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Nayla Foundations > Myocarditis > Flashcards

Myocarditis Flashcards

(54 cards)

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1
Q

What are the 3 structural types of cardiomyopathies

A 
Dilated (most common- systolic dysfunction)
hypertrophic
restrictive (diastolic dysfunction)
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2
Q

What is the leading cause of congestive HF

A

idiopathic dilated CM

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3
Q

What is dilated CM

A

LV enlarges (w/o hypertrophy) and can’t expel blood (reduced EF)

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4
Q

What happens to compensate for systolic dysfunction

A

HR and/or SV increase

CO=HRxSV, and CO is reduced in dilated CM

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5
Q

What causes dilated CM

A

**Idiopathic

also tons of others; genetics, myocarditis, etc.

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6
Q

What are the ABCD PIG for Dilated Cardiomyopathy

A 
Alcohol
Beriberi
Coxsackie/Chagas
Drugs (cocaine, chemo)
Pregnancy 
Idiopathic/infection
Genetic
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7
Q

What is Ischemic CM the most common cause of

A

HF due to systolic dysfunction

also causes Dilated CM

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8
Q

What happens in ischemic CM

A

LVEF <35-40% from CAD, often after MI

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9
Q

How do you treat Ischemic CM

A

ASA, high intensity statin, BB, Ace

Loop if fluid overloaded

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10
Q

What is Hypertensive CM

A

Concentric LVH that progresses to LV dilation

Usually causes systolic HF (but can rarely cause diastolic)

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11
Q

What is alcoholic cardiomyopathy

A

excess alcohol causes myocardial dysfunction

>90g (7-8 drinks) per day for 5 years (less for women)

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12
Q

What’s a characteristic ECG finding for alcoholic CM

A 
Prolonged QTc (cause ventricular arrhythmia)
Hypo-Mg and K prolong QT even more
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13
Q

What is peripartum CM

A

Development of HF late in pregnancy (36 wks) or 5 mo. postpartum
Wean therapy only after LVEF >50% for 6 mo.
Requires heart transplant
10% mortality in 2 years

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14
Q

What are RF for peripartum CM

A 
age
african descent
cocaine
pre-eclampsia
multiple fetuses
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15
Q

What is Takotsubo CM

A

Stress CM, broken heart syndrome
Transient ballooning of LV during systole
Associated with physical and emotional stress
WITHOUT CAD present (If present, probably not takotsubo)

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16
Q

How do Takotsubo patients present

A

Like MI (substernal CP)
7x elevated Troponin
ST elevation
decreased LVEF (ballooning)

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17
Q

How do you treat Takotsubo

A

recovery in 1-4 weeks!

BB if at risk for recurrence

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18
Q

What are dilated CM patients usually misdiagnosed as

A

Viral URI in young adults (viral myocarditis)

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19
Q

What are key points that indicate Dilate CM in History

A 
insomnia (sleeping sitting up) 
SOB,Cough, PND, orthopnea
Hx Breast cancer
alcohol or drug use
Fix sudden cardiac death
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20
Q

What would you see on dilated CM PE

A 
cariogenic shock, tachypnea
L/RHF symptoms
Hypoxia (clubbing, cyanosis)
Heaves, shifted PMI
(Kerley B lines on CXR)
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21
Q

What CMP finding in dilated CM indicates poor prognosis

A

Hyponatremia

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22
Q

How do you treat dilated CM

Study These Flashcards
A 
Same as HF; 
ACE (great if EF <35%)
ARB
BB (great if HFrEF and LVEF <40%)
aldosterone antagonist (reduce M&amp;M in Class III-IV HF)
23
Q

