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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

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