Cumulative Flashcards
(42 cards)
Define Cardiomyopathy
What is the MC type?
Decreased myocardium function w/out ischemic or valvular etiology.
Dilated- systolic dysfunction of myocardium d/t idiopathic etiology.
What genetic defect can cause dilated cardiomyopathy?
What viral etiology can cause this?
What parasitic etiology can cause this?
TTN- controls protein connection w/in sarcomeres.
Coxsackie-B, HIV, Parvo B-19
T. Cruzi- Chaga’s Dz
What two medications can cause dilated cardiomyopathy?
Why/How does B1 (thiamine) deficiency cause dilated cardiomyopathy?
Doxorubicin, Trastuzumab
B1 stims pyruvate dehydrogenase conversion of pyruvate in AcoA. Inc’d pyruvate inc lactic acid - vasodilation - AV shunting
What is the Cardiac Output equation?
Define Pre/Afterload
What is Frank Sterling’s Law?
CO= SV * HR
Pre: blood in heart during diastole
After: resistance LV has to overcome to circulate blood
Inc sarcomere stretch = inc contractility
What 3 factors affect SV?
Define Eccentric/Concentric Hypertrophy
What is LaPlace’s Law?
Pre/Afterload, Contractility
Ecc: inc volume adds sarcomeres longitudinally; thin walls
Con: inc pressure adds sarcomeres parallel/vertically; thick walls
P=2T/R (pressure, tension, radius)
Inc wall pressure= inc tension
What is the Gold Standard for Dx dilated cardiomyopathy?
What hallmark sound is heard on exam?
What are the 6 Ds of etiology for this condition?
Echo- eccentric hypertrophy w/ HFrEF <50% (n= 55-70%)
S3
Drinking
Dunno
Deficient B1
Doxorubicin
Drugs
Dz
What are the Tx goals for dilated cardiomyopathy?
What meds are used for these goals?
Dec pre/afterload, remodel, arrhythmia
Inc contractility
Dec P: Nitro, ACEI, Diuretic, ARB
Dec A: Hydralazine, ACEI/ARB, ISDN
Dec R: Spironolactone, Eplerenone, ACEI/ARB
Dec Arr: BB (M/E-olol)
Inc Con: Digoxin
What is used for anti-coagulation in Pts w/ dilated cardiomyopathy?
When are these Pts candidates for ICDs?
What meds lower mortality vs are used for Sx control?
Native valve: DOAC/Dabigatran
Mechanical: warfarin
LVEF <35%
BB ACEI/ARB Spironolactone Hydralazine Nitrate (ISDN)
Sxs: Loops, Digoxin
Define Restrictive Cardiomyopathy
What are the two MCCs of this condition?
Pts are more likely to present w/ ? type of Sxs?
Fibrotic/infiltrative process causing diastolic dysfunction.
Idiopathic > Amyloidosis
R-sided HF Sxs
How does amyloidosis cause restrictive cardiomyopathy?
How does sarcoidosis cause restrictive cardiomyopathy?
How does hemochromatosis cause restrictive cardiomyopathy?
Mis-folded proteins deposited in endocardium.
Asteroid bodies causing non-caseating granuloma deposition.
Inc hepcidin protein (regulated feroprotein: transports Fe across GI lumen/release from spleen) causing inc Fe uptake/deposition.
Define Loeffler’s Endocarditis
How/why does cardiac ischemia place Pt at higher risk for VT/VF?
What are the 3 phases of diastolic filling?
Inc eosinophil production leading to fibrosis (parasite, drug, allergic, leukemia).
Dec perfusion = inc permeability for inc cation flow;
HCM>restrictive
Early: atrial blood falls down
Mid: blood from vasculature falls down
Late: atrial kick
What will be seen on EKG, Echo and biopsy in restrictive cardiomyopathy?
When are the ventricles most compliant w/ this condition?
What what is the MC presenting Sx and what will be found on PE?
Bi-phasic P-waves
Atrial enlargement
Apple green w/ Congo red stain
Early diastole
Dyspnea; Early: S3 Late: S4
Kussmaul sign: inspiration increases JVD
What finding during cardiac cath suggests restrictive cardiomyopathy?
How to Tx/manage this condition?
Square root/Dip and plateau sign- end diastolic pressure rapidly increases.
Dec Pre: Na/Water restriction, diuretics
Dec Aft: ACEI/ARB, Hydralazine, ISDN
Arr: BB/CCBs
Coag: DOAC/Warfarin
What genetic mutation causes HOCM?
What triad d/o can occur w/ this condition?
Why is there an increase in septal wall growth?
Autosomal dominant mutation of heavy chain of myosin causing decreased sarcomere function.
Trinucleotide repeat of GAA= Frederick Ataxia: DM, HCM, Ataxia: loss of body function.
Dec sarcomere function stims release of GF causing concentric myocyte growth.
Why is the anterior leaflet of the MV pulled anteriorly during systole in HOCM?
What will be seen/heard on PE?
Venturri effect: volume under pressure passing through small area pulls on leaflet.
MR
JVP A-wave: RA contracting against resistance
Apical lift
Biphasic radial pulse
S4
What causes murmur of HOCM to increase?
What causes murmur of HOCM to decrease?
Inc preload: squat/leg raise
Inc afterload: hand grips
Dec preload: stand/valsalva
Dec afterload: vasodilators (amylnitrate, hydralazine)
How to manage HOCM?
What needs to be avoided?
Increase preload: hydrate
Maintain HR/contractility: BB, Non-DHP CCB
Dec afterload: dilation decreases blood return to heart= inc SV/dec ESV increasing obstruction
Inc contractility: worsens obstruction while increasing O2 demand
What are the two definitive Txs for HOCM?
What are the Echo Dx criteria?
Myomectomy
Alcohol septal ablation
15mm septal thickness
13mm w/ +FamHx
What are the cardiac causes of Afib?
What are the non-cardiac causes?
HTN/Hypertrophy
Ischemia/inflammation
MR/S
Stretch (CHF/DCM)
Post-surgical catecholamine response
E+ abnormality (hypoK/Mg)
Hypoxia
Thyrotoxicosis: inc T3/4 inc B-adrenergic receptors=inc SNS
Sepsis- fight/flight response to HOTN
Pheo ETOH Drugs: meth/coke
What is the MC location for the ectopic foci causing Afib?
What is the equation for MAP
Pulmonary veins
2(DBP)+SDP/3
Goal: 70-100 to perfuse kidney/brain
What are the four classifications of Afib?
What determines if they’re hemodynamically unstable?
Mitral valve
Onset/Duration
Hemodynamics
Ventricular rate: >100bpm= Afib w/ RVR; <60bpm= Afib w/ SVR
Chest pain HOTN AMS Pulm edema
What are the four groups of timing classifications?
How is unstable Afib Tx?
New: <72hrs
Paroxysmal: <7days
Persistent: >7days
Long standing: >12mon
Permanent: >7days w/out attempt to convert to NSR
+CHAP= cardio convert
How is stable Afib Tx?
When is conversion considered in stable Afib?
What is procedure/confirmation imaging is preferred before converting?
Rate control (Amiodarone, BB, CCB, Digoxin)
Anti-coagulate (DOAC/LMWH)
Afib <48hrs w/ low CHADSVASC score w/ anti-coag x 4wks
TEE
What is the risk of using Amiodarone for rate control in Afib?
BBs are c/i for use if ? exists?
CCBs are c/i for use if ? exists?
When is Digoxin preferred?
Pulmonary fibrosis
Asthma/COPD
Decompensated HF
HOTN/HF due to vagus nerve stimulation to inc acetylcholine
