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CVPR 312 Cardiac Pathophysiology > Cardiomyopathy / cardiac patho Test 2/2 > Flashcards

Cardiomyopathy / cardiac patho Test 2/2 Flashcards

1
Q

Cardiomyopathy Damages the muscle

A

tone of the heart

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2
Q

Cardiomyopathy

A

heart, muscle, disease

disease of the heart

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3
Q

Cardiomyopathies = Hetergeneous group of diseases which have _________.

A

intrinsic myocardial dysfunction as their common feature.

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4
Q

Cardiomyopathies by definition excludes what?

A 
myocardial disease caused by:
ischemia, 
rheumatic disease, 
congenitial disease, 
cor pulmonale or 
HTN
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5
Q

How does cardiomyopathy differ from other heart disorders?

A

fairly uncommon, affecting only about 50,000 Americans.

leading cause of heart transplantation.

It often occurs in the young.

It tends to be progressive and sometimes worsens fairly quickly

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6
Q

Non-ischemic cardiomyopathy is due to

A

specific causes, and is often associated with diseases involving other organs as well as the heart.

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7
Q

Primary Cardiomyopathy

A

unknown cause (idiopathic)

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8
Q

Secondary Cardiomyopathy

A

may have a recognized extrinsic cause:

drug toxicity
amyloidosis

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9
Q

Non-ischemic Cardiomyopathy

Pathophysiologic Groups

A
  1. Dilated
  2. Hypertrophic
  3. Restrictive
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10
Q

Most Common Cardiomyopathy

A

Dilated

all ages, but middle aged men most common

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11
Q

What are the symptoms of cardiomyopathy? Although symptoms may not appear until late in the progression of the disease.

A

Symptoms are that of Heart failure: SOB, weakness, edema, arrythmias

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12
Q

Etiology of dilated Cardiomyopathy ?

A

alcohol, genetic, postviral, pregnancy,

Most often; idiopathic

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13
Q

Pathology of dilated Cardiomyopathy ?

A

4-chamber dilatation
hypertrophy
thrombi

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14
Q

Once diagnosed, this disease has often reached an advanced stage and heart failure has occurred.

A

Dilated Cardiomyopathy

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15
Q

5-year survival rate once heart failure is diagnosed

A

50%

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16
Q

10-year survival rate for Dilated Cardiomyopathy ?

A

25%

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17
Q

2nd most common form of cardiomyopathy, (but still rare)

0.2% of US population have it (inherited)

A

Hypertrophic Cardiomyopathy

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18
Q

Although many people have no symptoms; what are some of the symptoms we might see?

A
  • SOB,
  • Chest discomfort,
  • Sudden death caused by chaotic heartbeat
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19
Q

Clinical symptoms of Hypertrophic Cardiomyopathy ?

A

angina
syncope
systolic murmur
dyspnea

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20
Q

Pathology of Hypertrophic Cardiomyopathy ?

A 
- Myocardial hypertrophy
L > R
- Septum > free wall
- Disorganized myofibrils
- Abnormal coronary arteries
thick-walled branches
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21
Q

Hypertrophic Cardiomyopathy AKA ?

A

(IHSS)
idiopathic hypertrophic sub- aortic stenosis

LV outflow tract obstruction

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22
Q

Severe hypertension

that was untreated for many years can lead to what?

A

Hypertrophic Cardiomyopathy

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23
Q

left ventricular hypertrophy, with asymmetric bulging of a very large interventricular septum into the left ventricular chamber describes what heart disease?

A

Hypertrophic Cardiomyopathy

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24
Q

Hypertrophic Carrdiomyopathy carries the risk of sudden death due to cardiac arrest brought on by arrythmias, what is the percentage of patients that die each year?

A

2 - 3%

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25
Q

What is the rarest form of cardiomyopathy?

A

Restrictive Cardiomyopathy

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26
Q

Restrictive Cardiomyopathy results from what?

A

Another disease which occurs elsewhere in the body

27
Q

Typical symptoms of CHF?

A

weakness,
SOB,
edema

28
Q

With Restrictive Cardiomyopathy the heart remains ?

A

small unlike all other forms

29
Q

Clinical symptoms of Restrictive Cardiomyopathy ?

A
  • Rarest Kind
  • Inhibition of diastolic filling (Diastolic Dysfunction)
  • Heart failure
  • R > L
30
Q

Etiology of Restrictive Cardiomyopathy ?

A

unknown: possibly genetic

31
Q

Pathology of Restrictive Cardiomyopathy is associated with what “myocardial” diseases ?

A

infiltrative
amyloidosis
sarcoidosis

32
Q

At what temperature do we feel comfortable removing the cross clamp?

A

34 degrees Celsius

33
Q

Deposition of abnormal substances that cause the ventricular walls to become progressively rigid, thereby impeding ventricular filling.

Some infiltrative cardiac diseases increase ventricular wall thickness,

while others cause chamber enlargement with secondary wall thinning.

A

Infiltrative cardiomyopathies

34
Q

Increased wall thickness, small ventricular volume, and occasional dynamic left ventricular outflow obstruction describes what disease?

