cardiomyopathy Flashcards Preview

clinical medicine II > cardiomyopathy > Flashcards

Flashcards in cardiomyopathy Deck (45):

what is cardiomyopathy

an abnormality of heart function secondary to changes in the structure of the heart muscle

  • can result in no symptoms, mild, moderate, or severe symptoms of heart failure 


what are the three types of cardiomyopathy

  1. dilated
  2. hypertrophic
  3. restrictive


what is the leading cause of "congestive heart failure"

dilated cardiomyopathy


does ventricular dysfunction caused by coronary disease (ischemic cardiomyopathy) fall under cardiomyopathy

No, may look the same, but has a different cause


name some causes of dilated cardiomyopathy

  • ideiopathic
  • infectious - cocksackie, adenovirus
  • alcoholism
  • uncontrolled tachycardia
  • chemotherapy
  • cocaine
  • peripartum/post-partum (3rd trimester-6 months post)


what are the diagnostic criteria for idiopathic dilated cardiomyopathy

  • EF < 45% or FS (fractional shortening) <25%
  • LVEDD (end diastolic dimension) > 117% of predicted 


make sure idiopathic: always ask about alcohol and cocaine use


define idiopathic cardiomyopathy

  • disease of unknown etiology that principally affects myocardium
  • LV dilated and systolic dysfunction
    • increased heart size and weight
    • ventricular dilation, usually normal wall thickness
  • can be post-viral or unknown genetic


what patient population is most affected by idiopathic cardiomyopathy

  • blacks: whites 2:1
  • men:women 3:1


alcoholic cardiomyopathy accounts for what percentage of clinical DCM



what is the risk for SVT in patients who drink > 6 drinks/day



peripartum cardiomyopathy affects what patient population the most 

  • twin pregnancies
  • multiparas: women who has given birth 2 or more times
  • > 30 y.o
  • african american 


*subsequent pregnancies discouraged


what are the non-pharmalogical treatment recommendations for dilated cardiomyopathy

  • limit activity based on functional status
  • salt restriction of 2 g (Na+) or 5g NaCl
  • fluid restriction for significantly low Na+ levels


what is the primary pharmacological treatment option for dilated cardiomyopathy 

  • ACE inhibitors
    • reduce afterload by vasodilation, BP reduction
    • underdosing is common error
    • most start with Captopril (50 mg/d in 3 divided doses)
  • Diuretics 
    • watch K+ levels


what are some other pharmalogical treatment options you can give a patient with dilated cardiomyopathy 

  • Digoxin: inotropic agent
  • B-blockers: if symptoms persist
  • anticoagulation for EF < 30%, h/o clots
  • antiarrhythmics


Putting it all together, what medication treatment should a patient with dilated cardiomyopathy put on when they are discharged home? (compensated DCM)

  • ACE -I afterload reduction
  • diuretics
  • B-blockers: reduce contractility 


What is the purpose of putting someone with dilated cardiomyopathy on a beta blocker?

  • in heart failure, there is massive catecholamine release and constant stimulation of heart -> causes B-receptor desentisization
  • B-receptor blockers enable B-receptors to recover and let them become more efficient 
    • may help prevent cardiac remodeling 


What are the only two B-blockers approved for treatment of chronic compensated heart failure 

Metroprolol and Carvedilol 


what is the treatment for uncompensated dilated cardiomyopathy

  • inotropes
  • diuretics
  • ACE-I
  • mechanical support
  • transplantation


Patients with dilated cardiomyopathy are are increased risk for ventricular arrhythmias and sudden cardiac death. Patients who have a LVEF < 30% can be considered for what medical treatment 

  • cardiac defibrillator 

*regardless of symptom status 


patients with LVEF < 35%, BBB (QRS >0.12 s) and persistant heart failure sypmtoms may benefit from 

cardiac resynchronization therapy via a biventricular pacemaker 


what is hypertrophic cardiomyopathy

disease of cardiac muscle characterized by severe myocardial hypertrophy, in absence of a cause for secondary hypertrophy 

  • LV is hypercontractile and during systole ejects all of its blood, with high wall stress
  • small LV cavity 


hypertrophic cardiomyopathy is familial, and inherited in 60% of cases, what is the genetic trait

  • autosomal dominant 


symptoms of hypertrophic cardiomyopathy are similar to what other cardiac condition 

  • vavlular Aortic stenosis
    • symptoms: dyspnea, syncope, angina, palpitations 


how is murmur in hypertrophic cardiomyopathy differ from vavular AS?

