(hans) cardio 105 - 110

Question 1

name 7 causes of dilated cardiomyopathy

Answer 1

1. previous MI
2. previous ischemia
3. alcohol
4. postviral myocarditis
5. radiation
6. toxins such as doxorubicin
7. chagas disease

Question 2

name 4 types of drugs that lower mortality in dilated cardiomyopathy

Answer 2

ACEi, ARBs, beta blockers (metoprolol or carvedilol), spironolactone

Question 3

what 2 drugs are used to control symptoms of dilated cardiomyopathy?

Answer 3

diuretics and digoxin

Question 4

if QRS is wide (more than 120 msec), what is the treatment option for dilated cardiomyopathy

Answer 4

biventricular pacemaker which improves both symptoms and survivial

Question 5

what is the diff btw hypertrophic cardiomyopathy vs. hypertrophic obstructive cardiomyopathy

Answer 5

HCM is a reaction to stressors on the heart such as inc blood pressure, whereas HOCM is a genetic disorder with an abnormal shape to the septum of the heart.

Question 6

what are the 2 things that worsen hypertrophic cardiomyopathy?

Answer 6

1. anything that leads to inc heart rate (exercise, dehydration, diuretics)
2. dec Lt. ventricular chamber size

Question 7

what are the 4 drugs that reduce Lt. ventricular chamber and worsens HOCM symptoms?

Answer 7

ACEi, ARBs, digoxin, hydralazine

Question 8

what are the 2 maneuvers that reduce Lt. ventricular chamber and worsens HOCM symptoms?

Answer 8

valsalva, standing suddenly

Question 9

what is the best initial test for HOCM?

Answer 9

echo

Question 10

best initial therapy for both HOCM and ordinary HCM?

Answer 10

beta blockers

Question 11

what particular drug is useful for HCM but contraindicated in HOCM?

Answer 11

diuretics

Question 12

what are the 2 specific treatments for HOCM?

Answer 12

1. implantable defibrillators

2. ablation of the septum

Question 13

HOCM pt comes in with symptoms of syncope, what is the best next step?

Answer 13

implantable defibrillators

Question 14

HOCM pt comes to see you with persisting symptoms after ablation of the septum, what is the best next step?

Answer 14

surgical myomectomy to remove part of the septum

Question 15

name 3 types of drugs that are helpful for dilated cardiomyopathy but no for hypertrophic cardiomyopathy

Answer 15

ACEi/ARBs, spironolactone, digoxin

Question 16

what are the 5 main causes for restrictive cardiomyopathy

Answer 16

1. sarcoidosis
2. amyloid
3. hemochromatosis
4. endomyocardial fibrosis
5. scleroderma

Question 17

more blood flow increases all murmurs except for 2?

Answer 17

MVP, HOCM

Question 18

standing or doing valsalva is equivalent to giving what kind of medication?

Answer 18

diuretic use

Question 19

what types of murmur will decrease by standing or valsalva?

Answer 19

mitral/aortic stenosis

mitral/aortic regurgitation

Question 20

what types of murmur will decrease by squatting or leg raising?

Answer 20

MVP, HOCM

Question 21

how does “hand grip” affect the intensity of the murmur of aortic stenosis? and explain why

Answer 21

decreases, b/c hand grip decreases the Lt. ventricular emptying by inc pressure

Question 22

how does “amyl nitrate” affect the intensity of the murmur of aortic stenosis? and explain why

Answer 22

increases, b/c amyl nitrate increases the Lt. ventricular emptying

Question 23

hand grip improves symptoms of MVP and HOCM why?

Answer 23

hand grip decreases ventricular emptying by increasing afterload. A bigger, fuller heart improves the obstruction of HOCM.

Question 24

what valvular motion is classic for HOCM?

Answer 24

systolic anterior motion (SAM) of the mitral valve

Question 25

what is the common pattern of HOCM in EKG?

Answer 25

septal Q waves in the inf. and lateral leads