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SALMAN HARRISON'S > 254 - Cardiomyopathy and Myocarditis > Flashcards

254 - Cardiomyopathy and Myocarditis Flashcards

1
Q

How much of the HF (Heart Failure) does cardiomyopathy account for?

A

5-10%

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2
Q

Define cardiomyopathy

A

Disorder characterized by morphologically and functionally abnormal myocardium in the absence of any other disease that is sufficient, by itself to cause the observed phenotype

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3
Q

How can cardiomyopathies by classified (3)?

A
  1. Dilated
  2. Restrictive
  3. Hypertrophic
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4
Q

What are the early symptoms of cardiomyopathy during exercise (3)?

A
  1. Exertional intolerance
  2. Breathlessness
  3. Fatigue
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5
Q

How much of the DCM (Dilated CardioMyopathy) is heritably?

A
  1. At least 30%
  2. Usually Autosomal dominant
  3. Occasional X-linked
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6
Q

Name two metabolic diseases related to cardiomyopathy in which early diagnosis is important

A
  1. Fabry’s disease

2. Gaucher disease

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7
Q

What is the EF (normal > 55%) in symptomatic cardiomyopathy (dilated, restrictive, hypertrophic)?

A
  1. <30% when symptoms are severe
  2. 25-50%
  3. > 60%
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8
Q

What is the left ventricular diastolic dimension (normal < 55) in symptomatic cardiomyopathy (dilated, restrictive, hypertrophic)?

A
  1. > = 60 mm
  2. <60
  3. often decreased
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9
Q

What are the congestive symptoms in symptomatic cardiomyopathy (dilated, restrictive, hypertrophic)?

A
  1. Left before right, except right prominent in young adults
  2. Right often dominants
  3. left sided congestion at rest may develop late
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10
Q

What are the arrhythmias in symptomatic cardiomyopathy (dilated, restrictive, hypertrophic)?

A
  1. Ventricular tachyarrhythmias, conduction block in Chagas’ disease, atrial fibrillation
  2. Ventricular uncommon- except in sarcoidosis, conduction block and amyloidosis, atrial fibrillation
  3. Ventricular tachyarrhythmias, atrial fibrillation
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11
Q

Define DCM

A
  1. Enlarged left ventricle (>=60 mm)
  2. Reduce EF (<30%)
  3. Systolic failure
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12
Q

Which valve is likely to be affected in DCM?

A

Mitral, resulting in mitral regurgitation

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13
Q

Which drugs might have a dramatic effect on patients with DCM?

A
  1. Beta adrenergic antagonists coupled with renin angiotensin system inhibition
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14
Q

When will we recommend cardiac resynchronization in patients with DCM?

A

When LBBB precedes clinical heart failure by many years

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15
Q

What are the two most common infective agents leading to myocarditis?

A
  1. Viruses

2. Trypanosoma cruzi protozoa

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16
Q

List what is necessary for myocarditis diagnosis (5)?

A
  1. ECG
  2. Echo
  3. CPK
  4. Troponin
  5. MRI
17
Q

What are the three levels of myocarditis?

A
  1. possible subclinical acute myocarditis- viral syndrome+ cardiac biomarkers/ECG hinting acute injury/reduced LV EF/ regional wall motion abnormality
  2. probable acute myocarditis- 1+carduac symptoms
  3. definite myocarditis- there’s histological/immunohistologic evidence of inflammation on endomyocardial biopsy
18
Q

What are the most common viral agents causing myocarditis (4)?

A
  1. Coxsackie
  2. Adenovirus
  3. HIV
  4. HCV
19
Q

How do you treat myocarditis?

A

No specific treatment- general recommendations for DCM

20
Q

What are the most common parasitic agents causing myocarditis (3)?

A
  1. T. Cruzi (Chagas)
  2. Trypanosomiasis
  3. Toxoplasmosis
21
Q

What are the most common bacterial agents causing myocarditis (3)?

A
  1. Diphtheria
  2. Clostridial infections
  3. Tuberculosis
22
Q

What are the most causes for noninfective myocarditis (2)?

A
  1. Sarcoidosis

2. Giant cell myocarditis

23
Q

How does Giant cell myocarditis usually present (2)?

A
  1. Rapidly progressive heart failure

2. Tachyarrhythmias

24
Q

In which stage of (PPCM) pregnancy does peripartum cardiomyopathy develops?

A

The last trimester or within 6 months post partum

25
Q

What are the risk factors for PPCM (6)?

A
  1. High maternal age
  2. Increased parity
  3. Twins
  4. Malnutrition
  5. Tocolytic therapy
  6. Preeclampsia/ toxemia
26
Q

What is the most common toxin implicated in chronic DCM?

A

Alcohol

27
Q

What are the most common drugs causing myocarditis (5)?

A
  1. Anthracycline (doxorubicin)
  2. Trastuzumab (Herceptin)
  3. Cyclophosphamide
  4. Tyrosine kinase inhibitors
  5. Proteasome inhibitor (MM treatment)
28
Q

What are the metabolic causes for cardiomyopathy?

A
  1. Endocrine disorders (hyper/hypothyroidism, Pheochromocytoma, )
  2. Obesity
  3. Thiamine deficiency (Beri Beri)
  4. Hypocalcemia/ hypophosphatemia
  5. Hemochromatosis
29
Q

How does Takotsubo presents?

A
  1. Pulmonary edema
  2. Hypotension
  3. Chest pain + ECG changes mimicking infraction
30
Q

How would you treat Takotsubo?

A 
No therapies have been proven beneficial
but what we usually use:
1. Nitrate
2. Intraaortic balloon pump
3. Alpha and beta blockers
4. Magnesium
31
Q

How much of DCM cases are diagnosed as idiopathic?

A

2/3

32
Q

What are the characteristics of restrictive cardiomyopathy

A
  1. Abnormal diastolic function
  2. Atrial enlargement
  3. Left ventricular dilation
  4. Right sided symptoms (edema, abdominal discomfort, ascites)
  5. JVP+ Kussmaul’s sign
33
Q

What are the most common causes of RCM (6)?

A
  1. Amyloidosis
  2. Hemochromatosis
  3. Metabolic defects (Fabry’s, Glycogen storage)
  4. Carcinoid
  5. Radiation
  6. Sarcoidosis
34
Q

Define hypertrophic cardiomyopathy

A

Left ventricular hypertrophy that develops in the absence of causative hemodynamic factors (hypertension, aortic valve disease, systemic infiltrative/storage disease)

35
Q

What are the two kinds of HCM?

A
  1. HCM with obstruction

2. HCM without obstruction

36
Q

Where is the typical location for maximal hypertrophy in HCM?

A

Interventricular septum

SALMAN HARRISON'S (163 decks)

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