Cardiomyopathy Flashcards
(136 cards)
1
Q
diseases of the heart muscle
A
cardiomyopathy
2
Q
what percent of HF are cardiomyopathies?
A
5-10%
3
Q
what can’t a patient have if they’re diagnosed with cardiomyopathy?
A
dysfunction from other structural heart disease
4
Q
what kind of dysfunctions do cardiomyopathies have?
A
mechanical and or electrical
5
Q
what is a common cause of cardiomyopathy
A
genetic
6
Q
what structural abnormality do cardiomyopathies have?
A
ventricular hypertrophy or dilation
7
Q
three types of cardiomyopathies
A
dilated
hypertrophic
restrictive
8
Q
early symptoms of cardiomyopathy
A
exertional intolerance
breathlessness & fatigue
may go unnoticed
9
Q
what does cardiomyopathy eventually resemble?
A
CHF
peripheral edema may not appear
10
Q
cardiomyopathy associated with
A
AV regurgitation
chest pain
Atrial and Ventricular tachycardias
embolic events
11
Q
what is the trend in prevelance with cardiomyopathies?
A
increasing due to increased awareness and testing
12
Q
what percent of cardiomyopathies associated with heritability?
A
30%
13
Q
what kind of inheritance are cardiomyopathies?
A
autosomal dominant
or spontaneous genetic mutations
14
Q
4 questions to ask about family history
A
Hx of cardiomyopathy
sudden death
a fib or pacer by middle age
muscular dystrophy
15
Q
3 types of cardiomyopathy
A
dilated
restrictive
hypertrophic
(all LV dysfunction)
16
Q
dilated cardiomyopathy
A
blown out ventricle
17
Q
restrictive cardiomyopathy
A
compromised filling
18
Q
hypertrophic cardiomyopathy
A
diastolic dysfunction
19
Q
EF of dilated cardiomyopathy
A
<30%
20
Q
EF of restrictive cardiomyopathy
A
25-50%
21
Q
EF of hypertrophic cardiomyopathy
A
> 60% (normal)
22
Q
LV diastolic size of dilated cardiomyopathy
A
increased
23
Q
LV diastolic size of restrictive cardiomyopathy
A
decreased
24
Q
LV diastolic size of hypertrophic cardiomyopathy
A
decreased
25
LV wall thickness of dilated cardiomyopathy
decreased
26
LV wall thickness of restrictive cardiomyopathy
normal
27
LV wall thickness of hypertrophic cardiomyopathy
increased
28
valvular regurg in all cariomyopathies
mitral
29
first symptom of all cardiomyopathies?
exertional intolerance
30
congestive symptom of dilated cardiomyopathy
Left before right
31
congestive symptom of restrictive cardiomyopathy
right
32
congestive symptom of hypertrophic cardiomyopathy
late finding left
33
arrhythmia for dilated cardiomyopathy
V tach
34
arrhythmia for restrictive cardiomyopathy
uncommon
35
arrythmia for hypertrophic cardiomyopathy
v tach
| a fib
36
an enlarged LV with decreased systolic function as measured by LV ejection fraction
dilated cardiomyopathy
37
when does diastolic failure increase with dilated cardiomyopathy?
as volume overload increases
38
what are acquired cased of dilated cardiomyopathy attributed to?
brief primary injury resulting in myocyte death
| infection or toxin exposure
39
pathophys of dilated cardiomyopathy
injury > myocyte death
myocytes hypertrophy to accomodate work load
remodeling of wall > dilation
dilation > mitral regurg
40
how long does the process of dilated cardiomyopathy take?
months to years
41
what social histories can contribute to dilated cardiomyopathy?
