Congestive Heart Failure Flashcards
(34 cards)
Peripartum Cardiomyopathy risks:
age > 30
multiparity
African descent
hx of eclampsia, preeclampsia, post partum htn
maternal cocaine use, > 4 wks tocolytic rx with b agonists
Peripartum Cardiomyopathy treatment:
optimize hemo
avoid ace
hydralazine drug of choice
anticoagulate
HIV cardiomyopathy:
not receiving HAART, 17% incidence in Rowanda
cmv in late stages- also direct hiv, coxsackie and ebv
30% reduction in hiv cm with HAART rx
etoh cardiomyopathy
80-90 gm etoh/d
1 liter wine, 8 beers/d 1/2 pt liquor
less fibrosis, better prognosis
Hemochromotosis
MRI T2
dm, arthritis, hyperpigmented
thalassemia transfusion
treat phlebotomy, chelation
Antracycline induced CM:
dose > 550 mg/m2 higher incidence than < 1 yr after exposure, but up to 10 yrs
associated with radiation, dm, htn, poor nutrition
attenuate/ prevent with ace, carvedilol, dexrazoxane
MM dystrophies, cardiomyopathies
types
Duchenne’s (dystrophin absent) myopathy more severe
beckers - abnormal dystrophin so myopathy less, but cardiomyopathy worse
dystrophin- in sarcolemmal membrane
Stress Cardiomyopathy
chf incidence
rx
recurrence
Takotsubo
post menopausal women
16% chf, pul edema- card shock 10%, trigger emotional stress
rx supportive- anticoag, ace, b blocker
recurrence <4% mortality 1.7% in hospital
Hypertrophic CM rx
avoid vol depletion
activity limit
avoid ionotropes, sauna, etoh
rx b blocker, or verap/dilt/ disopyramide, myectomy
ICD: arrest, sustained vt/vf (consider if fhx, >30mm, nsvt, syncope hx, bp fall with exercise
giant cell myocarditis
T cell mediated
rapid progressive, often fatal
rx thymoglobulin, corticosteroids, calcineurin inhib.
may be associated with other autoimmune dx
chagas dx
typannosoma cruzi portal of entry - chagoma fevers, hepatosplenomegaly, myocarditis worse with worse heart function rx nitrofurtimox in acute phase, chronic may benefit antiparasitic rx
Lyme disease cardiac disease hallmark card effects vector: cause, dx, rx
erythema migrans, joint involvement, meningoencephaltis
carditis: palpitations, conduction abnl, myocarditis, lv failure
vector: black legged tick
bacterium Borrelia burgdorferi
serologies: IgM positivity rx iv ceftriax if card involvment
Lupus card effects
systolic or diastolic dysfunction
conduction delays
bx shows mononuclear cell
Hypersensitivity myocarditis
clinical
causes
fevers, rash, peripheral eosinophilia- rx remove agent, corticosteroid
med induced: hctz, furosemide, amp, tetracycline, methyldopa, azithromycine, aminophylline, phenytoin, benzo, tca
Myocardial and celiac disease/ rx
5% of celiac pts have myocarditis
improves with gluten free diet
Cardiac amyloid types rx genetic counseling prognosis
AL, senile, transthyretin
AL can be rx with chemo and occasional stem cell xplant
transthyretin with liver xplant (usually presents 3rd decade)
familial usually transthyretin- genetic counsel
senile better prog than AL (7.5 vs 15 mths after chf presentation
Cardiac Sarcoidosis
cause
dx
t lymphocytes, noncaseating granulomas
5% card involvement
dx abnl echo, perfusion defect, delayed Gd enhancement,
infiltrative cardiomyopathies
fabry
friedreich ataxia
wegeners
danon
restrictive cardiomyopathies
amyloid, sarcoid, endomycardial fibrosis, noncompaction (icd and warfarin rx)
Staging for CHF
A: high risk, but without structural dz or chf
B: structural dz, but no signs/symptoms of chf
C: structural dz, with prior or current hf symptoms
D refractory of Hf
BNP vs NT BNP
NT 5-10x bnp in some pts
both affected by age and renal function
Ed >500 90% pos pred value
4000 predict mort and readmit
CPET
<14 cc/kg/min xplant
ve/vco2 increased mort increased mortality hf
HOPE trial
ramapril prevention of heart failure
ace intolerant studies
valheft and charm studies
charm with 3 arms- alternative to ace, added to ace, and arb with preserved lv function
