Cardiomyopathies Flashcards by Lauren F

Is an S3 gallop associated with systolic dysfunction or diastolic?

Systolic

Sys-tol-ic has 3 syllables = S3

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Is an S4 gallop associated with a systolic or diastolic dysfunction?

Diastolic

Di-as-tol-ic has 4 syllables =S4

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What is cardiomyopathy?

Your heart is fucked up NOT because of CAD, HTN, valve disease, or congenital heart disease

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What is the leading cause of cardiac transplant?

Dilated cardiomyopathy

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What is the #1 cause of sudden death in competitive athletes 35 and younger?

Hypertrophic cardiomyopathy

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What are the 3 main types of cardoimyopathy?

Dilated

Hypertrophic

Restrictive

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What is the most common cardoimyopathy?

Dilated

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Once someone is having symptoms of dilated CM, do they have a good prognosis?

No, 50% will die within 5 years…..need a transplant

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What happens with dilated CM?

Symmetric (stretches equally in every direction) LV dilation

Causes LV systolic dysfunction

Mayyyyy involve the RV

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What kind of symptoms will someone with Dilated CM have?

Sx that are very similar to CHF!!!

Exertional intolerance with SOB and fatigue**

Crackles, JVP

Edema, ascites

Mitral/tricuspid regurgitation murmur

Arrhythmias

Systemic emboli

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What is the most common etiology of dilated CM?

Idiopathic!

Other casues:
Familial

Infectious

Peripartum

Alcoholism

Cocaine or chemo

Tachycardia

Endocrine dysfunction

Nutritional deficiencies

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If someone with dilated CM finds out that 2 of their relatives also had it, do they still have idiopathic dilated CM?

No, it is familial

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What is the most common cause of infectious~ dilated CM in America?

What about in Latin America?

US- viral (influenza, herpes, parvo, CMV etc)

Latin America- Chagas’ disease (parasitic)

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What is the gold standard for diagnosing infectious dilated CM?

Endomyocardial biospy

Very invasive, not always done

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What kinds of risk factors may increase a woman’s risk of developing dilated CM?

Over 30

African American

Multiparous

Maternal cocaine abuse

4 wks+ of oral tocolytic (stops contractions)

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What labs do you need to order if you suspect a woman has peripartum dilated CM?

BNP- will be increased (stretching…)

Echo- EF will be less than 45%

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When will a pregnant woman develop peripartum dilated CM?

36wks pregnant to 1 month after delivery

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How do you treat someone with alcoholic dilated CM?

They NEED to stop drinking. Big improvement

Give them the standard meds for CHF (loop diuretics, ACE/ARB, maybe Bblocker, maybe digoxin)

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If someone with alcoholic dilated CM keeps drinking, what will happen?

50% die in 3-6 years

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What do you think caused dilated CM in a young otherwise healthy person?

Cocaine

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If someone has cocaine-related dilated CM, will it get better if they stop tooting the devils dandruff?

Yes may reverse it

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Which chemo drug may induce dilated CM?

Adriamycin (Doxarubicin)

Severity depends on the dose

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What is the most important part of diagnosing dilated CM?

A thorough H and P!

This was red, underlined, and had an exclamation point

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Will ECG, CXR, or Labs show you specific changes to definitively diagnose Dilated cardiomyopathy?

No, all nonspecific changes

ECHO is the best test

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What is the best test for diagnosing Dilated CM?

Echo

What wil you see on an echo of dilated cardoimyopathy?

Dilated ventricle(s) Reduced LV systolic function Decreased EF (Will also help you rule out valve disease)

What is the first line medication for dilated cardiomyopathy?

ACE inhibitors ********** was in red with stars Reduces afterload

What mediations other than ACEs will help dilated cardiomyopathy?

Diuretics- reduce preload B-Blockers- decrease O2 demand Digoxin- increases contractility VERY helpful Antiarrythmics- amiodarone if they have afib Anticoagulants- if they have afib, other thrombi

What is the definitive treatment for idiopathic dilated CM?

Heart transplant

In general, how do you treat dilated cardiomyopathy?

Remove the offending agent that caused it (impossible in idiopathic so thats why they get transplants)

What is the etiology of hypertrophic CM?

Familial

What is the difference between non-obstructive HCM and obstructive HCM?

Non-obstructive- no blockage of aortic valve outlet Obstructive-aortic outflow is obstructed

What factors will worsen obstructive hypertrophic CM?

Tachycardia (athletes..) Hypovolemia (dehydration) Standing Valsalva Inotropes (things that make muscle contract harder) Diuretics Vasodilators

What is the MAIN complaint of patients who present with symptoms of hypertrophic CM?