alcohol
illicit drugs
chemo
radiation
42
assessment of volume status in dilated cardiomyopathy
JVD
| edema
43
assessment of functional capacity in dilated cardiomyopathy
flight of stairs
exertional chest pain
dizziness
fatigue
44
bloodwork for dilated cardiomyopathy work up
CBC with diff
Chem 12
viral titers
rheumatologic factors
45
radiology for dilated cardiomyopathy work up
CXR (cardiomegaly)
echo
EKG
46
infective causes of dilated cardiomyopathy
viral
bacterial
parasitic
47
non-infective causes of dilated cardiomyopathy
```
non-infective inflammation
peripartum or postpartum
alcohol
stimulants
chemo
```
48
pathophys of viral myocarditis
acute viral infections in respiratory or GI tract
viral invasion & replication > direct myocardial injury
viral proteases degrade myocytes
viral antigens trigger immune response
49
clinical picture of viral myocarditis
young adult
progressive dyspnea & weakness over a few days
recent viral infection
fevers & myalgias
atypical or anginal chest pain
rapidly progresses from febrile respiratory syndrome > cardiogenic shock
50
what can viral myocarditis present as
acute fulminant myocarditis
51
treatment goals for viral myocarditis
hemodynamic stabilization
RAAS antagonism for HF treatment
betablockers, ACEIs, ARBs, nitrates, diuretics
52
viruses which cause viral myocarditis
```
coxsackie
echovirus
influenza
herpesviruses (varicella, cytomegalovirus, epstein-barr)
HIV
```
53
chagas' disease may cause
parasitic myocarditis
54
third most common parasitic infection in the world
chagas disease
55
most common cause of cardiomyopathy
chagas disease
56
what is the parasite in chagas disease
protozoan trypansoma cruzi
57
where is chagas disease seen
south and central america
58
where is there an increasing incidence of chagas disease?
western world
59
what does the acute phase of Chagas appear like?
goes unrecognized
60
how long does chagas develop over?
10-30 years (silently)
61
what is survival rate of chagas after onset of HF
<30%
62
what does the parasite cause in chagas disease
myocyte lysis
| chronic immune response
63
how does one get chagas disease
triamtomine bug bites infected animal & obtains protozoan
bug sleeps on face and defecates on you
transmision of protozoa through feces into mucous membranes
64
parasitic myocarditis contracted through undercooked beef or pork
toxoplasmosis
65
parasitic myocarditis contracted through tsete fly bites in africa
trypanosominasis (african sleeping sickness)
66
what does diphtheria cause
bacterial myocarditis from sepsis
67
where is diphtheria increasing
countries without routine vaccination
68
how does diphtheria affect the heart
releases a toxin that impairs protein synthesis
69
what infection produces gas bubbles in the myocardium from released toxin
clostridial infections
70
what infection is associated with rheumatic fever?
streptococcal
71
what causes spirochetal myocarditis
borrelia burgdorderi (lyme disease)
72
what does lyme's present as
arthritis and conduction disease
73
how do you treat lyme disease
antibiotics, resolves in 1-2 weeks
74
what is the most common noninfectious inflammatory cause
sarcoidosis
75
what is a multi-system disease most commonly affecting the lungs that leads to nonifectious cardiomyopathy
sarcoidosis
76
who is sarcoidosis most common in
AA males
77
what does sarcoidosis lead to
heart failure
| dysrhythmias
78
what is the injury in sarcoidosis
granuloma formation in myocardium
79
when does peripartum cardiomyopathy develop
last trimester
| within 6 months post partum
80
prevelance of peripartum cardiomyopathy
1:3-15,000 deliveries
81
increased risk of peripartum cardiomyopathy with
```
higher maternal age
twin pregnancy
malnutrition
tocolytic use (slow down contractions)
preeclampsia
toxemia (eclampsia)
```
82
most common toxic cardiomyopathy
alcohol
83
percentage of heart failure cases alcohol causes
10%
84
how much do you have to drink to get alcoholic toxic cardiomyopathy
6 drinks perday for 5-10 years
85
where does toxicity come from in alcohol
alochol and metabolite acetaldehyde
86
what does alcohol affect in cardiomyopathy
diastolic dysfunction
87
what illicit drugs cause toxic cardiomyopathy
cocaine and catecholamine stimulants (meth & bath salts)
88
what does cocaine and stimulants cause in toxic cardiomyopathy?
microinfarcts > chronic cardiomyopathy
89
what affect does cocaine have on the vessels
constriction
90
what medical treatment can cause toxic cardiomyopathy
chemotherapy
91
what is apical ballooning or stress-induced cardimyopathy called
tako-tsubo cardiomyopathy
92
who typically gets tako-tsubo cardiomyopathy?
older women
93
what affect on the heart does tako-tsubo have?
