cardiomyopathy Flashcards Preview

clinical medicine II > cardiomyopathy > Flashcards

Flashcards in cardiomyopathy Deck (45):
1

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 

2

what are the three types of cardiomyopathy

  1. dilated
  2. hypertrophic
  3. restrictive

3

what is the leading cause of "congestive heart failure"

dilated cardiomyopathy

4

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

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

5

name some causes of dilated cardiomyopathy

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

6

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

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7

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

8

what patient population is most affected by idiopathic cardiomyopathy

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

9

alcoholic cardiomyopathy accounts for what percentage of clinical DCM

1/3

10

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

2.6x

11

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

12

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

13

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

14

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

15

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 

16

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 

17

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

Metroprolol and Carvedilol 

18

what is the treatment for uncompensated dilated cardiomyopathy

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

19

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 

20

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

cardiac resynchronization therapy via a biventricular pacemaker 

21

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 

22

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

  • autosomal dominant 

23

symptoms of hypertrophic cardiomyopathy are similar to what other cardiac condition 

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

24

how is murmur in hypertrophic cardiomyopathy differ from vavular AS?

  • murmur is similar but LOUDER if patient STANDS or VALSALVAS

25

treatment for hypertrophic cardiomyopathy

  • calcium channel blockers
  • beta-blockers

26

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 

27

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 

28

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

29

what are the principe pathways of disease progression in hypertrophic cardiomyopathy

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

30

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 

31

what is the hallmark of restrictive cardiomyopathy

abnormal diastolic function

32

what is restrictive cardiomyopathy

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

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33

what are the classifiations for restrictive cardiomyopathy

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

34

symptoms of restrictive cardiomyopathy are consistent with 

right and left heart failure 

  • * jugular venous pulse prominent 

35

diagnosis of restrictive cardiomyopathy is confirmed by 

endomyocardial biopsy 

36

how can you differentiate between restrictive and constrictive pericarditis 

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

37

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

amyloidosis 

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

38

hemochromatosis is characterized by 

iron overload 

39

clinical presentation

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

hemochromatosis 

40

treatment for hemochromatosis

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

41

treatment of restrictive cardiomyopathy

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

42

what two conditions account for the highest percentrage of transplants 

  • CAD
  • cardiomyopathy (majority DCM)

43

what EKG changes are commonly seen in dilated cardiomyopathy 

  • sinus tachycardia
  • L BBB

44

what EKG changes are commonly seen in hypertrophic cardiomyopathy 

  • LVH
  • septal Q waves

45

what conditon causes sudden cardiac death in young athletes 

hypertrophic cardiomyopathy