Dyspnea on exertion**!!!***!! Over 90% have this

In addition to dyspnea on exertion, what other complaints will patients with hypertrophic CM have?

Exertional angina Fatigue Fainting Palpitations

What kind of murmur will patients with hypertrophic CM have?

Harsh crescendo-decrescendo | Plus an audible S4 due to the atria contracting against a noncompliant ventricle

What happens to the murmur of hypertrophic CM with valsalva and standing?

INCREASES | You are decreasing LV cavity size by reducing the amount of blood that goes in it, so you’re making it even worse

What happens to the hypertrophic CM murmur with squatting and isometric handgrip?

DECREASES | You are increasing the LV cavity size by filling it with more blood, so the murmur gets better

What is the best test to do to diagnose hypertrophic cardiomyopathy?

Echo

What will you see on ECG of someone with hypertrophic CM?

LVH with strain Supraventricular/ventricular arrhythmias

What will you see on Echo of someone with hypertrophic CM?

Increased LV wall thickness (15mm+ is diagnostic) +/- systolic anterior motion of mitral valve Asymmetric septal hypertrophy

Should you do an exercise stress test for young people who want to do sports?

Yes

If you’re doing a sports physical for a teenager, and you hear a murmur, what should you do?

Take it very seriously and ask about family history, do a stress test, echo etc ...

Do patients with hypertrophic CM need to restrict their physical activity?

Yes. They need to avoid most competitive sports and high intensity noncompetitive sports. Biking, swimming, doubles tennis, golf, and skating are probably OK

What drugs should your patient with hypertrophic CM be on?

B-blockers ******** Non-dihydropyridine CCB if the B blocker is not working (verapamil, diltiazem) Antiarryhtimics if they have arrhythmia

Would an ICD implantation be good for patients with hypertrophic CM?

Yes if they have high risk for sudden cardiac death or sustained ventricular arrhythmias

Can you do surgery for hypertrophic cardiomyopathy?

Yes you can go in and scoop out the overgrown wall and maybe replace the mitral valve

What happens with restrictive cardiomyopathy?

The ventricles are super rigid, which impairs filling The atria enlarge

Is systolic function preserved with restrictive cardiomyopathy?

Yes

What is the least common cardiomyopathy?

Restrictive

What is the most common cause of restrictive cardiomyopathy?

Amyloidosis-abnormal protein developing in the heart muscle

What kinds of symptoms will somone with restrictive CM have?

Right heart symptoms most common: Edema Ascites JVP +/- Kussmaul’s sign (increased JVP with inspiration)

What is Kussmaul’s sign and what type of cardiomyopathy may it be seen in?

Increased JVP on inspiration May be seen with restrictive cardoimyopathy

What is the pathognomic finding of cardiac amyloidosis?

Periorbital purpura with heart failure

What will you see on echo of someone with restrictive cardiomyopathy?

Increased ventricular thickness Bi-atrial enlargement abnormal filling

Does cardiac MRI help you diagnose restrictive cardiomyopathy?

Yes, will show you chamber size, wall thickness, fibrosis, inflammation

What is the mainstay of treatment for restrictive cardiomyopathy?

Low dose loop diuretics (reduces fluid accumulations....remember they have ascites, edema, etc)

What drugs other than loop diuretics should your restrictive cardiomyopathy pt be on?

Calcium channel blockers UNLESS they have amyloidosis (their myocytes work fine, they have amyloid proteins in them) Anticoagulants

What are the other names for Takotsubo Cardiomyopathy?

Stress cardiomyopathy Apical ballooning syndrome Broken heart syndrome

What is stress cardiomyopathy/takotsubo?

Transieent LV systolic and diastolic dysfunction that is preceded by an emotional trigger.

Who usually gets stress cardiomyopathy?

Postmenopausal women

Does stress cardiomyopathy come on gradually or suddenly?

SUDDENLY

What condition can stress cardiomyopathy mimic?

MI@ They will have substerbal chest ain, dyspnea, syncope, Levine’s sign, and symptoms of heart failure

Will troponins be elevated in stress cardiomyopathy?

Yes

What will you see on an ECG of someone with stress CM?

ST elevation Deep anterior T-wave inversions (This seriously looks like an MI)

What will you see on echo of someone with stress cm?

Decreased EF Possible LV outflow tract obstruction

How fo you manage stress CM right there in the ER?

Do whatever you’d do with any acute MI. Including sendin them to cath lab.

How do you manage long-term stress cardiomyopathy?

Resolve trigger ASA, Bblocker, and ACE until LV recovers If they have a thrombus, do warfarin for a 3 MONTH MINIMUM

Is stress cardiomyopathy something they will deal with forever?

NO, most recover systolic function within 4 weeks This is a transient issue

Cardiomyopathies Flashcards

(69 cards)