Cardiology Part 2 Flashcards
(45 cards)
Which of the following is NOT true in reference to Dilated cardiomyopathy?
A. Dilated Cardiomyopathy is 95% of all cardiomyopathies. B. It is most common in men
C. Onset is between 20-60 years of age
D. It is diastolic dysfunction that leads to ventricular dilation.
D. It is SYSTOLIC dysfunction that leads to ventricular dilation: weak, dilated heart
What are the causes for Dilated cardiomyopathy?
- Idiopathic* MC
- Viral myocarditis
- Toxic: ETOH, cocaine, anthracyclines (Doxorubicin), radiation tx
- Other: pregnancy, hyper/hypothyroidism
A patient is having systolic heart failure symptoms with an audible S3. You suspect dilated cardiomyopathy. What cardiac murmur(s) might you hear on auscultation?
Mitral OR Tricuspid regurgitation
A patient is having systolic heart failure symptoms with an audible S3. You also hear mitral regurgitation. The patient also has a laterally displaced PMI. How would you confirm your diagnosis of this patient?
Echo:
- Left ventricular dilation
- Decreased Ejection fraction
- Regional or Global left ventricular hypokinesis
Dilated Cardiomyopathy
A patient is having systolic heart failure symptoms with an audible S3. You also hear mitral regurgitation. The patient also has a laterally displaced PMI. What would a CXR of this patient look like?
Cardiomegaly
Pulmonary edema
Pleural effusion
A patient is having systolic heart failure symptoms with an audible S3. You also hear mitral regurgitation. The patient also has a laterally displaced PMI. Echo reveals Left ventricular dilation, decreased ejection fraction, and regional left ventricular hypokinesis consistent with Dilated Cardiomyopathy. What is the best management for this patient?
Standard heart failure treatment:
- ACE I
- Diuretics
- BB (if no decompensated CHF)
- Digoxin
- Na restriction
- Implantable Defibrillator if EF < 30-35%*
- Cardiac transplant*
Apical left ventricular ballooning is an indication of what condition?
“Broken heart syndrome” = Takotsubo Cardiomyopathy
A patient with Restrictive cardiomyopathy is more likely to have which of the following?
A. Kussmaul’s sign
B. S3
C. S4
D. Decreased ejection fraction
A. Kussmaul’s sign (JVP increases with inspiration)
-Patient may or may not have S3
What is the most common etiology of Restrictive cardiomyopathy?
Infiltrative disease: Amyloidosis*
-Sarcoidosis
How would an Echo of a Restrictive cardiomyopathy patient look like?
- Ventricles non-dilated with normal wall thickness
- Marked dilation of both atria*
- Diastolic dysfunction(systolic seen if advanced)
A patient is highly suspected of Restrictive Cardiomyopathy. How would you expect their EKG to look like?
Low voltage
+/- arrhythmias
“Bright speckled myocardium” seen on an Echo is an indication of what condition?
Restrictive cardiomyopathy
*seen in amyloidosis
How is a patient with Restrictive cardiomyopathy managed?
No specific tx: Symptomatic tx; GENTLE diuresis; vasodilators
Treat underlying disorder:
- Chelation for hemochromatosis
- Steroids for sarcoidosis
What is Hypertrophic Cardiomyopathy?
Inherited GENETIC disorder of inappropriate LV and/or RV hypertrophy (especially septal)
What is the pathophysiology of Hypertrophic cardiomyopathy?
Subaortic Outflow obstruction narrowed LV outflow tract 2ry to:
- Hypertrophied septum
- Systolic anterior motion (SAM) of the mitral valve & papillary muscle displacement
What is the most common initial complaint in Hypertrophic cardiomyopathy?
Dyspnea
When a patient with Hypertrophic Cardiomyopathy experiences sudden cardiac death, what is this due to?
Ventricular fibrillation
A patient is complaining of dyspnea and chest pain. EKG revealed LVH and CXR revealed cardiomegaly. What would you expect the murmur to sound like on auscultation?
Harsh systolic crescendo-decrescendo murmur best heard at the LLSB
While auscultating, you hear a systolic crescendo-decrescendo murmur at the LLSB of a patient complaining of dyspnea. What would make this murmur louder?
Decreased venous return
Valsalva and standing
- may have loud S4*
- mitral regurgitation
- S3
- Pulsus bisferiens
A patient is complaining of dyspnea and chest pain. EKG revealed LVH and CXR revealed cardiomegaly. A harsh systolic crescendo-decrescendo murmur is heard at the LLSB. How do you manage this patient?
Counseling to avoid dehydration & extreme exertion/exercise!!!!
ICD placement
Medical: BB 1st line*
Surgical: Myomectomy
Alcohol septal ablation
What is Constrictive pericarditis?
thickened, fibrotic, calcified pericardium that restricts ventricular diastolic filling
What is the most common symptom of Constrictive pericarditis?
Dyspnea
What will you hear on auscultation on a patient with Constrictive pericarditis?
Pericardial knock*: high pitched 3rd heart sound
-Due to sudden cessation of ventricular filling in early diastole from thickened inelastic pericardium
How is constrictive pericarditis diagnosed?
Echo: pericardial thickening*
