope

43
Q

What are the examination findings in aortic dissection?

A

1) Radio-radial delay
2) Radio-femoral delay
3) Blood pressure differential between arms

44
Q

What investigation is used to diagnose aortic dissection?

A

CT angiogram

45
Q

What might you see on ECG in aortic dissection?

A

Ischaemia in specific territories if dissection extends into coronary arteries

46
Q

What might you see on echo in aortic dissection?

A

Pericardial effusion + aortic valve involvement

47
Q

What might you see on CXR in aortic dissection?

A

Widened mediastinum

48
Q

What will blood tests show in aortic dissection?

A

1) Raised troponin
2) Raised D dimer

49
Q

Why is prompt diagnosis and treatment of aortic dissection required?

A

Bc aortic rupture carries an 80% mortality rate

50
Q

What is the initial management of aortic dissection?

A

1) Resuscitation
2) Cardiac monitoring
3) Strict BP control e.g. IV metoprolol infusion

51
Q

Which medication is given in aortic dissection and why?

A

IV metoprolol infusion (strict BP control)

52
Q

How is a Type A aortic dissection managed?

A

(Open) surgery e.g. aortic graft

53
Q

How is a type B aortic dissection managed?

A

1) Normally managed conservatively with BP control
2) If evidence of end organ damage then endovascular or open repair may be performed

54
Q

What are complications of aortic dissection?

A

1) Death due to internal haemorrhage
2) Rupture
3) End organ damage (renal or cardiac failure)
4) Cardiac tamponade
5) Stroke
6) Limb ischaemia
7) Mesenteric ischaemia

55
Q

What causes cardiac tamponade?

A

1) Accumulation of fluid, blood, purulent exudate or air in the pericardial space raises the intra pericardial pressure
2) Subsequently, diastolic filling is reduced thereby reducing the cardiac output
3) It is a life threatening emergency that requires prompt diagnosis with echocardiogram and treatment

56
Q

What does cardiac tamponade cause?

A

Reduced diastolic filling + cardiac output

57
Q

What are the symptoms of cardiac tamponade?

A

1) SOB
2) Tachycardia
3) Confusion
4) Chest pain
5) Abdominal pain

58
Q

What is the name for the set of signs of cardiac tamponade?

A

Beck’s triad

59
Q

What are the key signs of cardiac tamponade (Beck’s triad)?

A

1) Hypotension
2) Quiet heart sounds
3) Raised JVP

60
Q

What are the risk factors for cardiac tamponade?

A

1) Malignancy
2) Purulent pericarditis
3) Severe thoracic trauma
4) MI
5) TB

61
Q

What are two additional signs seen in cardiac tamponade to Beck’s triad?

A

1) Raised JVP on inspiration - Kussmaul’s sign
2) Pulsus paradoxus - pulse fades on inspiration

62
Q

What is the diagnostic test for cardiac tamponade?

A

Echo

63
Q

What is Kussmaul’s sign?

A

Raised JVP on inspiration

64
Q

What is pulsus paradoxus?

A

Pulse fades on inspiration

65
Q

What might you see on ECG in cardiac tamponade?

A

Low voltage QRS complexes or electrical alternans

66
Q

What would you see on CXR in cardiac tamponade?

A

Large globular heart

67
Q

What would you see on Echo in cardiac tamponade?

A

Shows amount of fluid around the heart and quantifies the level of ventricular compromise

68
Q

What would you do after echo diagnosing pericarditis?

A

Pericardiocentesis - allows for sampling of the fluid to find the underlying cause + treats the immediate problem

69
Q

What is the first line management for pericarditis in patients who are haemodynamically unstable?

A

Pericardiocentesis

70
Q

What is the first line treatment in patients with haemopericardium, associated malignancy or traumatic/purulent effusion?

A

Surgical drainage

71
Q

What are the complications of pericardiocentesis?

A

1) PTX
2) Damage to the myocardium or coronary vessels
3) Thrombus
4) Arrhythmias/cardiac arrest
5) Damage to the peritoneum

72
Q

What should all patients have post pericardiocentesis and why?

A

CXR - to exclude PTX

Stage 3 (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions