3 - Cardiomyopathies Flashcards by Samuel Halajian

What is the second MC cause of SCD in teens and the leasing cause of death in competitive athletes?

Hypertrophic cardiomyopathy

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The primary cardiomyopathies:

Slide 7 long list

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Common causes of secondary cardiac myopathies

Slide 8 - long list

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Clinical features and ECG for dilated cardiomyopathy?

Congestive heart failure
Chest pain
Regurgitant murmurs

LVH, poor R-wave progression

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Clinical features and ECG for myocarditis?

Fever
Tachycardia
Myalgias
CP

Nonspecific ST-T wave changes, often with pericarditis

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Clinical features and ECG for HOCM

DOE
CP
Palpitations
Syncope
Prominent J wave
Pulsus bisferiens
Systolic ejection murmur (increases with valsalva and decreases with squatting)

LVH, large septal Q waves

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Usual cause of dilated cardiomyopathy?

Idiopathic

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What is the primary indication for cardiac transplant in the US?

Dilated cardiomyopathy

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Risks for dilated cardiomyopathy

black, male, age 20-50

Majority have advanced dz by the time of presentation

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Describe dilated cardiomyopathy?

Systolic and diastolic dysfunction and diminished LV and RV contractile force, resulting in low CO and increased end-systolic and end-diastolic ventricular volumes

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Hallmarks of dilated cardiomyopathy?

LV (and often RV) dilation accompanied by normal LV wall thickness

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Sxs of dilated cardiomyopathy?

Looks like CHF

DOE
Orthopnea
PND
Bibasilar rales
Dependent edema

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Why CP with dilated cardiomyopathy?

Limited coronary vascular reserve rather than atherosclerotic dz

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Clinical features of dilated cardiomyopathy

Impaired valve closure

Holosystolic mitral or tricuspid regurgitant murmurs at LLSB

Enlarged liver and pulsatile if tricuspid insufficiency is significant

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Dx of dilated cardiomyopathy?

Not usually made in the ED

Typically made at follow-up via echo

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CXR with dilated cardiomyopathy

Enlarged cardiac silhouette and increased cardiothoracic ratio

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MC findings on ECG for dilated cardiomyopathy?

LV hypertrophy and left atrial enlargement

Also, a-fib is common

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How urgent is the echo with dilated cardiomyopathy?

Driven by patient presentation

Get it when:

Cause of HF is uncertain

To exclude known causes of HF that may be correctable

To estimate ejection fraction

To R/O other potential complications that may be amenable to therapy

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What improves pt survival in cardiomyopathy pts?

ACE inhibitors
Blockers

Carvedilol

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Dilated cardiomyopathy pts with ventricular ectopy may benefit from:

Amiodarone

Implanted pacemaker defibrillator

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ED txt for dilated cardiomyopathy 2/2 noncompliance

Nitrates
IV diuretics
Re-start normal meds
Patient counseling

Make sure you r/o severe issues, as well (i.e. possible ischemia)

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LVAD?

Awesome and weird device for severe dilated cardiomyopathy patients - moves the blood for em

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Hallmarks of HCM?

On echo -> asymmetric septal hypertrophy and histologic hypertrophy associated with myocardial fiber disarray surrounding areas of increased loose CT

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Describe the hemodynamics of HCM

Study These Flashcards

Abnormal LV diastolic dysfunction d/t reduced compliance of the hypertrophied left ventricle

In HCM, decreased compliance is reflected by:

Increase in LV filling pressure

Most frequent complaint associated with HCM?

DOE 2/2 exercise-induced sinus tach

Why CP in HCM?

Imbalance between o2 demand of hypertrophied LV and the available myocardial blood flow

How do HCM pt’s respond to NTG?

Poorly - highly variable Bc its a problem with the heart structure, not vessel issues

During a HCM episode, pt’s may complain of:

Palpitations d/t forceful ventricular contractions

Is JVP elevated in HCM pts?

Nope (not usually)

In most patients with HCM, cardiac exam will reveal

Where is the systolic ejection murmur of HCM best heard?

LLSB or at the apex

Maneuver to accentuate the murmur of HCM

Standing Valsalva

Maneuver to decrease the HCM murmur

Squatting Passive leg elevation Hand grip *things that increase LV filling

Effective bedside interventions on the murmur of HCM vs mitral valve prolapse

Chart - slide 33 *YOU NEED TO KNOW THIS

DX of HCM

Echo to confirm ECG - LVH and LAE, disproportionate septal hypertrophy

If the HCM pt experiences syncope:

They’re getting admitted

Mainstay therapy for CP in pt’s with HCM:

B-blockers Slow that HR down

Common causes of acute pericarditis:

Slide 40 KNOW THIS

Normal amt of pericardial fluid

50ml

MC symptom of acute pericarditis

Sharp, stabbing precordial or retrosternal CP

Sxs of acute pericarditis

Pericardial friction rub (hard to hear) Sudden or gradual onset Radiating pain, aggravated by inspiration or movement Pain more severe when supine, relieved when sitting up and leaning forward Fever, dyspnea

Stages of pericarditis

Slide 43 - know this

Low-voltage QRS and electrical alternans suggests:

Development of large pericardial effusion

Procedure of choice for acute pericarditis detection, dx, and follow-up:

Echocardiography

Txt of acute pericarditis

Most resolve on their own Ibuprofen 300-800mg’s every 6-8 hrs Colchicine 0.5mg PO BID

Which pericarditis pts am i admitting ?

``` >100.4 Subacute onset over weeks Immunosuppressed Hx of oral anticoagulant use Associated myocarditis Large pericardial effusion (>20mm) ```

Whats the big problem with cardiac tamponade?

Barney answer - prevents filling

Factors that determine the rate at which tamponade occurs?

1. Rate of fluid accumulation 2. Pericardial compliance 3. Intravascular volume

Common causes of nontraumatic cardiac tamponade:

Metastatic malignancy (MC) Acute Idiopathic pericarditis Uremia Bacterial or tubercular pericarditis Chronic idiopathic pericarditis Hemorrhage (anticoagulant use)

Possible findings with the cardiac tamponade patient

Pulsus paradoxus JVD Absent “y” descent Strong apical impulse “Distant” heart sounds on auscultation

ECG for cardiac tamponade

Electrical alternans is classic but uncommon...whatever the fuck that means... Low voltage QRS complexes with PR-depression

TOC for cardiac tamponade?

Echocardiography

Dx of cardiac tamponade should be suspected based on:

Clinical exam and chest radiograph findings Confirmed with echo

Txt for cardiac tamponade

Volume expansion with a bolus of saline (1/2 to 1 L) - temporary measure Pericardiocentesis is necessary for definitive therapy AND specific Dx

Admit your cardiac tamponade pt if:

Hemodynamically unstable Or You did an emergent Pericardiocentesis Or Pt has insufficient social situation to provide access to emergency care

What is Beck’s triad?

JVD HOTN Muffled heart sounds Think “cardiac tamponade”

According to a new study marijuana users are twice as likely to suffer from a heart condition known as stress cardiomyopathy

But they’re three times as likely not to care

3 - Cardiomyopathies Flashcards

(58 cards)