  • murmur is similar but LOUDER if patient STANDS or VALSALVAS


treatment for hypertrophic cardiomyopathy

  • calcium channel blockers
  • beta-blockers


how does hypertrophic cardiomyopathy lead to myocardial ischemia 

  • increased muscle mass and filling pressure increases O2 demand
  • decrease in vasodilatory reserve
  • systolic compression of arteries 


what are the two most common symptoms in patients with hypertrophic cardiomyopathy

  • dyspnea (90%)
  • angina pectoris (75%) 
  • fatigue, syncope
  • **increased risk of Sudden cardiac death in children and adolescents 


how do the following impact HCM murmur?

  • postextrasystolic beat
  • squatting
  • isometric handgrip exercises

  • postextrasystolic beat: increase contractility and increase preload: murmur is louder
  • squatting: softer
  • isometric handgrip exercises: increase afterload; murmur is softer


what are the principe pathways of disease progression in hypertrophic cardiomyopathy

  • progression of symptoms
  • AFIB
  • sudden death
  • end stage with systolic dysfunction 


when is surgery for hypertrophic cardiomyopathy considered 

  • gradient > 50 mmHg at rest
  • class III or IV heart failure 

treatment options

** non-surgical alcohol septal ablation or surgical myomectomy 


what is the hallmark of restrictive cardiomyopathy

abnormal diastolic function


what is restrictive cardiomyopathy

  • rigid ventricular wall with impaired diastolic ventricular filling
  • **can't correct with surgery
  • least common form of cardiomyopathy 


what are the classifiations for restrictive cardiomyopathy

  1. idiopathic
  2. myocardial
    1. noninfiltrative
    2. infiltrative
      • amyloid
      • sarcoid
    3. storage disease
      • hemochromatosis
  3. endomyocardial 


symptoms of restrictive cardiomyopathy are consistent with 

right and left heart failure 

  • * jugular venous pulse prominent 


diagnosis of restrictive cardiomyopathy is confirmed by 

endomyocardial biopsy 


how can you differentiate between restrictive and constrictive pericarditis 

  • **History
    • constrictive
      • h/o TB, trauma
    • restrictive
      • amyloidosis, hemochromatosis 
    • mixed
      • mediastinal radiation, cardiac surgery 


what is the most common cause of restrictive cardiomyopathy in the USA


  • amyloid of myocardial biopsy could be due to primary amyloidosis or secondary to multiple myeloma and hypergammaglobulinemia 


hemochromatosis is characterized by 

iron overload 


clinical presentation

  • cirrhosis, DM, hyperpigmentation, cardiac dysfunction
  • CHF-leading cause of death 



treatment for hemochromatosis

  • phlebotomy
  • chelation therapy
  • **cardiac function may normalize


treatment of restrictive cardiomyopathy

  • NO satisfactory medical therapy
    • drug therapy use with caution
      • diuretics for extremely high filling pressures
    • Inotropic agents are NOT indicated 


what two conditions account for the highest percentrage of transplants 

  • CAD
  • cardiomyopathy (majority DCM)


what EKG changes are commonly seen in dilated cardiomyopathy 

  • sinus tachycardia
  • L BBB


what EKG changes are commonly seen in hypertrophic cardiomyopathy 

  • LVH
  • septal Q waves


what conditon causes sudden cardiac death in young athletes 

hypertrophic cardiomyopathy