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CV <3 > Lecture 12: Cardiomyopathy > Flashcards

Lecture 12: Cardiomyopathy Flashcards

1
Q

Define cardiomyopathy.

A
  • Morphologically and functionally abnormal myocardium.
  • Excludes cardiac dysfunction caused by structural heart disease.

Structural HD: CAD, primary valve disease, and HTN

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2
Q

What are the 3 classifications of cardiomyopathy?

A
  • Dilated
  • Hypertrophic
  • Restrictive
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3
Q

What part of the heart is primarily affected in cardiomyopathy?

A

LV function

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4
Q

What is the initial imaging modality for cardiomyopathy?

A

Echocardiography

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5
Q

What does systolic dysfunction eventually lead to?

A
  1. LV enlargement
  2. Higher stroke volume
  3. HF develops once this fails
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6
Q

What characterizes systolic dysfunction?

A
  • Decreases in myocardial contractility
  • Reduction in LVEF
  • Heart will compensate by enlarging LV.
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7
Q

What characterizes diastolic dysfunction?

A
  • Abnormal LV relaxation and filling
  • Elevated filling pressures
  • Does not always occur with systolic dysfunction.
  • However, if there is systolic dysfunction, it will always occur.
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8
Q

What is myocarditis?

A
  • Inflammatory, infiltrative process due to both infectious and non-infectious causes.
  • Leads to myocardial dysfunction and dilated cardiomyopathy.
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9
Q

What are the two main mechanisms by which myocarditis occurs?

A
  • Host-mediated: direct cytotoxic effect of the causative agent.
  • Autoimmune-mediated: secondary immune response.
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10
Q

What occurs in the acute phase of myocarditis?

A
  • First 2 weeks
  • Myocyte death due to causative agent.
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11
Q

What occurs in the chronic phase of myocarditis?

A
  • After 2 weeks
  • Result of inappropriate, overactive immune response.
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12
Q

What are the primary viral causes of myocarditis?

A
  • Adenovirus
  • Coxsackie B virus
  • CMV
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13
Q

What are the primary toxins that cause myocarditis?

A
  • Alcohol
  • Anthracyclines
  • Cocaine
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14
Q

Who is myocarditis MC in?

A

20-50 y/o men

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15
Q

What typically precipitates infective myocarditis?

A
  • Acute febrile illness/respiratory infection

Will develop a few days or weeks after.

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16
Q

What are the classic symptoms associated with infective myocarditis?

A
  • SOB
  • Pleural chest pain
  • Fever/chills
  • HF
  • Arrhythmias
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17
Q

What PE findings are we looking for in infective myocarditis?

A
  • Pericardial friction rub
  • S3/S4
  • Mitral/tri regur
  • Volume overload
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18
Q

What are the important initial diagnostic tests to order for suspected infective myocarditis?

A
  • EKG (PVCs)
  • Cardiac Biomarkers (elevated troponins)
  • CXR (non-specific)
  • Echocardiogram
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19
Q

What labs are appropriate to order for suspected infective myocarditis?

A
  • CRP
  • ESR
  • CBC (eosinophilia)
  • Rheumatology workup
  • Serum viral antibody titers
  • BNP > 100
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20
Q

How is infective myocarditis concretely diagnosed?

A

Histologic evidence via endomyocardial biopsy.

Only do this if there is a high probability it will change management.

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21
Q

What is the primary treatment for myocarditis?

A
  1. Consult cardiology
  2. ACEi, BBs, Colchicine (pain)
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22
Q

What is the primary treatment for noninfectious myocarditis?

A

Monitoring until HF symptoms start occurring.

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23
Q

What is the #1 reason for heart transplant?

A

Dilated cardiomyopathy

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24
Q

What is dilated cardiomyopathy?

A
  • LVEF < 40%
  • No CAD or valvular disease
  • Dilation and impaired contraction of one or both ventricles

Regurgitation may occur due to the stretch of mitral/aortic valves.

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25
Q

Who is dilated cardiomyopathy MC in?

A

Black patients

26
Q

What is the primary cause of dilated cardiomyopathy?

A

Idiopathic

27
Q

What are the two main diseases that can lead to DCM?

A
  • Chagas disease (protozoan infection in central and south america)
  • Lyme disease (conduction abnormality)

Trypanosoma cruzi

28
Q

What are the 3 main bacterial causes of DCM?

A
  • TB
  • Meningococcal
  • Pneumococcal
29
Q

What is the main genetic inheritance of DCM?

A

Autosomal Dominant

30
Q

When specifically does peripartum CM occur?

A

Late pregnancy or early postpartum.

Early treatment can resolve it within 2-3 months.

