Cardiomyopathies Flashcards
(36 cards)
What are the three key types of cardiomyopathy?
Dilated Hypertrophic Restrictive
What kind of cardiomyopathy involves increased left ventricular volume, decreased ejection fraction and systolic dysfunction?
Dilated Cardiomyopathy aka Congestive Heart Failure
What type of cardiomyopathy involves thick cardiac muscle, decreased ventricular volume and decreased compliance?
Hypertrophic Cardiomyopathy
What type of cardiomyopathy involves myocardial and/or pericardial stiffness and decreased compliance?
Restrictive Cardiomyopathy
What is the pathophysiology of dilated cardiomyopathy?
- Genetic factors which can lead to DNA mutation and Altered immune system
- Viral infection which can lead to myocarditis
- The above factors can lead to altered myocardial function
- Which leads to dilated cardiomyopathy
What are some causes of dilated cardiomyopathy?
- Idiopathic
- Infections such as myocarditis, coxsackie, parvo
- Ischemia: MI leading to scar tissue
- Toxins from alcohol, uremia, cobalt, chemo
- Peripartum (7th month of preg to 3 mos after)
- Metabolic Ds: Diabetes, Beriberi
- Arrhythmogenic RV Dysplasia
What are the Signs/Sx of dilated cardiomyopathy?
SOB and exercise intolerance, rales
tachycardia, S3, holosystolic murmur, JVD, displaced PMI, precordial heave
pallor, cyanosis, cachexia
ascites, hepatomegaly
Decreased cardiac output
What do you see on a CXR re dilated cardiomyopathy?
Bilateral pulmonary edema
Large heart silhouette
Enlarged ventricles
How do you treat dilated cardiomyopathy (CHF)?
Diuretics (Sx only, no increased survival)
Inotropes to increase contractility
ACEi and ARBs to decrease afterload to decrease work
Beta Blockers to increase LV systolic fcn and increase survival
Hydralazine + Nitrates for African Americans
NOTE: No beta blockers if in decompensated heart failure!!
What is hypertrophic cardiomyopathy?
Genetic form of hypertrophy of the heart
that is without an underlying cause.
Due to mutation of sarcomeric proteins
Prevalence: .26%
What is the most common cause
of sudden death in athletes?
Hypertrophic cardiomyopathy (44%)
How do you Dx hypertrophic cardiomyopathy?
Heart has thick muscle, decreased volume and decreased compliance
Myocardial fiber disarray
Asymmetrical LV hypertrophy (large septum)
LV outflow obstruction
What are the Signs/Sx of hypertrophic cardiomyopathy?
Often no Sx but FHx of sudden death at young age
Syncopy, chest pain, dyspnea
Prominent apical pulse
Grade 2/6 midsystolic murmur at left sternal border
Possible arrhythmia
What would you find in an Echocardiogram of
hypertrophic cardiomyopathy?
Thick muscle
Large septum
Tiny heart chamber
Possible valve problems
High velocity of blood
How do you treat hypertrophic cardiomyopathy?
NO inotropes or diuretics!
CCB and B blockers to increase size of ventricle and decrease obstruction
Septal myotomy/myectomy or nonsurgical septal ablation
Implanted defibrillator
What is the pathophysiology
of restrictive cardiomyopathy?
- Myocardial infiltration or hypertrophy leading to decrease myocardial compliance
- Pericardial effusion leading to increased intrapericardial pressure
- Pericardial constriction leading to decreased pericardial compliance
- All of the above leading to increased ventricular diastolic pressure
- Leading to elevated diastolic pressure and suboptimal ventricular filling
What are some causes of myocardial infiltration?
Idiopathic
Amyloidosis, Sarcoidosis
Fibrosis
Tumor(s)
Radiation
Heart transplant
What are two causes of pericardial stiffness?
Pericardial effusion
Pericardial constriction
How do myocardial infiltration and myocardial hypertrophy differ in terms of voltage?
Both conditions result in a large, stiff heart but…
Myocardial hypertrophy causes high voltage on an EKG (high amplitude) because the increased size is muscle
Myocardial infiltration causes low voltage because the increased size is due to infiltrates like sarcoid.
What is Tako-Tsubo Cardiomyopathy?
aka Broken Heart Syndrome
Temporary condition where the heart muscle is suddenly weakend or stunned resulting in apical ballooning
It is a form of stress cardiomyopathy
What are Epidemiology, Sx, Dx, Tx
of Tako-Tsubo Cardiomyopathy?
Epidemiology: 90% women, thought to be due to estrogen conversion to catecholamines and glucocorticoids
Sx: chest pain, SOB, collapse (palpitations, N/V)
Dx: EKG, blood test, angiogram, Echo, cardiac MRI
Tx: just monitor w serial echos
What are the ETX, Sx, Dx and Tx
of infectious myocarditis?
ETX: viruses, URI, Lyme
SX: SOB upon exertion 7-10 days post infection, nocturnal dyspnea, fatigue, palpitations, chest pain/pressure, edema, (lightheadedness, arrhythmias, loss of consciousness)
Can lead to dilated cardiomyopathy
DX: EKG, CXR, Echo, cardiac MRI, heart biopsy
Tx: rest, decreased salt, steriods,
If severe: pacemaker, defibrillation
What are the Signs/Sx, ETX and Tx of
Acute Pericarditis?
Signs/Sx: sudden onset, sharp, anterior chest pain (<6 wks), worse with inspiration and coughing or lying down,
better if sit forward
Pericardial friction rub at Left sternal border (“squeaky”)
ETX: idiopathic/viral (90%), CT dz (SLE), cancer
Tx: NSAIDs, colchicine, corticosteriods
Pericardiocentesis is severe
What are two complications of acute pericarditis?
Cardiac Tamonade
Constrictive Pericarditis
