Cardiomyopathy and Obstructive Sleep Apnea Flashcards Preview

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Flashcards in Cardiomyopathy and Obstructive Sleep Apnea Deck (36):
1

What is the most important thing to control in HF?

Blood Pressure

2

Cardiomyopathy can lead to what?

Heart failure

Arrhythmias

Conduction Abnormalities 

Thromboembolic strokes

3

Clinical forms of cardiomyopathy

Dilated MC

Hypertrophic 

Restrictive (diastolic)

4

Dilated Cardiomyopathy etiologies and general characteristics

Common etiologies

  • Post Viral (MC)
  • EtOH
  • Cocaine 
  • Familial 
  • Post partum 

4 Chamber cardiac enlargement 

CO may be normal at rest, but does not adequately increase with exertion 

5

Dilated Cardiomyopathy Physiology 

EF <30% may improve with time and tx 

RIsk for ventricular tachyarrhythmias and sudden death 

 

6

Dilated Cardiomyopathy sxs

Non-specific non-ischemic CP

Syncope 

Sxs of HF (DOE, PND, orthopnea, peripheral edema)

7

Dilated Cardiomyopathy PE 

Cardiomegaly 

Signs of L sided HF 

  • Rales 
  • Wheezing

Signs of R Sided HF 

  • Edema 
  • HJR
  • Concurrent signs of L sided HF 

 

8

Dilated Cardiomyopathy Tx

Treat underlying cause 

Tx HF 

Tx arrhythmias and conduction disturbances 

Prevent thromboembolic complications 

9

Hypertrophic Cardiomyopathy Etiology

Genetic heterogenous autosomal dominant mutation in genes coding for sarcomeres 

Lead to thickening of L ventricle and septum 

Presents between ages 20-40

10

Hypertrophic Cardiomyopathy Physiology

EF >60%

L ventricular volume decreased (doesn't eject as much blood)

Sxs: DOE, CP, syncope, palpitations 

Risk for ventricular tacchyarrhythmias and A Fib 

 

11

Common cause of sudden death in athletes

Hypertrophic cardiomyopathy 

Syncopal episode during exercise is a warning sign of HD and requires cardio evaluation 

EKG (makes Dx), Echo, Exercise stress test 

12

Hypertrophic Cardiomyopic PE 

Prominent L Ventricular Impulse 

S4 gallop 

Murmur along L sternal border that increases on expiration, increases going from squatting to standing

13

Etiology of Restrictive Cardiomyopathy

Infiltrative diseases: amyloidosis, sarcoidosis 

Restrictive pericarditis 

Chemo 

Radiation 

 

14

Restrictive Cardiomyopathy Physiology

Diastolic and systolic dysfunction 

EF dec'd 25-50%

LV internal dimension decreased

Sxs: exertional intolerance 

Risk for arrhythmia: ventricular, conduction block, A fib 

15

Restrictive Cardiomyopathy PE 

May be normal 

May be signs of L sided HF 

A fib may be present

16

Evaluation of Restrictive Cardiomyopathy

CXR 

EKG 

Echo 

17

Systolic dysfunction (Causes HF)

Inability of heart to contract strongly enough to supply blood to periphery 

Primarily in dilated cardiomyopathy

18

Diastolic  Dysfunction (Causees HF)

Associated with reduced filling of the ventricle because heart cannot relax properly 

Hypertrophic or Restrictive Cardiomyopathy

19

Left Ventricular Failure

Acute MI 

Papillary muscle rupture secondary to AMI 

CAD 

Cardiomyopathy

20

Right Ventricular Failure

PE 

Pumonary HTN 

RV Infarct 

Cardiomyopathy

21

Can have L, R or Biventricular failure

True or False?

True

22

High Output Failure

Heart is unable to meet abnormally high metabolic demands of peripheral tissue

Anemia, thiamine deficiency (EtOH, Refeeding Syndrome), Thyroid disorders

23

Low Output Failure

insufficient forward output at rest or with increasing metabolic demands 

Dilated, restrictive, ischemic cardiomyopathy

24

Acute vs. Chronic Heart Failure

Previously normaly, develops HF because of AMI, papillary muscle rupture or PE 

Pre-existing heart disease, can be compensated and then have decompensation 

25

HF/Cardiomyopathy Evaluation

H&P

EKG 

CXR

Echo

MRI

Cardiac Cath

Lab Tests

Genetic Tests 

26

Left Sided HF PE

Rales & Wheezes

27

R Sided HF PE

Distended neck veins, HJR

Peripheral Edema

28

EKG Findings 

LVH 

Sum V1 + V5 or V6 >35mm

29

Cardiomyopathy Cardiac Cath

Chamber size

EF

Valvular Function 

Coronary Artery Anatomy

30

Cardiomyopathy Labs

BNP 

  • secreted by ventricles in setting of volume expansion and pressure overload 
  • >100 indicates HF

Maybe also: 

  • Thyroid function (TSH)
  • Drug screenings 
  • Viral titers 
  • Renal and liver function

31

Pathophys of Sleep Apnea (2 kinds)

Obstructive--narrowing or collapse of upper airway (MC)

Central--absent drive to breathe

32

Obstructive Sleep Apnea Sxs

Snoring 

Nocturnal arousal 

excessive daytime sleepiness

personality changes

intellectual deterioration 

morning HAs 

chronic fatigue

33

Associated Disorders of Sleep Apnea

Obesity 
Nasal obstruction 
Adenoidal or tonsillar hypertrophy 
Small jaw (micrognathia)
Macroglossia
Hypothyroidism 

Neuromuscular disease

34

Associated Cardio Disorders with Sleep Apnea

Systemic HTN 

HF 

Stroke

DM 

Metabolic Syndrome 

35

Diagnosis of Sleep Apnea

Epworth Sleepiness Scale (normal 1-10)

H&P

Gold Standard--Sleep Study

36

Treatment of Sleep Apnea

Weight loss 

CPAP

Surgery 

 

Treatment results in cardiac remodeling, improving cardiac function, improves metabolic syndrome, better sleep and decreased daytime sleepiness