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PANCE 2.0 > Cardiology #1 (Cardiomyopathies) > Flashcards

Cardiology #1 (Cardiomyopathies) Flashcards

1
Q

What is the MC type of cardiomyopathy?

A

Dilated cardiomyopathy

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2
Q

What is dilated cardiomyopathy?

A

Systolic dysfunction, leading to a dilated, weak heart

-Reduced strength of ventricular contraction, leading to dilation of left ventricle

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3
Q

Risk factors for dilated cardiomyopathy

A

Men

Age 20-60 years old

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4
Q

Etiologies of dilated cardiomyopathy

A
  • Idiopathic: MC
  • Genetic abnormalities
  • Excessive alcohol consumption, ETOH abuse
  • Infection: Viral MC (Enteroviruses such as Coxsackievirus B)
  • Cocaine use
  • Doxorubicin use
  • Vitamin B1 (thiamine) deficiency
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5
Q

Symptoms of dilated cardiomyopathy

A
  • MC presentation is dyspnea
  • S3 gallop
  • Pulmonary crackles/rales
  • Increased JVP

-Symptoms of left ventricular heart failure

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6
Q

Diagnostic study of choice for dilated cardiomyopathy

A

Echo: left ventricular dilation, decreased ejection fraction

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7
Q

What does a chest radiograph show for dilated cardiomyopathy?

A

-Cardiomegaly and pulmonary congestion

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8
Q

What is the treatment for dilated cardiomyopathy?

A

Standard systolic heart failure treatment

  • Abstinence from alcohol
  • ACE inhibitor
  • BB (Metoprolol, Carvedilol)
  • ARBs
  • Spironolactone
  • Symptom control with diuretics, Digoxin
  • Automated implantable cardioverter/defibrillator if EF < 35-30%
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9
Q

What is stress (Takotsubo) Cardiomyopathy?

A

Transient regional systolic dysfunction of the left ventricle that can mimic an MI but is associated with absence of obstructive coronary artery disease or evidence of plaque rupture

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10
Q

Risk factors for stress cardiomyopathy

A
  • Postmenopausal women exposed to physical or emotional stress
  • Death of a loved one, catastrophic medical diagnosis, etc
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11
Q

Pathophysiology of stress cardiomyopathy

A

Catecholamine surge during physical or emotional stress

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12
Q

Symptoms of Takotsubo Cardiomyopathy

A
  • Retrosternal chest pain similar to MI
  • Dyspnea
  • Syncope
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13
Q

Diagnostics for stress cardiomyopathy

A
  • Cardiac enzymes: often positive (mimics MI)
  • ECG: ST elevations (especially in anterior leads)
  • Echo: Apical left ventricular ballooning
  • Coronary angiography: absence of plaque rupture or obstructive coronary disease. “Patent coronary arteries with hypocontractility of left ventricular apex”
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14
Q

Again, what should you be looking for if a patient is having symptoms mimicking an MI, and you are doing an angiography?

A

Stress cardiomyopathy: patent coronary arteries and left ventricular apex hypocontractility

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15
Q

Because the initial presentation of stress cardiomyopathy presents similar to ACS/MI, patients are treated as ACS with 5 things. Name them.

A 
Aspirin
Nitroglycerin
BB
Heparin
Coronary angiography to rule out coronary artery disease
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16
Q

Short-term management for stress cardiomyopathy

A
  • Transient condition: conservative and supportive care is mainstay (BB, ACEi for 3-6 months with serial imaging to assess for improvement)
  • Anticoagulation if EF < 30%
17
Q

What is restrictive cardiomyopathy?

A
  • Diastolic dysfunction in a non-dilated ventricle, which impedes ventricular filling (decreased compliance)
  • LV is small or normal, with mildly reduced function
18
Q

Etiologies of restrictive cardiomyopathy

A
  • Infiltrative disease: amyloidosis (MC), sarcoidosis, hematochromatosis, scleroderma
  • Radiation, chemotherapy
  • Diabetes
  • Endomyocardial fibrosis
19
Q

Symptoms of restrictive cardiomyopathy

A
  • Right sided heart failure: decreased exercise tolerance, peripheral edema, JVD, hepatomegaly, ascites, GI symptoms, pulmonary HTN
  • S3 may be heard
  • Kussmaul’s Sign: increased in JVP with inspiration
20
Q

What is Kussmaul’s Sign

A

Increased in JVP with inspiration

21
Q

Diagnostics for restrictive cardiomyopathy

A
  • CXR: mildly to moderately enlarged cardiac silhouette
  • Echocardiogram: diagnostic of choice (non-dilated ventricles with normal thickness, diastolic dysfunction, marked dilation of both atria).
  • Endomyocardial biopsy: definitive diagnosis
22
Q

If restrictive cardiomyopathy is associated with amyloidosis, what will be seen on an echocardiogram and what will be seen on a biopsy?

A

Echocardiogram: bright speckled myocardium
Biopsy: apple-green birefringence with congo-red staining

23
Q

Treatment for restrictive cardiomyopathy

A
  • No specific treatment
  • Treat the underlying disorder: glucocorticoids for sarcoidosis, etc.
  • Gentle diuresis for symptoms, vasodilators
24
Q

What is hypertrophic cardiomyopathy?

A

Autosomal dominant genetic disorder of inappropriate LV and/or RV hypertrophy with diastolic dysfunction

25
Q

The obstruction of hypertrophic cardiomyopathy worsens with…

A
  • Increased contractility (exercise, Digoxin, beta agonists)

- Decreased LV volume (dehydration, Valsalva maneuver)

26
Q

Symptoms of hypertrophic cardiomyopathy

A
  • Dyspnea (MC symptom)
  • Fatigue, angina, syncope, dizziness, arrhythmias
  • Sudden cardiac death, especially in adolescents during time of extreme exertion due to V fib
27
Q

What is the murmur like in a patient with hypertrophic cardiomyopathy?

A
  • Harsh systolic murmur heard best at the LSB
  • Increased murmur intensity with decreased venous return (Valsalva, standing)
  • Decreased murmur intensity with increased venous return (squatting, supine, leg raise)
  • May have loud S4, S3, or pulsus biferens
28
Q

Diagnostics for hypertrophic cardiomyopathy

A
  • CXR often normal
  • ECG: LVH, nonspecific ST and T wave changes
  • Echo: asymmetric ventricular wall thickness (especially septal) 15 mm or greater, small LV chamber size
29
Q

What is the treatment for hypertrophic cardiomyopathy?

A
  • BB are first line management (Alternatives are CCB and Disopyramide)
  • Myomectomy if refractory and young
  • Alcohol septal ablation of septum
30
Q

What should patients with hypertrophic cardiomyopathy avoid?

A
  • Dehydration
  • Extreme exertion
  • Exercise
  • Digoxin
  • Nitrates
  • Diuretics

PANCE 2.0 (62 decks)

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