Cardiomyopathy

Question 1

3 types of cardiomyopathy

Answer 1

1. dilated (most common)
2. restrictive
3. hypertrophic

Question 2

describe dilated cardiomyopathy

Answer 2

• dilation of LV
• muscle is too stretched

Question 3

how can dilated cardiomyopathy occur?

6

Answer 3

1. ischemic
2. chemo
3. idiopathic
4. viral
5. familial
6. tachy mediated

Question 4

describe restrictive cardiomyopathy

Answer 4

• impaired diastolic filling
• muscle can’t move

Question 5

how can restrictive cardiomyopathy occur?

3

Answer 5

1. amyloid
2. infiltrative disorders
3. familial

Question 6

describe hypertrophic cardiomyopathy

Answer 6

thickening of muscle impairs LV filling/movement

Question 7

how can hypertrophic cardiomyopathy commonly occur?

Answer 7

1. Genetic (most common, autosomal dominant)
2. medications (tacrolimus)

Question 8

CHF

Describe what happens with Right HF?

4 things

Answer 8

1. congestion of peripheral arteries
2. GI tract congestion (anorexia, GI distress, wt. loss)
3. Liver congestion (impaired liver function)
4. edema & ascites

Question 9

CHF

describe what happens with left HF?

4 things

Answer 9

1. decreased CO (activity intolerance, reduced tissue perfusion)
2. Pulmonary congestion
3. Impaired gas exchange (cyanosis & hypoxia)
4. Pulmonary Edema (frothy sputum, cough, paroxysmal nocturnal dyspnea, orthopnea)

Question 10

CHF

what are the “fantastic 4” of meds for tx?

Answer 10

1. BB: carvedilol or metoprolol
2. RAAS (ARNI/ACE/ARB)
3. MRA (spironolactone)
4. SGLT-2

Question 11

CHF

what education to provide?

Answer 11

1. diet
2. wt
3. sx to watch for

Question 12

Dilated Cardiomyopathy

what is typical EF for dilated CM?

Answer 12

< 40%

Question 13

Dilated Cardiomyopathy

mortality rate over 5 years?

Answer 13

50%

Question 14

Dilated Cardiomyopathy

signs & sx

5

Answer 14

1. gradual development of HF sx
2. progressive dyspnea on exertion
3. impaired exercise ability
4. orthopnea
5. peripheral edema

Question 15

Dilated Cardiomyopathy

PE findings

8

Answer 15

1. rales
2. cardiomegaly
3. S3 audible
4. peipheral edema
5. elevated JVP
6. sinus tachy
7. +/- mitral/tricuspid regurgitation
8. +/- arrhythmias

Question 16

Dilated Cardiomyopathy

Dx

Answer 16

1. Labs: BNP, CMP, CBC, TSH
2. Echo
3. Heart Cath (+/-)
4. CXR (+/-)

Question 17

Dilated Cardiomyopathy

what is seen on echo?

3

Answer 17

1. dilated LV
2. decreased EF
3. ventricular hypokinesis

Question 18

Dilated Cardiomyopathy

what is seen on CXR?

3

Answer 18

1. cardiomegaly
2. pulm edema
3. pleural effusion

Question 19

Dilated Cardiomyopathy

Tx

2- Always

Answer 19

1. HF meds (BB, ARNI/ACE/ARB, spironolactone, SGLT-2)
2. avoid cardiotoxic agents + CCB

Question 20

Dilated Cardiomyopathy

+/- Tx options

3

Answer 20

1. ICD (EF < 35% 90d post QDMT)
2. CRT (EF < 35% w/ wide QRS 90d post GDMT)
3. Referral for LVAD/transplant

Question 21

Dilated Cardiomyopathy- Takotsubo

describe

Answer 21

broken heart syndrome, occurs after surge of catecholamines

Question 22

Dilated Cardiomyopathy- Takotsubo

common in who?

Answer 22

postmenopausal women

Question 23

Dilated Cardiomyopathy- Takotsubo

resovles after how long with GDMT?

