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Senior - EMED 2 > 3 - Cardiomyopathies > Flashcards

3 - Cardiomyopathies Flashcards

1
Q

What is the second MC cause of SCD in teens and the leasing cause of death in competitive athletes?

A

Hypertrophic cardiomyopathy

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2
Q

The primary cardiomyopathies:

A

Slide 7 long list

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3
Q

Common causes of secondary cardiac myopathies

A

Slide 8 - long list

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4
Q

Clinical features and ECG for dilated cardiomyopathy?

A

Congestive heart failure
Chest pain
Regurgitant murmurs

LVH, poor R-wave progression

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5
Q

Clinical features and ECG for myocarditis?

A

Fever
Tachycardia
Myalgias
CP

Nonspecific ST-T wave changes, often with pericarditis

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6
Q

Clinical features and ECG for HOCM

A 
DOE
CP
Palpitations
Syncope
Prominent J wave
Pulsus bisferiens
Systolic ejection murmur (increases with valsalva and decreases with squatting)

LVH, large septal Q waves

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7
Q

Usual cause of dilated cardiomyopathy?

A

Idiopathic

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8
Q

What is the primary indication for cardiac transplant in the US?

A

Dilated cardiomyopathy

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9
Q

Risks for dilated cardiomyopathy

A

black, male, age 20-50

Majority have advanced dz by the time of presentation

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10
Q

Describe dilated cardiomyopathy?

A

Systolic and diastolic dysfunction and diminished LV and RV contractile force, resulting in low CO and increased end-systolic and end-diastolic ventricular volumes

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11
Q

Hallmarks of dilated cardiomyopathy?

A

LV (and often RV) dilation accompanied by normal LV wall thickness

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12
Q

Sxs of dilated cardiomyopathy?

A

Looks like CHF

DOE
Orthopnea
PND
Bibasilar rales
Dependent edema
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13
Q

Why CP with dilated cardiomyopathy?

A

Limited coronary vascular reserve rather than atherosclerotic dz

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14
Q

Clinical features of dilated cardiomyopathy

A

Impaired valve closure

Holosystolic mitral or tricuspid regurgitant murmurs at LLSB

Enlarged liver and pulsatile if tricuspid insufficiency is significant

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15
Q

Dx of dilated cardiomyopathy?

A

Not usually made in the ED

Typically made at follow-up via echo

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16
Q

CXR with dilated cardiomyopathy

A

Enlarged cardiac silhouette and increased cardiothoracic ratio

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17
Q

MC findings on ECG for dilated cardiomyopathy?

A

LV hypertrophy and left atrial enlargement

Also, a-fib is common

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18
Q

How urgent is the echo with dilated cardiomyopathy?

A

Driven by patient presentation

Get it when:

Cause of HF is uncertain

To exclude known causes of HF that may be correctable

To estimate ejection fraction

To R/O other potential complications that may be amenable to therapy

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19
Q

What improves pt survival in cardiomyopathy pts?

A

ACE inhibitors
Blockers

Carvedilol

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20
Q

Dilated cardiomyopathy pts with ventricular ectopy may benefit from:

A

Amiodarone

Implanted pacemaker defibrillator

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21
Q

ED txt for dilated cardiomyopathy 2/2 noncompliance

A

Nitrates
IV diuretics
Re-start normal meds
Patient counseling

Make sure you r/o severe issues, as well (i.e. possible ischemia)

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22
Q

LVAD?

A

Awesome and weird device for severe dilated cardiomyopathy patients - moves the blood for em

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23
Q

Hallmarks of HCM?

A

On echo -> asymmetric septal hypertrophy and histologic hypertrophy associated with myocardial fiber disarray surrounding areas of increased loose CT

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24
Q

Describe the hemodynamics of HCM

A

Abnormal LV diastolic dysfunction d/t reduced compliance of the hypertrophied left ventricle

25
Q

In HCM, decreased compliance is reflected by:

A

Increase in LV filling pressure

26
Q

Most frequent complaint associated with HCM?

A

DOE 2/2 exercise-induced sinus tach

27
Q

Why CP in HCM?

A

Imbalance between o2 demand of hypertrophied LV and the available myocardial blood flow

28
Q

How do HCM pt’s respond to NTG?

