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CSI Exam 4 > Cardiomyopathy > Flashcards

Cardiomyopathy Flashcards

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1
Q

Cardiomyopathy definition

A

group of diseases of the myocardium associated with mechanical &/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation

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2
Q

Cardiomyopathy often lead to

A

to cardiovascular death or progressive heart failure-related disability

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3
Q

Dilated cardiomyopathy

A

Dilatation and impaired contraction of the left or both ventricles.

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4
Q

Hypertrophic cardiomyopathy

A

Left and/or right ventricular hypertrophy, typically involving the IVS

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5
Q

Restrictive cardiomyopathy

A

Restricted filling and reduced diastolic size of either or both ventricles with normal or near-normal systolic function

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6
Q

Arrhythmogenic right ventricular cardiomyopathy (ARD)

A

Progressive fibro-fatty replacement of the right ventricle

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7
Q

Congestive presentation is due to what type of cardiomyopathy?

A

Dilated cardiomyopathy

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8
Q

Describe the ventricle/s in Dilated cardiomyopathy.

A

large chambers + thin/weak muscular wall

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9
Q

Causes of Dilated cardiomyopathy

A

Idiopathic, EtOH, Radiation, Infectious/Acute viral myocarditis, MI, Peripartum, Genetics, Sarcoidosis, Hemochromatosis, Thiamine deficiency (Beriberi), thyrotoxicosis, Toxin Induced: anthryacycline, cobalt, catecholamine,

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10
Q

Toxin-induced causes of Dilated cardiomyopathy

A

EtOH, anthryacycline, cobalt, catecholamine

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11
Q

Dilated Cardiomyopathy is characterized by

A

large weak R/L/Both ventricles w/ impaired systolic function

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12
Q

Patient population of Dilated Cardiomyopathy

A

middle-aged, Male > Females

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13
Q

Annual mortality rate of Dilated Cardiomyopathy

A

12%; complete recovery from DCM is rare

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14
Q

Beriberi

A

Thiamine deficiency + Systolic HF (Dilated Cardiomyopathy)

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15
Q

Primary Dilated Cardiomyopathy

A

DCM of unknown etiology leading to LV dilation and systolic dysfunction

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16
Q

Secondary causes of Dilated Cardiomyopathy most commonly include

A

ischemia, alcoholic, peripartum, post-infectious, viral

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17
Q

Sx of Dilated Cardiomyopathy

A

Pulmonary congestion, dyspnea, orthopnea
Systemic congestion, edema, nausea, abdominal pain, nocturia
Hypotension, tachycardia, tachypnea
Fatigue and weakness

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18
Q

Cardiac S/S of Dilated Cardiomyopathy

A

Cardiac exam reveals -> S3, S4 and murmur of TR and/or MR; Low cardiac output;
Atrial fibrillation, conduction delays, complex PVC’s, sudden death

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19
Q

For Dilated Cardiomyopathy , what would be seen on CXR?

A

enlarged heart, CHF

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20
Q

For Dilated Cardiomyopathy , what would be seen on Electrocardiogram?

A

tachycardia, A-V block, LBBB, NSSTT changes, PVC’s

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21
Q

For Dilated Cardiomyopathy , what would be seen on EKG?

A

left ventricular dilation, global hypo kinesis, low EF

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22
Q

For Dilated Cardiomyopathy, when would cardiac catheterization be done?

A

if age >40, ischemic history, high risk profile, abnormal ECG

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23
Q

Pharmaceutical Treatments for Dilated Cardiomyopathy

A

Diuretics, Beta Blockers, ACE/ARB

Hydralazine/nitrate combination if cannot tolerate ACE/ARB

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24
Q

Pharmaceutical Treatments for Dilated Cardiomyopathy for EF < 35% with Class III/VI HF