A

amyloidosis

35
Q

A poorly understood disease that most commonly affects the lungs but can also involve almost every part of the body including the heart. Sarcoidosis is characterized by the presence of granulomas, which are ball-like collections of white blood cells that cluster around and react to a foreign substance. The inflammation associated with granulomas can damage virtually every part of the heart, including the electrical system, muscle, valves, arteries, and surrounding tissue called the pericardium.

A

Sarcoidosis

36
Q

Pathology of Restrictive Cardiomyopathy that is associated with what “endocardial” diseases ?

A
  • Loffler’s eosinophilic endocarditis

- Primary endocardial fibroelastosis

37
Q

A form of restrictive cardiomyopathy which affects the endocardium and occurs with white blood cell proliferation, specifically of eosinophils.
This type of restrictive cardiomyopathy describes what disease?

A

Loffler’s eosinophilic endocarditis

38
Q

Restrictive cardiomyopathy is defined as a disease of the heart muscle which results in

A

impaired filling of the heart ventricles during diastole.

39
Q

Restrictive cardiomyopathy characterized by a thickening of the innermost lining of the heart chambers (the endocardium) due to an increase in the amount of supporting connective tissue and elastic fibers. It is an uncommon cause of unexplained heart failure in infants and children.

A

Primary endocardial fibroelastosis

EFE

40
Q

Restrictive Cardiomyopathy Generally gets progressivily worse. What is the 5 year survival rate?

A

30%

41
Q

What are 6 pharmacologic treatments for Cardiomyopathy ?

A 
Inotropes
Diuretics
Vasodilators
ACE-inhibitors/Beta blockers
Others:
Angiotensin II inhibitors, Anticoagulants
42
Q

Nitropruside =

A

Vasodilator

43
Q

What are 5 surgical treatments for Cardiomyopathy ?

A
  • Pacemaker
  • LaPlace Surgery
  • LVAD
  • Transplantation
  • TAH (
44
Q

LaPlace surgical treatments for Cardiomyopathy ?

A

Cardiomyoplasty (historic)
Batista
Acorn

45
Q

Batista Procedure

Developed by Dr. Randas Batista (Brazil) in 1996

A

(PLV) Partial Left Ventriculectomy between both papillary muscles and extends from the appex to the mitral annulus.

Mitral valve and subvalvular apparatus were either preserved, repaired, or replaced,

“LV Reduction”

46
Q

LVAD surgical treatments for Cardiomyopathy ?

A

Bridge to Recovery
Bridge to Transplant
Destination Therapy

47
Q

Surgical remodeling for Ischemic heart Failure?

A
  • Batista

- Left ventricular aneurysmectomy

48
Q

Surgical remodeling for Non-Iscemic heart Failure?

A

Cardiomyoplasty

49
Q

Current and Future LV Reconstructive procedure for Ischemic heart Failure?

A

Dor procedure

50
Q

Current and Future LV Reconstructive procedures for Non-Ischemic heart Failure?

A
  • Acorn (CorCap Cardiac Support Device)

- Myosplint

51
Q

Cardiomyoplasty AKA

A

dynamic cardiomylasty

52
Q

Surgical therapy for dilated cardiomyopathy in which the latissimus dorsi muscle is wrapped around the heart and paced during ventricular systole.

A

Cardiomyoplasty

“It appears that those who can survive the operation do not need it and those who need it, cannot survive it”

53
Q

Initial experience with the Batista procedure demonstrated what?

A

↑ LVEF
↑ Clinical Function Status
↓ Heart Size

54
Q

Of 120 patients Batista reported a 22% operative mortality and 2 year survival of what ?

A

55%.

55
Q

Late fatal arrhythmias plagued the Batista procedure, forcing the use of concomitant implantable defibrillators.
Therefore the Batista procedure

A

has fallen out of favor and is no longer considered to be an appropriate option.

56
Q

Dor procedure AKA

A

Endoventricular circular patch pasty (EVCPP),

Shortens the Long axis
Unchanged Short axis

.

57
Q

An approach to surgical LV reconstruction in the setting of postinfarction aneurysm formation

A

Dor procedure AKA (EVCPP)

58
Q

The Dor procedure for ischemic heart failure can be considered for patients with ?

A
  • Symptomatic Aneurysms
  • Angina Pectoris
  • Systemic Embolization
  • Malignant ventricular tachyarrhythmias
59
Q

A net that is placed around and attached to the heart to support the damaged heart muscle and limit further enlargement. It provides passive support that
reduces the stress on the ventricular wall.

A

The CorCap Cardiac Support Device by Accorn

Treats Non-Ischemic Cardiomyopathy

60
Q

Accorn Device Preliminary data suggest what?

A

Improves HF symptoms
↑ LVEF
↑ LVEDD
↑ Quality of life

61
Q 
Device that is composed of:
-Two pads on the surface of the  
  heart
- Wire that passes through the  
  ventricle
- Placed under tension to  
  create a bilobular shape
A

Myosplint

62
Q

What is the ultimate treatment for heart failure?

A

Heart transplantation

63
Q

What part of the recipient heart

remains with the recipient during heart transplantation?

A

Partial Left Atrium

64
Q

HEART TRANSPLANTATION
ACTUARIAL SURVIVAL (1982-2000)
Half Life =
Conditional Half Life =

A

Half Life = 9.1 yrs

Conditional Half Life = 11.6 yrs

CVPR 312 Cardiac Pathophysiology (15 decks)

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