9 - Cardiomyopathies Flashcards
3 kinds of cardiomyopathy
dilated, hypertrophic, restrictive
key features of dilated cardiomyopathy
ventricular dilation > impaired systolic function
generally progressive
arrhythmias common, sudden death can occur at any age
what is the major disease associated with dilated cardiomyopathy?
congestive heart failure
2 major reversible causes of dilated cardiomyopathy
alcohol, ischemia
what happens in dilated cardiomyopathy due to ischemia and how can it be reversed?
chronically ischemic myocardium becomes “hibernating” myocardium
it can be revascularized to restore function
4 irreversible causes of dilated cardiomyopathy
idiopathic
post MI scarring
familial
HIV
hypertrophic cardiomyopathy - key features
genetic disease (AD)
thick walls and filling abnormalities
arrhythmias common
sudden death at a younger age
which type of cardiomyopathy is associate with LV outflow track obstruction?
hypertrophic
clinical manifestations of hypertrophic cardiomyopathy
dyspnea, chest pain, syncope, impaired filling, arrhythmias
restrictive cardiomyopathy - key features
non-dilated ventricle with normal wall thickness and function and dilated atria. myocardium is rigid
diastolic dysfunction - ventricles fill at high pressures only
causes of restrictive cardiomyopathy
most idiopathic
amyloidosis, sarcoidosis, hemochromatosis, radiation, etc
clinical manifestations of restrictive cardiomyopathy
dyspnea and edema most common
elevated jugular venous pressure, pulm venous congestion
later - fatigue, weakness w/ low CO
mitral and tricuspid insufficiency, S3 gallop
dilated cardiomyopathy physical findings
dec S1, weak pulses
S3 gallop, maybe S4 gallop
MR and TR holosystolic murmurs
pulsus alternans - every other beat SV changes
hypertrophic cardiomyopathy physical findings
spike and dome / bisferiens arterial pulse - pulse shoots up quickly, then stops, then has a second wave as pressure becomes enough to overcome obstruction
triple apical impulse
prominent palpable S4
standing increases murmur, squatting decreases
paradoxical A2-P2 split - late A2
what is the brockenbrough-morrow-braunwald phenomenon and with what condition is it observed?
dec pulse in beat following ectopic beat
hypertrophic cardiomyopathy
ECG findings for 3 types of cardiomyopathy
congestive - LBBB, low voltage
hypertrophic - severe LVH, pathologic Q waves, WPW
restrictive - low voltage
which type of cardiomyopathy is assoc with systolic heart failure and dec EF?
dilated
which cause of dilated cardiomyopahy is not reversible? alcohol ischemia w/ hibernating myocardium hypothyroidism post MI scarring
post MI scarring
Which is true about murmur of LVOT obstruction in hypertrophic cardiomyopathy? best heard in axillary area softer w/ valvsalva louder w/ standing louder w/ leg elevation
louder w/ standing
which type of cardiomyopathy is suggested by normal size lv, normal wall thickness, normal systolic fn, and very large atria?
restrictive
all are true about braunwald phenomenon except: occurs in hypertrophic cardiomyopathy dec pulse in pulse after ectopic beat inc pulse after ectopic related to dynamic change in LVOT
inc pulse after ectopic
