Cardiomyopathies Flashcards

(41 cards)

1
Q

problem with structure and function of the myocardium

A

HF

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2
Q

ventricular filling issue from rigid/scarring/hypertrophic walls resisting filling and increase filling pressures

A

diastolic HF

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3
Q

ejection of blood issue from cardiac muscle is weak/thin, poorly perfused, uncoordinated or severely dilated –> poor pumping

A

systolic HF

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4
Q

EF 41-49%

A

mid range HFmrEF

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5
Q

Class II - III, EF 35% or less, ARS>150ms w/ LBBB what device would you choose for HrEFHF?

A

CRT (cardiac resynchronization therapy w/ biventricular pacing)

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6
Q

IF EF <35%, what is recommended?

A

ICD (implantable cardioverter defibrillator

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7
Q

if a HrEFHF patient has Severe mitral regurg, what do you treat them with?

A

Transcatheter mitral valve repair (tMVR)

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8
Q

If a patient is NYHA class 3-4 symptomatic following hospitalization, how do you manage?

A

Wireless pulmonary arterial pressure monitors

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9
Q

Diagnostic approach to HF:

A

CXR
BNP
★Echo to differentiate between right + left sided
Right heart cath
Measures pressures + can confirm diagnosis
PCWP>18 = LHF
EKG
Assess for MI

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10
Q

What is key in diagnosis for HF

A

echo

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11
Q

INCREASING afterload → unable to fill LV

Normal LVEF

“Hypertrophy” - filling issue

A

heart failure w/ preserved ejection fraction

DIASTOLIC

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12
Q

LOWER contractility in LV → lower LVEF

“Dilated” – flow issue

A

SYSTOLIC

heart failure w/ reserved ejection fraction

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13
Q

Most common - dilation + impaired contraction of ventricles “floppy heart”

Peripheral/pulmonary edema, fatigue, ascites, Cheyne-Stokes breathing, pallor, cyanosis, pulsus alternans

A

dilated cardiomyopathy

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14
Q

In who is dilated cardiomyopathy common?

A

Genetic!
Black patients 3x as often
Male

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15
Q

What does this cause:
Hereditary, viral myocarditis, chronic alcohol use, pregnancy, cocaine, peripartum, HIV, idiopathic

Ventricular dilation → thin muscle → weak contractions → reduced ejection fraction → ultimate RV failure → functional mitral + tricuspid regurgitation

Systolic dysfunction + dilation NOT from cardiac disease processes

A

dilated cardiomyopathy

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16
Q

What does this indicate:
S3 gallop, displaced PMI, elevated JVP, MR or TR murmur

EKG: nonspecific findings like sinus tach, LBBB, atrial or ventricular arrhythmias
BNP/pro-BNP = elevated
CXR: cardiomegaly, fluid overload
TTE: Systolic dysfunction EF <40% if low LVEF

A

dilated cardiomyopathy

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17
Q

After an echo, what do you do

A

refer for more tests

18
Q

How do you treat dilated CMP?

A

Control BP + cholesterol (statin!)
Mirrors HFrEF if EF<40% = 4 pillars
Diuretics for symptom management (thiazides)
Consider DOAC if a fib present

19
Q

What are lifestyle changes for dilated cardiomyopathy?

A

Drug, alcohol, smoking cessation
Managing obesity, diabetes
salt/fluid restriction
CPAP for OSA

20
Q

What can be done for severe dilation cardiomyopathy?

21
Q

What does this indicate:
Dyspnea, DOE, and chest pain

Syncope also common and post-exertional

Arrhythmias from chronic elevation + means poor prognosis - a fib, v fib is common

Sudden death may occur after exertion

22
Q

What can predispose someone to hypertrophic cardiomypathy?

A

Athletes - family history of death from heart problems, unexpected/unexplained sudden death before 50 years

Marfan syndrome, QT syndromes, Brugada syndrome, heart problems, pacemaker, ICD, unexplained fainting, seizures, drowning

Hx of HTN, murmur, HLD, Kawasaki disease, infection, syncope, dizziness, angina, palpitations, abnormal EKG, dyspnea

23
Q

Hypertrophy of septum wall – from genetic mutations of autosomal dominance with incomplete penetrance → diastolic dysfunction

→ associated with subaortic LV outflow obstruction (narrowed) and worsens with increased contractility (digoxin, beta agonists, exercise) and less LV volume (dehydration or Valsava)

A

hypertrophic cardiomyopathy

24
Q

What does this indicate:
Harsh, systolic crescendo-decrescendo murmur heard best at LLSB WITHOUT carotid radiation
Decreased by handgrip and increased venous return (squatting)
Increased by decreased venous return (valsalva)

Bisferiens carotid pulse (biphasic pulse)

Triple apical impulse

Loud S4

JVP = prominent A wave

Femoral pulses are NORMAL (rule out coarctation of aorta)

A

hypertrophic cardiomyopathy

25
What's the most senstive test for hypertrophic cardiomyopathy?
EKG - LVH, exaggerated septal Q waves inferolaterally
26
What's diagnostic for HCM?
echo
27
What's the first thing you do when you suspect HCM?
If you suspect HCM, get a cardiologist - needs to go home with an external defibrillator (LifeVest) Complete activity restriction until evaluation/management Avoid dehydration + extreme exertion
28
What do you prescribe for HCM?
Beta blockers CCBs (verapamil) Disopyramide
29
What are procedures you can do for HCM?
Myomectomy of septum Ethanol septal ablation ICD placement
30
What's a medication you can add for NYHA class II-III?
Mavacamten
31
If HCM has a fib, always
add DOACs
32
Least common RHF: pitting edema, JVD, Kussmauls, hepatic congestion
restrictive cardiomyopathy
33
Restrictive filling + reduced diastolic volume Amyloidosis, sarcoidosis, hemochromatosis, scleroderma, MCTD RHF>LHF
restrictive cardiomyopathy
34
PE: periorbital purpura, thickened tongue, hepatomegaly EKG: low voltage High levels of BNP>400 Echo= primary TOC → marked dilation of both atria, ventricles non-dilated, diastolic dysfunction Cardiac MRI: hyperenhancement w/ amyloidosis Biopsy needed to confirm if amyloidosis (apple-green with Congo red stain)
restrictive cardiomyopathy
35
How do you treat restrictive cardiomyopathy
Treat underlying cause, diuresis for symptoms
36
Angina, dyspnea, arrhythmia, substernal chest pain
takotsubo cardiomyopathy
37
Who's at risk for takotsubo cardiomyopathy?
Postmenopausal women after large stress, after death
38
Broken heart syndrome – LV apical ballooning
takotsubo cardiomyopathy
39
EKG: ST elevation and deep anterior TWI in anterior leads CXR: fluid overload Elevated troponin Echo: LV apical dyskinesia and ballooning NOT consistent with any coronary distribution Cath is normal
takotsubo cardiomyopathy
40
diagnosis of exclusion that can only be made after angiography!
takotsubo cardiomyopathy
41
How do you treat takotsubo cardiomyopathy?
Similar to any acute MI Long term therapy if LV dysfunction persists Aspirin + BBs + ACE-Is Refer to cardio