252-254 Hf, Cm, Transplant Flashcards
MCC HFpEF
Htn 75%
Cad 60-75%
Normal jvp height
8cm
Normal pulmo artery pressure
15mmHg
Dilated cardiomyopathy tx
- almost 1/2 shows spontaneous recovery
- bb, raas inhibitors
- cardiac resynchronization pacing: in whom lbbb precedes clinical hf by many years
Dallas criteria for myocarditis
- lymphocytic infiltrate with evidence of myocarditis
Mcc myocarditis
Infective
- viral
- t cruzi: most common infective caus eof ccardiomyopathy and 3rd mc parasitic infxn in the world
Viral myocarditis
No effective tx
Viral myocarditis
No effective tx
Chagas disease phases, dx, tx
- acute: nonspecific
- chronic: progresses over 10-30yrs, gi and cardiac (conduction system abnormalities)
- dx: at least 2 serologic positive test
- tx: supportive, benznidazole/nifurtimox unclear if can prevent disease progression
- <30% 5yr survival when onset of clinical hf
African trypanosomiasis
- tse tse fly
- western: t. Brucei gambiense, slow silent progression
- eastern: t. Brucei rhodesiende, rapid progression
- antiparasitic tx of limited efficacy
Bacterial infection myocarditis
Diphtheria - affects 1/2 of cases and is mcc death, antitoxin priority over antibiotic
Clostridium - abscess
Strep (GAS) - rheumatic fever
Tb
Tropheryma whipplei - tx antitb meds, high recurrence
Lyme disease: resolves in 1-2 wks of tx
Sarcoidosis
- right ventricular affectation
- dx: pet scan, biopsy of mediastinal ln (partchy cardiac involvement likely to be missed with cardiac biopsy)
- tx: glucocorticoids, immunosuppression
Giant cell myocarditis
- granulomatous lesions surrounded by extensive inflammatory infiltrate unlikely to be missed on myocardial biopsy
- tx: glucocort + immunosuppression
- rapid detoriation
Eosinophilic myocarditis
- churg strauss
- malignancy
- hypersensitivity: antibiotics, thiazides, methyldopa, anticonvulsants, indomethacin
- glucocort and withdrawal of offending agent
Peripartum cardiomyopathy onset and risk factors
Last trimester and first 6mos postpartum
- age, parity, twin, mulnutrition, use of tocolytic, preecclampsia
Mcc toxic cardiomyopathy
- Alcohol
- Contribute to >10% of hf
- 5-6drinks (4oz of pure alcohol) daily for 5-10yrs
- improvement in 3-6mos of cessation
- tx: neurohormonal antagonist and diuretics
Chemotx cardiomyopathy
- Anthracyclines
- vacuolar degeneration and myofibrillar loss
- occur late after exposure
- tx: neurohormonal antagonist and bb - Trastuzumab
- less than anthracyclines
- reversible - 5fu, cisplatin, alkylators
- coronary vasospasm - Carfilzumab>bortezomib
- Ipilimumab, nivolumab - fulminant myocarditis when combined
- Vegf inhibitors
Beri beri
High output cardiac failure
Left ventricular noncompaction findings
- taz gene (tafazzin)
- multiple trabeculations in the lv distal to the papillary muscles
Left ventricular noncompaction triad
- Arrhythmia
- Heart failure
- Emboli
Tx: anticoag, icd, neurohormonal antagonist
Takotsubo cardiomyopathy
- apical ballooning syndrome, global ventricular dilation with basal contractikn
- ecg: mimic mi
- intense sympathetic activation
- no tx supportive (bb, nitrates for pulmo edema,mgso4 for long qt arrhythmia), prognosis generally good
Fabry disease biopsy findings
Diagnostic vesicles containing concentric lamellar figures
Danon’s disease
Lamp2 gene: x linked
Cardiomyopathy, mental retardation, skeletal myopathy
Restrictive carduomyopathy amyloidosis gene
- Transthyretin V122I chromosome 13
- 50%risk of hf
- Refractile brightness on 2d echo
- amyloid fibrils infiltrate the conduction system and coronary arteries
- if primary amyloid tx: bortezomib
Loeflers endocarditis
Eosinophilic injury to the myocardium
Dense fibrotic layer obliterate the ventricular apices
Tx glucocorticoids
Hocm 80% of mutations are due to
- myh7
- mybpc3: average onset 40y/o
- obstruction + in 30%, provoked by exercise in another 30%
Tx: bb, ccb, disopyramide (antiarrhythmic with potent negative inotropic properties)
Cardiac transplant cold ischemia time
4hrs
Cardiac conditioning hormone used
Thyroid
Most common heart transplant surgery
- bicaval orthotopic cardiac transplant
- denervated: if with bradycardia cannot be treated with atropine need to give isoproterenol
Triple drug immunosuppresion for cardiac transplantation
- calcineurin inhibitor (cyclosporine, tacrolimus)
- glucocorticoids
- antiproliferative immunosuppression (azathioprine, mycophenolate mofetil, sirolimus, everolimus)
Assist devices
- heart mate II:pulsatile, intrathoracic+ abdominal, no intrinsic pulse
- heart ware: continuous centrifugal flow
- heart mate III: continuous, fully intrathoracic magnetically levitated, with intrinsic pulse
(MOMENTUM trial) - syncardia: biventricular
Reductions in mortality
Acei
Bb
Spironolactone
Ace inhibitor 23%
Beta blocker 35%
Spironolactone 30%