31
Q

What is the DCM etiology mnemonic?

A
  • Alcohol Abuse
  • Beriberi (wet)
  • Coxsackie B myocarditis
  • Chronic cocaine use
  • Chagas’ disease
  • Doxorubicin toxicity

ABCCCD

A Bunch of stuff Can Cause Cardiac Disease

32
Q

What EKG findings can be seen in DCM?

A
  • Tachycardia
  • Pulsus alternans
  • LBBB
33
Q

What symptom would prompt us to order a BNP or NT-proBNP for DCM?

A

Dyspnea

34
Q

What characterizes restrictive cardiomyopathy?

A
  • Nondilated ventricle with impaired filling
  • Fibrosis or infiltration of the ventricular wall
  • Diastolic dysfunction
  • Biatrial enlargement

Most uncommon type.

35
Q

What are the primary causes of restrictive cardiomyopathy?

A
  • Infiltrative disorders (amyloidosis, sarcoidosis, fatty infiltration)
  • Storage Disease (Hemochromatosis, Fabry’s)
  • Radiation, chemo, carcinoid heart disease, hypereosinophilic syndrome

MCC is chemo in the US.

36
Q

How do we treat restrictive cardiomyopathy?

A
  • Treat underlying causes
  • Diuretics (edema and congestion)

Most likely bc it backs up into the lungs since filling gets back up due to poor diastolic function.

37
Q

What characterizes hypertrophic cardiomyopathy?

A
  • LV hypertrophy
  • Interventricular dysfunction most commonly involved as myocytes build up.
  • NOT due to HTN or valvular issues.
  • Diastolic dysfunction
38
Q

How is HCM typically inherited?

A

Autosomal dominant

39
Q

What valve is at risk in HCM?

A

Aortic valve, since it sits above the interventricular septum.

40
Q

How does HCM typically present?

A
  • Fatigue
  • CP
  • CHF
  • Syncope
  • SCA
  • Carotid pulses bisferiens d/t mimicked AS
41
Q

What murmur may occur in HCM?

A
  • Mid-systolic, harsh, 3rd-4th intercostal that is louder with valsalva
  • Quieter on squatting.
42
Q

What is the usual EKG change seen in HCM?

A

LVH

43
Q

What is the diagnostic modality of choice for HCM?

A

Echocardiogram

44
Q

What medications are we advised to AVOID in HCM treatment?

A
  • Diuretics
  • Vasodilators

We do not want lowering of preload.

45
Q

What medications are indicated for HCM?

A
  • BBs
  • Verapamil specifically
46
Q

What procedures may help with HCM?

A
  • Septal myectomy
  • Alcohol septal ablation
47
Q

What screening is recommended for any 1st degree relative with HCM?

A
  • Annual echo until 20
  • Q5years afterwards
48
Q

What is the MCC of HF in the US?

A

Ischemic cardiomyopathy

49
Q

What is the typical cause of ischemic cardiomyopathy?

A

CAD

50
Q

What characterizes ischemic cardiomyopathy?

A
  • Systolic dysfunction
  • LV involvement primarily
  • CHF (edema, dyspnea, JVD)
51
Q

What should appear on echo for ischemic cardiomyopathy?

A
  • Decreased LVEF
  • Regional wall motion abnormality
52
Q

What diagnostic study after an echo may help with ischemic cardiomyopathy?

A

Coronary angiography

53
Q

How do we manage ischemic cardiomyopathy?

A
  • Revascularization via PCI or CABG
  • Nuclear viability study to check for sleeping myocardium
  • CHF management
54
Q

How do we prevent SCA?

A
  • External wearable defibrillator (Lifevest)
  • ICD
55
Q

What characterizes arrhythmogenic RVCM?

A
  • Ventricular arrhythmias
  • RV dilation
  • Causes sudden death in young adults in Europe primarily
56
Q

How do we manage arrhythmogenic RVCM?

A
  • Diuretics for systemic congestion
  • Anitarrhythmics, ablation, or ICD for ventricular arrhythmias.
57
Q

What is Left ventricular noncompaction cardiomyopathy?

A
  • Congenital cardiomyopathy
  • Altered myocardial wall
58
Q

How do we treat Left ventricular noncompaction cardiomyopathy?

A

Heart transplant

59
Q

What is takotsubo cardiomyopathy?

A
  • Stress-induced/broken heart syndrome
  • Causes ACS due to high catecholamine surge

MC in postmenopausal women.

60
Q

How is takotsubo diagnosed?

A

LV apical ballooning

61
Q

How is takotsubo’s treated?

A

BBs for a year

CV <3 (25 decks)

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