Foundations-Myocarditis/Cardiomyopathy Flashcards Preview

Foundations-Myocarditis/Cardiomyopathy > Foundations-Myocarditis/Cardiomyopathy > Flashcards

Flashcards in Foundations-Myocarditis/Cardiomyopathy Deck (59):
1

Cardiomyopathy

Structural/functional abnormality of heart muscle in the absence of:
-CAD
-HTN
-Valvular disease
-Congenital heart disease

2

What are the three main structural/functional categories

1. Dilated
2. Hypertrophic
3. Restrictive

3

What is the most common cardiomyopathy

Dilated

4

Define Dilated cardiomyopathy

Thin, enlarged ventricular wall, systolic dysfunction

5

Define hypertrophic cardiomyopathy

Myocardial hypertrophy (thick muscle) in the absence of HTN or aortic stenosis

6

Define restrictive cardiomyopathy

Nondilated ventricles, impaired filling, reduced diastolic function

7

Define Heart Failure

-Results from any structural or functional cardiovascular abnormality causing a supply/demand mismatch
-With Systemic perfusion being inadequate to meet the body’s metabolic demand

8

What is the main cause of dilated cardiomyopathy?

Idiopathic

9

What are the other non-idiopathic causes for dilated cardiomyopathy?

"ABCD PIG":
Alcohol
Beriberi (thiamine deficiency)
Coxsackie B, Chagas disease
Drugs: adriamycin (anthracycline), cocaine
Pregnancy
Idiopathic, infection
Genetic

10

What is the most common cause of heart failure due to systolic dysfunction?

Ischemic cardiomyopathy

11

What is a common cause of dilated cardiomyopathy?

Ischemic cardiomyopathy

12

How is Ischemic cardiomyopathy characterized?

LVEF≤35-40% FROM coronary artery disease
-often occurs after MI

13

Treatment for ischemic cardiomyopathy

ASA
High-intensity statin
Beta-blocker
ACE-inhibitor
Loop diuretic if fluid overload

14

How is hypertensive cardiomyopathy characterized?

Concentric LVH

15

What can lead to hypertensive cardiomyopathy?

Uncontrolled and sustained HTN over a long time period

16

Define alcoholic cardiomyopathy

Excessive alcohol use leads to myocardial dysfunction

17

Who is at risk for alcoholic cardiomyopathy?

>90g (7-8 drinks) per day for at least 5 years

18

When would you see a prolonged QTc (precursor to ventricular arrhythmias)

Alcoholic cardiomyopathy

19

Define Peripartum Cardiomyopathy

-Development of heart failure late in pregnancy or within 5 months of giving birth
-LVEF<45% with or without dilation
-Most common w/in 1 month postpartum

20

What are the risk factors for Peripartum Cardiomyopathy?

-age>30
-African descent
-Cocaine abuse
-Multiple fetuses
-Preeclampsia/eclampsia

21

What is the treatment for Peripartum Cardiomyopathy?

Heart transplant performed in 1/3

22

Define Takotsubo Cardiomyopathy

-"Stress Cardiomyopathy"
-->Catecholamine induced
-Characterized by transient LV dysfunction that appears as systolic apical ballooning

23

Sx's of Takotsubo Cardiomyopathy

-Substernal chest pain
-Troponin levels often 7x the upper limit of normal
-ECG with ST-elevation is common
-Echocardiography shows apical ballooning pattern, decreased LVEF

24

What age group does dilated cardiomyopathies occur in?

Age 20-60

25

Physical exam findings in dilated cardiomyopathy- Vitals

-Hypotensive
-Tachycardic (cardiogenic shock)
-Tachypnea

26

Signs of left sided HF in dilated cardiomyopathy

Pulmonary congestion:
-Productive cough
-Dyspnea (at rest, exertional, lying flat)
-Crackles or wheezing

27

Signs of right sided HF in dilated cardiomyopathy

-JVD
-Hepatojugular reflux
-Peripheral edema (pitting)

28

Diagnostic findings on a CXR in dilated cardiomyopathy

-Enlargement of cardiac silhouette
-Pulmonary vascular congestion
-Pleural effusion (R sided)
-Kerley B lines

