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Clinical Medicine II > Cardiology: Cardiomyopathy > Flashcards

Cardiology: Cardiomyopathy Flashcards

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1
Q

is cardiomyopathy a primary or secondary disorder?

A

primary

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2
Q

Does CAD, valvular disease, or HTN cause dilated cardiomyopathy?

A

no

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3
Q

The most common physiologic cause of DCM is…

A

LV systolic dysfunction

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4
Q

A patient presents with HF sxs , syncope and palpitations. on exam, you find…

S3 gallop
JVD
Basal crackles
Mitral/Tricuspid regurg murmur

What should you immediately suspect?

A

DCM

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5
Q

The most common type of DCM is…

A

idiopathic DCM

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6
Q

What is required for a Dx of familial DCM?

A

FHx of DCM in 2+ relatives

consider cardiac protein Abs

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7
Q

This cardiomyopathy occurs secondary to infectious or non-infectious causes…

A

infectious DCM

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8
Q

What is the most common cause of infectious DCM in the US?

A

viral

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9
Q

what is the MC cause of infectious DCM in latin america?

A

Chagas/parasitic

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10
Q

A 36wk gestation mother presents with dyspnea, orthopnea/PND, pedal edema, cough, hemoptysis.

These findings are indicative of what?

A

peripartum DCM

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11
Q

Peripartum DCM can occur when?

A

36 weeks gestation to 5 mo post-partum

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12
Q

An EF of ______ is diagnostic of DCM

A

Echo showing EF < 45%

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13
Q

what are the risk factors for peripartum DCM?

A

> 30

African descent

H/o preeclampsia, eclampsia, postpartum HTN

maternal cocaine abuse

> 4 week use of oral tocolytic

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14
Q

A patient has an EtOH hx of 6 drinks daily for the last 5-10 years. What heart condition is he at increased risk for?

A

alcoholic DCM

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15
Q

Alcoholic DCM will present with what sxs?

A

HF sxs

Signs of long-term EtOH use

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16
Q

Cocaine DCM reduces LV function by what percent in asymptomatic users?

A

4-9%

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17
Q

A patient is counseled for cocaine related DCM. He is worried that his drug use has permanently damaged his heart. What can you tell him?

A

stopping can reverse myocardial dysfunction

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18
Q

What chemotherapeutic class of drugs can cause chemotherapy-induced DCM?

A

anthracyclines including doxarubicin

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19
Q

In chemotherapy-induced DCM, it is important to get a baseline and continuing _______ to monitor ________.

A

get echo

measure EF

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20
Q

a sustained rapid ventricular rate of 130-200 can cause what cardiac condition?

A

tachycardia mediated DCM

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21
Q

In tachycardia mediated DCM, is tachycardia the cause of dysfunction?

A

no, tachy is a symptom, not the cause

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22
Q

Which conditions can cause endocrine dysfunction DCM

A

Diabetes

Thyroid dysfunction

Pheochromocytoma

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23
Q

Can cardiac dysfunction be reversed by correcting endocrine dysfunction?

A

yes

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24
Q

Which nutritional deficiencies can cause DCM? Is it correctable?

A

thaimine

carnitine

correctable

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25
what provides definitive diagnosis of DCM?
echo showing dilated ventricle and reduced EF
26
What is the nonpharmacologiical tx of DCM?
treat/remove underlying cause lifestyle modification
27
What medications are DOC in DCM?
ACE-I
28
Besides ACE-Is, what other medications can be considered in managing DCM?
diuretics beta blockers digoxin
29
If a patient with DCM presents with afib, what can you give
amiodarone (antiarrhythmic) anticoagulation
30
What surgical interventions can be used to treat DCM?
implanted cardioverter defibrillator cardiac transplant
31
A histological assessment of cardiomyocytes shows the following. what are these findings a hallmark of? Myocyte hypertrophy and disarray interstitial fibrosis
LVH
32
What differentiates non-obstructive and obstructive HCM?
obstruction of left ventricular outflow tract
33
what is the most common cause of obstructive HCM?
asymmetric septal wall thickening
34
Symptomatic HCM is indicative of what subtype of HCM?
obstructive HCM
35
What sxs can be expected from someone with obstructive HCM?
HF sxs syncope palpitations
36
The following physical exam findings are consistent with what condition? Brisk, bifid carotid pulse audible S4 crescendo-decrescendo systolic ejection murmur
HCM with LVOT obstruction
37
Valsalva and standing will _______ the murmur of HCM, while __________ will decrease it.
increase: valsalva and standing decrease: squat and isometric handgrip
38
An Echo is a preferred diagnostic for HCM. What should be seen on echo to make a dx of HCM?
increased LV wall thickness 15mm or greater
39
What diagnostic can be added to the general workup to help evaluate HCM?
Stress/Exercise echo
40
Patients with the following characteristics are at increased risk for what? prior sustained VT non sustained VT < 30 yo FHx of sudden death 30mm or greater LVH unexplainable syncope Brady arrhythmias
sudden cardiac death
41
How do you manage asymptomatic HCM
monitor
42
How should symptomatic HCM be treated?
beta blockers DOC, or non-dihydropyridine CCBs
43
for whom is ICD implantation recommended for in HCM?
high risk of SCD or sustained VT
44
A patient with symptomatic LVOT obstruction with advanced HF refractory to medical therapy can be treated with what procedures?
surgical septal myectomy EtOH ablation Mitral valve surgery
45
What type of cardiomyopathy occurs due to the following? non-dilated, rigid ventricles HFpEF R and L atrial enlargement
restricted cardiomyopathy
46
RCM can mimic what condition?
constrictive pericarditis
47
what is the most common cause of RCM?
amyloidosis
48
Broadly, what etiologies cause RCM?
Infiltrative processes Storage disease idiopathic, scleroderma, secondary fibrosis
49
what is the least common cardiomyopathy?
RCM
50
What sxs are expected in RCM?
RHF sxs angina, syncope, dyspnea
51
A physical exam has the following findings, which suggests what condition? S3 gallop prominent JVD kussmaul's sign MR/TR murmur
RCM
52
S3 gallop is heard in RCM, but isn't heard in what similarly presenting condition?
constrictive pericarditis
53
What condition presents with the following sxs? Elevated JVD Hepatomegaly/ascites periorbital purpura HF
Cardiac amyloidosis
54
What is a pathognomonic presentation for cardiac amyloidosis?
periorbital purpura with HF
55
TOC for RCM is _______. The expected findings are...
Echo showing: bi atrial enlargement normal to small ventricular cavity normal EF
56
How is RCM managed?
tx underlying cause low dose loop diuretics consider heart transplant
57
Does RCM have a good or poor prognosis?
poor
58
A condition presents with transient LV systolic and diastolic dysfunction in the absence of CAD. What condition is this?
takotsubo cardiomyopathy
59
A patient presents to the clinic with the following hx and sxs... What should be included in you list of DDx? Postmenopausal woman Husband died a week ago Abrupt onset Substernal chest pain dyspnea syncope
TCM. Sxs mimic ACS
60
What should immediate treatment of TCM include?
acute MI tx... cath lab
61
A patient with TCM is ready for discharge. what treatment should be considered?
ASA, beta blocker, ACE-I until LV recovery
62
The general workup for cardiomyopathy should include...
Thorough 3-4 generation FHx and Hx CBC, CMP, Thyroid, BNP, Cardiac enzymes EKG Echo +/- Cardiac MRI, endomyocardial biopsy
63
What conditions would endomyocardial biopsy be helpful?
RCM Cardiac amyloidosis Infectious DCM (gold standard)

Clinical Medicine II (31 decks)

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