Answer 23

6 mo- is transient

Question 24

Dilated Cardiomyopathy- Takotsubo

Management & Disposition

4

Answer 24

1. repeat echo
2. BB
3. ACE/ARB/ARNI
4. Spironolactone

Question 25

# Hypertrophic Cardiomyopathy signs & sx | 4

Answer 25

1. dyspnea 2. chest pain 3. post-exertional syncope 4. sudden cardiac death

Question 26

# Hypertrophic Cardiomyopathy PE findings

Answer 26

1. harsh systolic murmur on S4 2. bisferiens carotid pulse 3. enlarged PMI

Question 27

# Hypertrophic Cardiomyopathy what increases/decreases murmur? | 2 then 4

Answer 27

1. valsalva, standing (decreased venous return) 2. squatting, supine, leg raise, hand grip (increased venous return)

Question 28

# Hypertrophic Cardiomyopathy Dx | 4

Answer 28

1. echo 2. EKG 3. Genetic testing 4. preg counseling

Question 29

# Hypertrophic Cardiomyopathy what is seen on EKG?

Answer 29

LVH

Question 30

# Hypertrophic Cardiomyopathy what is seen on echo? | 3

Answer 30

1. repeat w/ exercise, valsalva 2. asymmetric septal wall thickening (> 1.5 cm) 3. systolic anterior motion of mitral valve w/ small LV chamber

Question 31

# Hypertrophic Cardiomyopathy Tx | 6

Answer 31

1. BB, CCB, disopyramide 2. Avoid dehydration 3. maintain NSR 4. surgical myectomy 5. alcohol ablation 6. +/- ICD/DDD pacing

Question 32

# Hypertrophic Cardiomyopathy Rec for athletic activity

Answer 32

1. avoid most competitive sports 2. low-risk older pts can participate given certain factors are absent

Question 33

# Restrictive Cardiomyopathy characterized by?

Answer 33

nondilated, rigid ventricles with impaired ventricular filling (diastolic dysfunction)

Question 34

# Restrictive Cardiomyopathy which side HF is more common? what is seen with it?

Answer 34

1. R > L 2. pulm HTN, decline in activity tolerance

Question 35

# Restrictive Cardiomyopathy signs & sx | 6

Answer 35

1. dyspnea 2. peripheral edema 3. palpitations 4. fatigue 5. weakness 6. exercise intolerance

Question 36

# Restrictive Cardiomyopathy what must be ruled out?

Answer 36

constrictive pericarditis

Question 37

# Restrictive Cardiomyopathy if caused by amyloidosis, what signs/sx can be expected? which organs are involved? | 5 sx, 2 organs

Answer 37

1. periorbital purpura 2. thickened tongue 3. hepatomegaly 4. diarrhea 5. wt loss 6. kidney & heart most commonly involved

Question 38

# Restrictive Cardiomyopathy Physical Exam Findings | 6

Answer 38

1. R sided failure 2. elevated JVP 3. ascites 4. edema 5. S3 audible 6. Kussmaul's sign pos

Question 39

# Restrictive Cardiomyopathy what is kussmaul's sign?

Answer 39

increase in jugular venous pressure w/ inspiration

Question 40

# Restrictive Cardiomyopathy dx

Answer 40

1. EKG- low voltage 2. Echo 3. Cardiac MRI 4. Pulmonary HTN 5. Biopsy (amyloidosis)

Question 41

# Restrictive Cardiomyopathy Echo findings | 5

Answer 41

1. thickened LV and RV walls 2. biatrial enlargement 3. elevated atrial pressure 4. normal systolic function 5. poor diastolic function

Question 42

# Restrictive Cardiomyopathy cardiac MRI findings | 1

Answer 42

diffuse hyper enhancement

Question 43

# Restrictive Cardiomyopathy what is associated with amyloidosis on biopsy?

Answer 43

apple-green birefringence w/ congo-red staining

Question 44

# Restrictive Cardiomyopathy Tx | 4

Answer 44

1. treat underlying disorder 2. +/- diuretics 3. Amyloidosis- chemo, +/- stem cell transplant 4. cardiac transplant