global ventricular dilation with basal contraction
94
shape of tako-tsubo heart
narrow necked jar shape from increased sympathetic stimulation
95
presentation of tako-tsubo cardiomyopathy
```
pulmonary edema
chest pain
EKG mimics AMI
LV dysfunction beyond one coronary artery
symptomatic care
```
96
marked LV hypertrophy in absense of other causes
hypertrophic cardiomyopathy
97
septum larger than free wall
hypertrophic cardiomyopathy
98
old terms for hypertrophic cardiomyopathy
hypertrophic obstructive cardiomyopathy (HOCM)
| idiopathic hypertrophic subaortic stenosis (IHSS)
99
cardinal features of hypertrophic cardiomyopathy
```
LV hypertrophy
diastolic dysfunction
systolic outflow obstruction
systolic anterior motion of mitral valve
excessive LV emptying
```
100
variable factors of hypertrophic cardiomyopathy
severity
| level of peripheral resistance
101
what do low resistance and low blood volume lead to in hypertrophic cardiomyopathy
obstruction
102
incidence of hypertrophic cardiomyopathy
incidence of 1:5,000 adults
103
main cause of hypertrophic cardiomyopathy
genetic
| 1/2 autosomal dominant
104
age of hypertrophic cardiomyopathy
20-40
105
most common presenting symptom for hypertrophic cardiomyopathy
DOE
106
other symptoms of hypertrophic cardiomyopathy
chest pain
paliptations
first manifestation could be sudden cardiac death
107
murmur of hypertrophic cardiomyopathy
crescendo-decrescendo mid systolic murmur
108
where is hypertrophic cardiomyopathy murmur heard best?
LLSB
109
what is murmur in hypertrophic cardiomyopathy a result of
outflow tract obstruction (turbulent flow to aorta)
110
how is hypertrophic cardiomyopathy diffferent than aortic stenosis?
location
| does not radiate
111
which murmur has the opposite effect of venous return than most murmurs
hypertrophic cardiomyopathy
112
pulse in hypertrophic cardiomyopathy
bifid due to delayed ejection
113
EKG on hypertrophic cardiomyopathy
LV hypertrophy
114
ECHO of hypertrophic cardiomyopathy
enlarged LV
| mitral regurg
115
goals of hypertrophic cardiomyopathy
symptom management
reduce HR and contractility to increase diastolic filling
prevent sudden cardiac death
116
what is used to prevent sudden cardiac death in hypertrophic cardiomyopathy
amiodarone
117
what is used to reduce HR and contractility in hypertrophic cardiomyopathy
verapamil
beta blockers
CCB
118
who are those at highest risk for sudden cardiac death?
```
previous sustained V tach
family history of sudden death
septal wall thickness >3cm
recurrent syncope
exercise induced hypotension
non-sustained V tach
```
119
how to treat sudden cardiac death hypertrophic cardiomyopathy
ICV!
120
what should patients avoid if they have Hypertrophic cardiomyopathy
intense training or competition
121
what is the best solution for hypertrophic cardiomyopathy
implant a cardioverter defibrillator (ICD)
| treat symptoms
122
what medications might you give for hypertrophic cardiomyopathy
diuretics for fluid
| anticoagulants for a fib
123
what surgery is an option for hypertrophic cardiomyopathy
surgical myomectomy
124
non-dilated LV with normal wall thickness
restrictive cardiomyopathy
125
stiff ventricular wall leading to diastolic failure
restrictive cardiomyopathy
126
decreased ventricular filling
increase filling pressures
increase LA pressures
restrictive cardiomyopathy
127
what happens to systolic function of LV in restrictive cardiomyopathy
systolic function preserved
128
causes of restrictive cardiomyopathy
storage diseases: amyloidosis
immunologic diseases: sarcoidosis
scarring post radiation therapy
129
what age does restrictive cardiomyopathy present at
any
130
what side HF does restrictive cardiomyopathy cause
either
131
signs/symptoms of restrictive cardiomyopathy
```
dyspnea
peripheral edema
palpitations
fatigue
weakness
exercise intolerance
```
132
EKG findings of restrictive cardiomyopathy
no specific
| maybe a fib
133
conduction issues of restrictive cardiomyopathy
premature beats or AV blocks
134
findings on CXR for restrictive cardiomyopathy
cardiomegaly secondary to atrial enlargement
pulmonary venous congestion
pleural effusions
pericardial calcification
135
how do we differentiate restrictive pericarditis from restrictive cardiomyopathy?
BNP usually elevated in restrictive cardiomyopathy
history of pericarditis or storage disease
ECHO
136
Tx of cardiomyopathy
none
symptomatic care
diuretics, CCB, BB, ACEI, ARBs
anticoagulation for a fib patients