A

Poorly - highly variable

Bc its a problem with the heart structure, not vessel issues

29
Q

During a HCM episode, pt’s may complain of:

A

Palpitations d/t forceful ventricular contractions

30
Q

Is JVP elevated in HCM pts?

A

Nope (not usually)

31
Q

In most patients with HCM, cardiac exam will reveal

A

S4

32
Q

Where is the systolic ejection murmur of HCM best heard?

A

LLSB or at the apex

33
Q

Maneuver to accentuate the murmur of HCM

A

Standing

Valsalva

34
Q

Maneuver to decrease the HCM murmur

A

Squatting

Passive leg elevation

Hand grip

*things that increase LV filling

35
Q

Effective bedside interventions on the murmur of HCM vs mitral valve prolapse

A

Chart - slide 33

*YOU NEED TO KNOW THIS

36
Q

DX of HCM

A

Echo to confirm

ECG - LVH and LAE, disproportionate septal hypertrophy

37
Q

If the HCM pt experiences syncope:

A

They’re getting admitted

38
Q

Mainstay therapy for CP in pt’s with HCM:

A

B-blockers

Slow that HR down

39
Q

Common causes of acute pericarditis:

A

Slide 40

KNOW THIS

40
Q

Normal amt of pericardial fluid

A

50ml

41
Q

MC symptom of acute pericarditis

A

Sharp, stabbing precordial or retrosternal CP

42
Q

Sxs of acute pericarditis

A

Pericardial friction rub (hard to hear)

Sudden or gradual onset

Radiating pain, aggravated by inspiration or movement

Pain more severe when supine, relieved when sitting up and leaning forward

Fever, dyspnea

43
Q

Stages of pericarditis

A

Slide 43 - know this

44
Q

Low-voltage QRS and electrical alternans suggests:

A

Development of large pericardial effusion

45
Q

Procedure of choice for acute pericarditis detection, dx, and follow-up:

A

Echocardiography

46
Q

Txt of acute pericarditis

A

Most resolve on their own

Ibuprofen 300-800mg’s every 6-8 hrs

Colchicine 0.5mg PO BID

47
Q

Which pericarditis pts am i admitting ?

A 
>100.4
Subacute onset over weeks
Immunosuppressed
Hx of oral anticoagulant use
Associated myocarditis
Large pericardial effusion (>20mm)
48
Q

Whats the big problem with cardiac tamponade?

A

Barney answer - prevents filling

49
Q

Factors that determine the rate at which tamponade occurs?

A
  1. Rate of fluid accumulation
  2. Pericardial compliance
  3. Intravascular volume
50
Q

Common causes of nontraumatic cardiac tamponade:

A

Metastatic malignancy (MC)

Acute Idiopathic pericarditis

Uremia

Bacterial or tubercular pericarditis

Chronic idiopathic pericarditis

Hemorrhage (anticoagulant use)

51
Q

Possible findings with the cardiac tamponade patient

A

Pulsus paradoxus

JVD

Absent “y” descent

Strong apical impulse

“Distant” heart sounds on auscultation

52
Q

ECG for cardiac tamponade

A

Electrical alternans is classic but uncommon…whatever the fuck that means…

Low voltage QRS complexes with PR-depression

53
Q

TOC for cardiac tamponade?

A

Echocardiography

54
Q

Dx of cardiac tamponade should be suspected based on:

A

Clinical exam and chest radiograph findings

Confirmed with echo

55
Q

Txt for cardiac tamponade

A

Volume expansion with a bolus of saline (1/2 to 1 L) - temporary measure

Pericardiocentesis is necessary for definitive therapy AND specific Dx

56
Q

Admit your cardiac tamponade pt if:

A

Hemodynamically unstable

Or

You did an emergent
Pericardiocentesis

Or

Pt has insufficient social situation to provide access to emergency care

57
Q

What is Beck’s triad?

A

JVD
HOTN
Muffled heart sounds

Think “cardiac tamponade”

58
Q

According to a new study marijuana users are twice as likely to suffer from a heart condition known as stress cardiomyopathy

A

But they’re three times as likely not to care

Senior - EMED 2 (10 decks)

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