Flashcards in Myocarditis Deck (54)
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1
What are the 3 structural types of cardiomyopathies
Dilated (most common- systolic dysfunction)
hypertrophic
restrictive (diastolic dysfunction)
2
What is the leading cause of congestive HF
idiopathic dilated CM
3
What is dilated CM
LV enlarges (w/o hypertrophy) and can't expel blood (reduced EF)
4
What happens to compensate for systolic dysfunction
HR and/or SV increase
(CO=HRxSV, and CO is reduced in dilated CM)
5
What causes dilated CM
**Idiopathic
also tons of others; genetics, myocarditis, etc.
6
What are the ABCD PIG for Dilated Cardiomyopathy
Alcohol
Beriberi
Coxsackie/Chagas
Drugs (cocaine, chemo)
Pregnancy
Idiopathic/infection
Genetic
7
What is Ischemic CM the most common cause of
HF due to systolic dysfunction
(also causes Dilated CM)
8
What happens in ischemic CM
LVEF <35-40% from CAD, often after MI
9
How do you treat Ischemic CM
ASA, high intensity statin, BB, Ace
Loop if fluid overloaded
10
What is Hypertensive CM
Concentric LVH that progresses to LV dilation
Usually causes systolic HF (but can rarely cause diastolic)
11
What is alcoholic cardiomyopathy
excess alcohol causes myocardial dysfunction
>90g (7-8 drinks) per day for 5 years (less for women)
12
What's a characteristic ECG finding for alcoholic CM
Prolonged QTc (cause ventricular arrhythmia)
Hypo-Mg and K prolong QT even more
13
What is peripartum CM
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
14
What are RF for peripartum CM
age
african descent
cocaine
pre-eclampsia
multiple fetuses
15
What is Takotsubo CM
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)
16
How do Takotsubo patients present
Like MI (substernal CP)
7x elevated Troponin
ST elevation
decreased LVEF (ballooning)
17
How do you treat Takotsubo
recovery in 1-4 weeks!
BB if at risk for recurrence
18
What are dilated CM patients usually misdiagnosed as
Viral URI in young adults (viral myocarditis)
19
What are key points that indicate Dilate CM in History
insomnia (sleeping sitting up)
SOB,Cough, PND, orthopnea
Hx Breast cancer
alcohol or drug use
Fix sudden cardiac death
20
What would you see on dilated CM PE
cariogenic shock, tachypnea
L/RHF symptoms
Hypoxia (clubbing, cyanosis)
Heaves, shifted PMI
(Kerley B lines on CXR)
21
What CMP finding in dilated CM indicates poor prognosis
Hyponatremia
22
How do you treat dilated CM
Same as HF;
ACE (great if EF <35%)
ARB
BB (great if HFrEF and LVEF <40%)
aldosterone antagonist (reduce M&M in Class III-IV HF)
23
What is sacubitril-Valsartan
Drug that reduces M&M in HFrEF patients
24
What are the positive functions of the drugs used to treat Dilated CM
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
