68. Myocarditis and pericarditis Flashcards
Dilated cardiomyopathy: what two things is this characterized by?
ventricular dilation and decr contractility
Dilated cardiomyopathy: 1/3 cases are ?
herediatry - mutation of genes
Dilated cardiomyopathy: major sx
dyspnea - exertion or supine
other:
cp
peripheral edema
dysrhythmias
syncope sudden death
Dilated cardiomyopathy: EF <?% required?
45
Dilated cardiomyopathy: possible ECG findings
poor R wave progression
IV conduction delay
LBBB
LVH with or without repol changes
ectopy common
Dilated cardiomyopathy: mc nongenetic cause?
ischemic cardiomyopathy by CAD
Dilated cardiomyopathy: List 10 causes
- CAD -> ischemic
- etoh
- cocaine
- meth
- chemo with antrhacycline
- hemochromatosis
7.pseudoephedrine - ephedra
- phenothiazines
- Li
- anabolic steroid
- clozapine
- hydroxychloroquine
Dilated cardiomyopathy: medical tx generally
- diuretics
- furos 1-2x pt baseline dose or 10mg if naiive - vasodilators
-NTG 5mcg/min and titrate up
Dilated cardiomyopathy: LT management meds by cardio?
acei/arb (mortality benefit)
sglt2i also helpful mortality
spirono
diuretic? sx only
Dilated cardiomyopathy: when to get an ICD?
ef <35%
Dilated cardiomyopathy: when to be adm to hospital
- new rhythm not adq controlled with meds
- deterioration of function by sx or dx data
- sign pulmonary fluid overload that cannot be reversed
- first dx (ish indication)
Hypertrophic cardiomyopathy: what is this?
AD sarcomere mutation causing LVH and scar formation, leading to dysrh and heart failure
Hypertrophic cardiomyopathy: pathophys
Mutation in beta myosin heavy chain and myosin pro C often leading to affect to actin-myosin bridge, storke power and sn ATP/Ca
Therefore, compensation by m hypertrophy and fibroses
When are most HCM patient’s diagnosed?
30-40y
HCM - diastolic dysfunction symptoms common. Examples?
exertional dyspnea
orthopnea
peripheral edema
Signs of HCM on exam:
displaced left pmi
harsh midsystolic grade 3-4 murmur loudest apex and LLSB
valsalva incr murmur
HCM: ECG
90% abnormal:
afib
LVH
st segment alteration
twi
LAE
abnormal q wave
dimished or absent R wave in lateral leads
Meds in HCM for exercise related sx
metop or ccb if intolerant (dilt)
Meds in HCM for afib (acute)
cardioversion and rate control - dilt consider or emsmolol
Meds in HCM for afib (chronic)
amiodarone
doac
Persistent hypotension in a HCM pt - what med to use?
what to avoid?
phenylephrine
dobutamine
Risk calculation for ICD in HCM pt includes what factors?
pt age
family hx of first degree relative with Sudden cardiac death age <40y or confirmed HCM, presence of vent tachy, and unexplained syncope
What pt with HCM should be hospitalized? (ie what presentations?)
angina
syncope
near syncope
dysrth
abrupt HD changes
Restrictive cardiomyopathy: how does this occur?
gradual and proressive limit of vent filling secondary to myocardial infiltration - stiffness of. ventricles with normal diastolic vol and ventricular wall thickness