A

Spironolactone

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25
Non-Pharmaceutical Treatments for Dilated Cardiomyopathy
Limited activity, Na+ restriction, Fluid restriction, transplantation
26
Pharmaceutical Treatments for Dilated Cardiomyopathy for EF <30%, history of LV thrombus or embolic events
Anticoagulation
27
Non-Pharmaceutical Treatments for Dilated Cardiomyopathy for EF <35% on optimal medical therapy
Implantable defibrillators
28
Most common indication for heart transplant (non-ischemic causes)?
Dilated Cardiomyopathy
29
Procedures to treat Dilated Cardiomyopathy once clotting is apparent
LV reshaping
30
Hypertrophic Cardiomyopathy
hypertrophy of the left ventricle with marked variable clinical manifestations morphologic and hemodynamic abnormalities
31
Obstructive Hypertrophic Cardiomyopathy
hypertrophied septum interferes w/ the anterior mitral leaflet displacement, both obstruct LV outflow
32
Causes of Hypertrophic Cardiomyopathy
Genetic (AD, beta-myosin heavy-chain mutation)
33
The severity of Sx increases in Hypertrophic Cardiomyopathy w/
any maneuver that increases the force of contraction or decreases filling of the ventricle
34
What type of Cardiomyopathy is associated w/ sudden cardiac death in young athletes?
Hypertrophic Cardiomyopathy; Left ventricular outflow obstruction
35
Myocyte characteristics of DCM?
Myocyte injury and fibrosis
36
Atrial fibrillation is seen w/ DCM, why is this?
thinning of the atrial septum which contains the SA node -> SA node impairment
37
Why is thromboembolism a problem in DCM?
LV dilation, pressure and reduced blood flow -> stagnant blood -> clotting in LV
38
How can you measure LV outflow obstruction?
Outflow tract gradient: measure blood flow before and above the LV obstruction
39
Hypertrophic Cardiomyopathy is considered a systolic or diastolic dysfunction?
Diastolic (inability to fill, increased filling pressure)
40
Maneuvers/Things that cause worsening of Sx in HCM patients
exercise, positive inotropic agents, volume depletion, sudden upright position, tachycardia, valsalva
41
Explain how valsalva causes a worsening of HCM.
valsalva -> increased intrathoracic Pressure -> decreases venous return to the heart -> decreases ventricular filling (low preload)
42
Clinical presentation of HCM is typically:
asymptomatic
43
Be suspicious of HCM when
family member w/ sudden cardiac death at younger age
44
Symptoms of HCM?
Dyspnea, Angina, Fatigue, Syncope, Palpitations
45
Cardiac Findings w/ HCM
Systolic ejection murmur at left sternal border, Afib, thromboembolism
46
HCM w/ loss of consciousness indicates what treatment?
defibrillation
47
Angina w/ HCM is due to
reduced blood flow, less blood entering coronaries
48
What maneuvers increase the ejection murmur associated w/ HCM?
Valsalva, Standing (decreased venous return)
49
What maneuvers decrease the ejection murmur associated w/ HCM?
squatting (increases venous return)
50
Imaging of the heart in HCM pts shows:
EKG - LVH
51
negative ECHO in child w/ FMHx of HCM
does NOT rule out HCM, serial ECHOs are required up to 20 y/o
52
EKG Findings in HCM
Abnormal ST-T's, giant T wave inversion, abnormal Q, Bundle Branch Block, Left atrial enlargement, Ventricular arrhthymias
53
Management of HCM patients
FHx of SCM, exercise testing, avoidance of strenuous exercise, screen family members, genetic testings
54
Pharmacologic Treatment of HCM patients
b-blockers, CCB, anti-arrhythmics
55
Non-Pharmacologic Treatment of HCM patients
Myomectomy, EtOH septal ablation
56
Beta-blockers are used for treatment of HCM, due to their...
Negative Inotropic Effects
57
Restrictive Cardiomyopathy characteristics
small ventricular chamber, inability of ventricles to stretch and fill during diastole causing increased ventricular filling P
58
Restrictive Cardiomyopathy is a systolic or diastolic dysfunction?
Diastolic
59
Restrictive Cardiomyopathy is most common where
tropics, Africa, India, S/C America, Asia
60
Common Causes of Infiltrative Restrictive Cardiomyopathy
Amyloidosis, Sarcoidosis, Hemochromatosis
61
Common Causes of Non-Infiltrative Restrictive Cardiomyopathy
Idiopathic, Genetics, Radiation, Chemotherapy toxicity
62
Genetic causes of Restrictive Cardiomyopathy
Loffler Syndrome (endomyocardial fibrosis + eosinophilic infiltrate), fibroelastosis, Fabry's
63
Sx of Restrictive Cardiomyopathy
JVD, Hepatomegaly, Ascites, weakness, fatigue
64
Restrictive Cardiomyopathy physiology
increased diastolic ventricular pressure + decreased ventricular filling --> venous congestion, decreased CO
65
ECHO of Restrictive Cardiomyopathy shows
prominent E wave, abnormal mitral inflow -> dilated Left atrium
66
patient with predominantly R-sided heart failure without evidence of either cardiomegaly or systolic dysfunction indicates
Restrictive Cardiomyopathy
67
Cardiac Findings in Restrictive Cardiomyopathy
S3, Dilated left atrium
68
Treatment for Restrictive Cardiomyopathy
CHF therapy, no clear medical therapy --> transplant
69
EF in HCM?
increased EF
70
EF in DCM?
decreased EF
71
EF in RCM
normal-decreased EF
72
Diagnostic test of choice for HCM?
ECHO
73
First line therapy for asymptomatic HCM pts?
beta-blockers (Negative inotropic effects)

CSI Exam 4 (11 decks)

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