cardiomyopathy

Question 1

group of diseases of the myocardium associated with cardiac dysfunction

Answer 1

cardiomyopathy

Question 2

main types of cardiomyopathy

Answer 2

1. dilated cardiomyopathy
2. stress cardiomyopathy
3. hypertrophic cardiomyopathy
4. restrictive cardiomyopathy

Question 3

dilated cardiomyopathy

Answer 3

systolic (pumping) problem, and dilated baggy ventricles
impaired contraction of one or both ventricles

Question 4

reduced ejection fraction is less than ___

Answer 4

40%

Question 5

most common etiologys of dilated cardiomyopathy

Answer 5

idiopathic,,most common

infectious myocarditis, coxsakie b
toxic causes; etoh, cocaine,
b1 deficiency
doxorubicin

Question 6

dilated cardiomyopathy best test

Answer 6

echo
echo shows left ventrciular dilation, decreased ef <40%

Question 7

clinical presentastion. of dilated cardiomyopathy

Answer 7

heart failure

left heart failure signs include, orthopnea,
right heart failure signs include, jvd, peripheral edema

Question 8

lab tests in dilated cardiomyopathy

Answer 8

serum BNP, usually elevated
helpful to determine prognosis, and severity

Question 9

physical exam for dilated cardiomyopathy will show an ___ gallop rhythm,

Answer 9

s3
peripheral edema, acites, jvd, crackles

Question 10

pt comes in with complaints of diffculty breathing when walking, you note tachycardia on monitor, and in listeing to lungs you hear crackles, and see pedal edema, you decide to order an echo and you see left ventricular dilation and reduced ef at 35%. (1) what do you suspect? and (2) how will you treat this pt?

Answer 10

dilated cardiomyopathy, will tx using a combination of meds including

beta blocker, to reduce contractility (metoprolol)
ARNI- sacubitril-valsartan or ACE (pril)
spironolactione
diuretic, furosemide

also control contributin f factors

Question 11

pt with dilated cardiomyopathy when to admit

Answer 11

with hypoxia, fluid overload, or pulmonary edema, that is not fixed in an outpt setting

Question 12

stress cardiomyopathy is characeterized by a transient -______ dysfunction of the left ventricle, myocardial infarction, but is in _______of coronary artery diseas or in a plque rupture

Answer 12

systolic
absense

Question 13

stress cardiomyopathy is also called _________ and ______

Answer 13

broken heart syndrome

and takomondo (octopus)

Question 14

stress cardiomyopathy occurs after a major______ surge

Answer 14

catecholamine

(epinephrine and norepinephrine)

Question 15

ecg in stress cardiomyopathy will show

Answer 15

st elevations similar to st elevation in mi

Question 16

what other lab work is elevated in stress cardiomyopathy

Answer 16

cardiac enzymes, and bnp

Question 17

what lab diagnostic is required in stress cardiomyopathy to exclude acute coronary syndrome due to similar symptoms

Answer 17

coronary angiography, needs to shows absense of a plaque ruptue or obstructive coronary disease

Question 18

stress cardiomyopathy symptoms

Answer 18

acute substernal chest pain
dyspnea
syncope

frequently, a recent intense emotional or physcial stress, death of a loved one,

Question 19

______ performed after acute coronary syndrome is ruled out via coronary angiography absense of plaque rupture or obstructive coronary disease in stress cardiomyopathy

Answer 19

echocardiogram

Question 20

echocardiogram for stress cardiomyopathy (takotsubo syndrome) shows

Answer 20

transient systolic dysfunction
apical left ventricle ballooning

Question 21

initial tx for stress cardiomyopathy

Answer 21

aspirin, nitroglycerin, beta blocker, heparin, pt comes in and appears like a heart attack

conservative and supportive care, is the mainstay treatment in most patients

Question 22

a 80 year old pt with a recent loss of her husband complaint pf substernal chest pain, dyspnea, ecg highlights st elevations, and cardiac enzymes elevated troponin and bnp are elevated, what other diagnostic test will you perform

Answer 22

coronary angiograpohy, (CTA) first
if absense of plaque rupture then echo,
shows transient systolic dysfunction and left ventricle ballooning

Question 23

stress cardiomyopathy is a type of _____ cardiomyopathy

Answer 23

dilated

Question 24

who does stress cardiomyopathy predominantly affect

Answer 24

post menopausal women

Question 25

hypertrophic cardiomyopathy characterized by

Answer 25

increase in left ventricular wall thickness >15 mm on ECHO mutation in cardiac sarcomere genes

Question 26

hypertrophic cardiomyopathy most common cause of ____-

Answer 26

sudden cardiac death

Question 27

hypertrophy cardiomyopathy results in _____ dysfunction

Answer 27

diastolic dysfunction

Question 28

sudden cardiac arrest can occur in which cardiomyopathy

Answer 28

hypertrophic cardiomyopathy usually in adolescent, children, times of extreme exertion