What is sacubitril-Valsartan

Study These Flashcards
A

Drug that reduces M&M in HFrEF patients

24
Q

What are the positive functions of the drugs used to treat Dilated CM

Study These Flashcards
A

ACE: decrease preload and after load
BB: reduce HR and decreased afterload

25
What are surgical options for dilated CM
LVAD CRT (LVEF <35%) AICD (LVEF <30-35%) Heart transplant
26
What is hypertrophic CM
Unexplained LV hypertrophy >15 mm (w/o dilation) with high incidence of sudden cardiac death AKA: IHSS and ASH
27
What causes hypertrophic CM
Familial HCM structural abn subendocardial ischemia
28
What is the pathophysiology of HCM
higher systolic outflow= more severe disease Increased ventricular filling pressure Mitral Regurgitation
29
What are the two types of HCM
Obstructive (due to systolic anterior motion of mitral valve obstructing flow) Non-obstructive
30
What happens when you increase LVOTO (L ventricular outflow tract obstruction)
decrease preload decrease after load increased inotropy (contraction) --Achieved by standing quickly or valsalva
31
How do you decrease LVOTO
supine with legs up | this increases chamber size and decreases inotropy
32
What makes HCM related to sudden cardiac death
increased risk for ventricular and supra ventricular arrhythmias
33
What are risk factors for sudden cardiac death in HCM
``` Hx syncope FHx LV wall >30 mm abn BP with exercise <30 y/o ```
34
How do HCM patients usually present
asymptomatic (until VTach) | -Fatigue, dyspnea, angina, palpitations, syncope, PMN/orthopnea, dizziness
35
What will you see on PE for HCM
Double apical impulse (S3 gallop) S4 Systolic ejection crescendo/decrescendo murmur at apex/LSB (increased with low preload/afterload aka valsalva)
36
How do you diagnose and treat HCM
TEE to diagnose | Risk stratify, restrict physical activity, avoid volume depletion
37
What is pharmacologic treatment for HCM
Arrhythmias: BB (- inotropy but not vasodilator) HCM and AFib: Anticoagulation! Sx despite BB: replace BB with Non-DHP CCB (Verapamil) Disopyramide: anti arrhythmic, STRONG - inotrope (more than BB and CCB), prolongs QT, accelerates AV (use WITH BB)
38
What is surgical treatment for HCM
surgical septal myectomy | alcohol septal ablation
39
What is restrictive CM
Ventricles impaired filling WITHOUT hypertrophy or dilation (diastolic dysfunction) Severe cases have bi-atrial enlargement
40
What are the causes of restrictive CM
``` Idiopathic Loeffler eosinophilic endomyocardial disease (#1 world wide) Amyloidosis (#1 in US) High incidence in tropics Resembles constrictive pericarditis ```
41
How dos RCM present clinically
Late stage with pronounced Sx | Exercise intolerance, SOB, fatigue, orthopnea, palpitations, syncope
42
What will you see on RCM PE
RHF Sx Cardiac cachexia amyloidosis signs (easy bruising, periorbital purpura, macroglossia) JVD (Kussmaul's sign)
43
How do you diagnose RCM
``` *Echo! Cardiac MRI ECG: ST depression, AFib, low voltage QRS Cardiac cath Ventricular biopsy (last resort) ```
44
What will lab findings for RCM show
eosinophilia LFT high NT-pro-BNP
45
How can you tell the difference between RCM and constrictive pericarditis
Cardiac cath | NT-pro-BNP elevated in RCM but NOT in constrictive pericarditis
46
How do you manage RCM
want to reduce filling pressure w/o reducing CO- BB, CCB Diuretics (but use caution) ACE and ARB not for amyloidosis Anticoagulate if in AFib -Treat underlying disease (chemo for amyloidosis) (phlebotomy for hemochromatosis) -Pacemaker, LVAD
47
What is cardiac amyloidosis
deposition of amyloid fibrils systemically, infiltrating the heart 4 types with varying prognosis
48
What is Myocarditis
inflammation of myocardium associated with CAD can be rapidly progressive and manifest in otherwise healthy patient -Usually cause systolic dysfunction
49
What are the types of myocarditis
Fulminant myocarditis (after viral prodrome) acute myocarditis chronic active myocarditis (fibrosis on biopsy) chronic persistent myocarditis (no systolic dysfunction)
50
What causes myocarditis
Idiopathic **Viral in developed countries (enterovirus, coxsackie B, adenovirus, CMV, EBV) developing countries (rheumatic carditis, chagas, HIV
51
What is the prognosis of Myocarditis
Fulminant myocarditis survivors: good prognosis 1/3 develop DCM Mild Sx recover completely Postpartum CM have 50% mortality at 1 yr
52
How does Myocarditis present clinically
Acute decompensating HF (**edema, S3 gallop, tachycardia) Recent URI, flu Sx (1-2 wk) CP (pericardial friction rub)
53
How do you diagnose myocarditis
Endomyocardial biopsy*** | indicate in fulminant HF w/in 2 wks/new onset HF w/o treatment response
54
How do you treat Myocarditis
avoid strenuous activity supportive care If fulminate myocarditis, manage as if HF

Nayla Foundations (18 decks)

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