29

Diagnostic findings on an EKG in dilated cardiomyopathy

-LVH
-Conduction delay
-Arrhythmias

30

What are the effects of ACE inhibitors in treating dilated cardiomyopathy

-Reduce preload and afterload by vasodilation--> BP reduction

31

What are the effects of Beta Blockers in treating dilated cardiomyopathy

Reduce detrimental effects on the heart from catecholamine stimulation
-Slow HR to increase diastolic perfusion
-Decrease after load

32

When do we use Beta blockers in treating dilated cardiomyopathy

HFrEF and LVEF ≤40%

33

Contraindications for beta blockers in dilated cardiomyopathy

HR<50
2nd or 3rd degree AV block
Asthma is a contraindication; COPD is NOT

34

What are the surgical options for dilated cardiomyopathy

-LVAD
-Cardiac resynchoronization therapy (CRT)
-Automatic implantable cardioverter-defibrillator (AICD)
-Heart transplantation

35

What is hypertrophic cardiomyopathy caused by?

Genetic disease of heart muscle (myocardium)
-Autosomal dominant
-Mutation in sarcomere protein genes

36

Define hypertrophic cardiomyopathy

Unexplained LV hypertrophy without dilation of the ventricles or a cardiovascular disease that could cause the degree of hypertrophy seen

37

What is diagnostic of hypertrophic cardiomyopathy

>15 mm LV wall thickness

38

What are the two classifications of hypertrophic cardiomyopathy

1. Obstructive
2. Non-obstructive

39

Define obstructive hypertrophic cardiomyopathy

midsystolic obstruction of flow through the LV outflow tract as a result of systolic anterior motion of the mitral valve (SAM) toward the septum

40

What is the number one risk for sudden cardiac death?

History of syncope and/or a family history of sudden death

41

Hypertrophic cardiomyopathy sx's

Fatigue
Dyspnea
Angina
Palpitations
Presyncope or syncope
Orthopnea and paroxysmal nocturnal dyspnea (PND)
Dizziness

42

What is a systolic ejection crescendo-decrescendo murmur indicate?

Hypertrophic cardiomyopathy

43

What is diagnostic of Hypertrophic cardiomyopathy

Transthoracic echocardiogram

44

What is the treatment for pt's with symptomatic arrhythmias in hypertrophic cardiomyopathy

beta-blocker or anti-arrhythmic

45

What is the treatment for pt's with arrhythmias sustaining frequent shocks from ICD with hypertrophic cardiomyopathy

Antiarrhythmic therapy:
-Sotalol
-Amiodarone

46

What is the treatment for pt's with HCM and Atrial Fibrillation, despite CHADS2VASc score

Anticoagulation

47

Non-pharmacologic treatment for hypertrophic cardiomyopathy

Surgical septal myectomy
Alcohol septal ablation

48

How is restrictive cardiomyopathy characterized

Non-dilated, non-hypertrophied ventricles with impaired LV filling
=Diastolic dysfunction

49

What is the most common cause of secondary restrictive cardiomyopathy in the US?

Amyloidosis

50

What diseases cause secondary restrictive cardiomyopathy

Sarcoidosis
Scleroderma (Progressive Systemic Sclerosis)
Metastatic malignancy
Radiation induced
Drug induced (chloroquine, hydroxychloroquine)
Hemochromatosis

51

Clinical presentation of restrictive cardiomyopathy

Progressive exercise intolerance and SOB
Fatigue
Orthopnea
Palpitations (frequently causes atrial fibrillation)
Thromboembolic complications
Orthostatic hypotension and syncope

52

Amyloidosis systemic signs

easy bruising
periorbital purpura macroglossia

53

+ Kussmaul Sign

JVP fails to fall during inspiration, and actually rises

54

Define cardiac amyloidsosis

-Multisystem deposition of amyloid fibrils
-Amyloidosis is a systemic disease, with cardiac infiltration being common

55

Myocarditis

-An inflammatory infiltrate of the myocardium with necrosis and/or degeneration of adjacent myocytes not typical of the ischemic damage associated with coronary artery disease

56

What is the most common cause of myocarditis in developed countries?

Viral infections

57

In developing countries, what are causes of myocarditis

-Rheumatic carditis
-Chagas disease
-Complications of HIV are more common

58

What is the gold standard diagnostic test for myocarditis

Endomyocardial Biopsy

59

When is Endomyocardial Biopsy indicated?

1. New onset fulminant HF within 2 weeks with hemodynamic compromise
2. New onset HF with failure to respond to treatment