Question 29

physical exam hypertrophic cardiomyopathy

Answer 29

harsh crescendo descrescendo systolic murmur., instensifiys with decreased venous return, from squat to stand decreases murmur with increased venous return mvp hates conforming to rules mitral valve prolapse, hypertrophic cardiomyopathy, increased murmur with decrease venous loud s4

Question 30

echo for hypertrophic cardiomyopathy will demonstrate

Answer 30

hypertrophy of ventricle wall, esp septal LV wall thickness >15 mm

Question 31

ecg for hypertrophic cardiomyopathy shows

Answer 31

left ventricular hypertrophy pseudo q waves

Question 32

treatment for hypertrophic cardiomyopathy is

Answer 32

first line is beta blockers verapamil or diltiazem are alternatives if first line fails try disopyramide surgical: myomectomy in young pts refractory to medical treatment risk for sudden cardiac death, implantable defibrillator

Question 33

what should be avoided in hypertrophic cardiomyopathy

Answer 33

digoxin, extreme exertion, alcohol nsaid, diuretic

Question 34

restrictive cardiomyopathy

Answer 34

chambers become stiff and rigud, do not cause wall thickening, resulting in diastolic (filling problem) dysfunction

Question 35

etiology for restrictive cardiomyopathy

Answer 35

amyloidosis (Mc) hemochromatosis sarcoidosis, "AMY has restrictvie sarcoidosis amy= amyloidosis has (hemochromatosis, amyloidosis, sarcoidosis)

Question 36

amyloidosis is what? how is it confirmed ? and how does it present?

Answer 36

abnormal protein build up in body, confirmed by endomyocardial biopsy other signs include macroglossia, periorbital purpura hepatomegaly

Question 37

restrictive cardiomyopathy symptoms

Answer 37

heart failure left sided hf, lungs, orthopnea, dyspnea on exertion right sided hf, jvd, peripheral edema

Question 38

restrictive cardiomyopathy exam

Answer 38

kussmauls sign, increase in jvp, jugular venous pressure with inspiration

Question 39

echo for restrictive cardiomyopathy will show

Answer 39

diastolic dysfunction preserved systolic disfunction bi atrial enlargement

Question 40

main differential for restrictive cardiomyopathy is

Answer 40

constrictive pericaerditis, how to differentiate both have heart failure, with normal systolic, but abnormal filling features that favor rcm, elevated bnp, cardiomegaly, audible s3 features that favor constrictive pericarditis - pericardial knock on exam - endomyocardial biopsy if unclear

Question 41

tx for restrive cardiomyopathy

Answer 41

tx underlying disorder amyloidosis, loop diuretics, (furosemide) tx symptoms of heart failure, general diuresis

Question 42

what to avoid with restrictive cardiomyopathy

Answer 42

digoxin

Question 43

hypertrophy cardiomyopathy most commonlly seen in

Answer 43

young/adolescent

Question 44

hypertrophy cardiomyopathy is most common cause of ______ in young adults/adolescents

Answer 44

sudden cardiac death

Question 45

a 23 year old patient presents after playing football and passed out, dagger q waves are present on ekg, and left axis deviation, long qrs, you seen left ventricular hypertrophy, you hear harsh creschendo-decreschendo systolic murmur, which increases when patient goes from squat to standing (decrease venous return standing to lying down and leg raise, murmur is decreased with increased venous return pulsus bisfereine, 2 upstrokes of pulse on echo you note ventricular wall thickness greater at 20 mm, what do you suspect, and how do u treat?

Answer 45

hypertophic cardiomyopathy beta blocker first, slows, heart rate allows for filling verapamil, or diltiazem, if cannot take beta blocke disopyramide, if cant do other two myomectomy, counseling - avoid dehydration avoid alcohol avoid digoxin, avoid extreme exercise (mild-mod exercise is ok) cardiologist

Question 46

with hypertrophy cardiomyopathy need to assess for ______

Answer 46

risks of sudden cardiac death, may need ICD

Question 47

risk for sudden cardiac death from hypertrophy cardiomyopathy

Answer 47

left ventricular hypertrophy >30 mm sudden cardiac death in a family member unexplained syncope

Question 48

left axis devition shows qrs is ___ in lead 1

Answer 48

down

Question 49

hypertrophy cardiomyopathy

Answer 49

dagger q waves left axis, lead 1 qrs down. large qrs complexes

Question 50

hypertrophy cardiomyopathy tests

Answer 50

genetic test ekg echo**

Question 51

hypertrophy cardiomyopathy results in ____ dysfunction due to _____

Answer 51

diastolic thickening of the ventricle

Question 52

with echocardiogram in suspected restrictive cardiomyopathy u see, bright speckled myocardium what do u suspect is the cause in restrictive cardiomyopathy

Answer 52

amyloidosis

Question 53

restrive cardiomyopathy must be differentiated from ____ pericarditis

Answer 53

constrictive

Question 54

for RCM vs constrictive pericarditis, -

Answer 54

restrictive cardiomyopathy (rcm): audible s3, elevated BNP pericarditis, pericardial knock,