Cardio: buzzwords/diseases Flashcards
Dilated Cardiomyopathy
- what type of HF
- RF
- Etiologies (6)and which is mc?
- CM
- PE
- Diagnosis —TOC?
- whats EF like?
reduced strength of contraction and systolic dysfunction–>leading to dilated weak heart–>right and/or left ventricular enlargement–incr risk for sudden cardiac death
SYSTOLIC HF*
RF: 20-60 YO and M>F
ETIOLOGIES:
- Idiopathic– MC–can be familial
- infections–viral MC (esp enteroviruses, coxsackievirus B, echovirus)
- postviral myocarditis, HIV, lyme dz, parovivrus B19 and Chagas dz
- Toxic: etoh, cocaine, anthracycline (Doxorubicin–chemo) and radiation
- Pregnany, autoimmune, HTN
- Metabolic: thryoid disorders, B1 (thiamine) deficiency
CM
- systolic HF
- ->LEFT SIDED: L for lungs….. dyspnea (exertional or at rest), fatigue, cough,
- ->RIGHT SIDED: periph edema, JVD, hepatomegaly, GI s/s, loss of appetite,
- embolic events, arrhythmias
PE
- S3 gallop hallmark due to filling of a dilated ventricle
- mitral or tricuspid regurg
Diagnosis:
TOC=echo–>left ventricular dilation— DECR EJEC FRAC
CXR: cardiomegaly
ECG: sinus tach or arrythmias
what is the MC type of cardiomyopathy
dilated (95%)
S3 gallop
- physiologically whats happeneing
- dz
- filling of a dilated ventricle*
- dilated cardiomyopathy
dilated cardiomyopathy is assoc with what heart sound
s3
Hypertrophic Cardiomyopathy
- what is it and how is it passed
- type of HF (dia or systolic)
- what makes it worse
- what makes murmur decrease in intensity and increase? desribe murmur
- common age group
- MC s/s? other cM?
- what is common cause of death
- diagnosis
HOCM–hypertrophic obstructive cardiomyopathy
- autosomal dom genetic disorder of inapp. LV and.or RV hypertrophy with DIASTOLIC dysfunction
- subaortic outflow obstruction due to asymmetrical septal hypertrophy + systolic anterior motion (SAM) of the mitral valve
*WORSENS WITH
1. increased contractility–>exercise, Digoxin, Beta agonists
and/or
2. decreased LV volume–>dehydration, decr venous return, Valsava
MURMUR: harsh systolic murmur best heard at LSB
- –>increased intensity with decreased venous return (Valsalva, standing)) or decrease after load (nitries)
- ->decreased intensity with inreased venous return (squatting, supine, leg raise) or increased afterload (handgrip) ——>incr LV volume preserves outflow
***common presents at young age---->sudden cardiac death OTHER CM *Dyspnea MC s/s *fatigue *angina-CP *pre syncope *dizziness *arrhythmias *sudden cardiac death--esp in young pt--esp during exercise/extreme exertion--MC from VFIB
DIAGNOSIS
- ECHO: asymmetric ventrical wall thickness (esp septal)
- ECG: LVH
murmur increased intensity with decreased venous return (Valsalva, standing)) or decrease after load (nitries)
HOCM
Murmur decreased intensity with incr venous return (squatting, supine, leg raise) or increased afterload (handgrip)
HOCM
Restrictive Cardiomyopathy
- type of HF
- etiologies–MC?
- CM–most commmon?
- PE
- diagnosis–toc? def diagnosis?
Diastolic HF in a non-dilated ventricle— impedes ventricular filling (decr compliance)—stiff ventricle fill with great effort
ETIOLOGIES
- infiltrative dz–>amyloidosis MC, sarcoidosis, hemochromatosis, scelroderma, CA METS,
- chemo/radiation
CM
- RIGHT HF»» LEFT HF s/s
- RIGHT HF= periph edema, JVD, hepatomegaly, ascites, GI s/s
PE
*Kussmaul’s sign–>lack of an inspiratory decline or increase in JVP with inspiration
DIAGNOSIS
- ECHO–>TOC: non-dilated ventricles with normal thickness, diastolic dysfunction, marked dilated of atria**
- ->if amyloidosis is cause–>will see bright speckled myocardium
- EKG: low voltage QRS, arrythmias
- DEFINITIVE DIAGNOSIS: endomyocaridal biopsy–>if amyloidosis=apple-green birefringence with Congo-red staining
Kussmaul’s sign
seen in restrictive cardiomyopathy
lack of an inspiratory decline or increase in JVP with inspiration
MCC of myocarditis
viral–enteroviruses–Coxsackievirus B
Viral Myocarditis
- MC age
- mc etiology
- cm
- diagnosis– gold standard?
-inflamm of heart muscle
-MC in young adults
MCC=enteroviruses–Coxsackievirus B
CM
- Viral prodrome–>s/s of SYSTOLIC dysfunction aka dilated cardiomyopathy
- HF s/s= S3 gallop, dyspnea, fatigue, exercise intolerance
- OTHER: megacolon, pericarditis
DIAGNOSIS
- CXR: cardiomegaly=classic
- EKG: nonspecific ST MC
- LABS: +/- cardiac enzymes, incr ESR
- ECHO: ventric systolic dysf
- GOLD STANDARD= endomyocardial biopsy–infiltration of lymphocytes w/ myocardial tissue necrosis—this is done for refractory or severe cases
this rhythm increases with inspiration and decrs with expiration
sinus arrhythmia
sinus arrest with alternating paroxysms of atrial tachycardia and bradycardia
sick sinus syndrome
define paroxysmal AFIB
self terminating within 7 days (usuaully <24hrs)
+/- recurrent
define persistent AFIB
fails to self terminate
lasts >7 days
-requires medical or electrical termination
define permanent afib
> 1 year
-refractory to cardioversion or cardioversion never tried
define lone AFIB
paroxysmal, persistent or permanent without evidence of heart disease
pSVT
-where originate
*above ventricles
MAT
-assoc with what dz
COPD
-same as wondering atrial pacemaker except the HR is >100
EKG shows over 3 p-wave morphologies
WPW
- where is accessory pathway
- EKG findings
- CM
- TX—stable, unstable and definitive
- bundle of kent–outside AV node—it preexcites tbe venrticles
- type of AV reciprocating tachycardia *AVRT)
WPW—“WPW”
- W=wave–>delta wave
- P=PR–>short PR interval
- W=wide QRS (>0.12)
CM
- most are asympto
- prone to develop tachyarrythmia
- can become unstable
TX **** (what i missed on packrat)
- STABLE: wide complex tachycardia:
* antiarrhythmics–> Procainamide 1st choice— can use amino too
* AVOID AV NODE BLOCKING AGENTS (ABCD–> Adenosine, BB, CCBs, Digoxin) - UNSTABLE
- cardiovert - DEFINITIVE
* radiofrequency catheter ablation
delta wave
WPW
-slurred upstroke in QRS with a short PR interval
ABDC pneumonic stands for
AV NODE BLOCKING AGENTS
A= adenosine
B=BBs
C= CCBs
D=digoxin
Left BBB EKG findings
- wide QRS >0.12
- broad, slurred R wave in V5, 6
- Deep S wave V1
- ST elevations V1-3
Right BBB ekg findings
wide QRS >0.12 sec
RsR’ in V1, 2
Wide S wave V6
