Cardiology: Cardiomyopathy Flashcards
name 3 types of myocardial disease? which is most common?
dilated, hypertrophy, restrictive
dilated
what must be present for dilated cardiomyopathy?
left ventricular dilation and decreased EF
what is mc cause of dilated cardiomyopathy? name 8 other causes. what are 2 mc secondary causes
idiopathic
alcohol,myocarditis, postpatum status, drugs (doxorubicin, AZT, cocaine), infection (coxsackievirus, HIV, Chagas’ disease, parasites), genetic factors, and nutritional disorders (wet beriberi)
the most common causes are ischemia and long standing HTN
what symptoms and physical exam findings are expected in dilated cardiomyopathy?
gradual development of CHF symptoms
displacement of left ventricular impulse, JVD, S3/S4 gallop, or MR/TR
what does S3 gallop signify? what is it associated with?
rapid ventricular filling in setting of fluid overload
associated with dilated cardiomyopathy
what is used to diagnose dilated cardiomyopathy? 3
- ECHO
- ECG=non specific St-T changes, a low voltage QRS sinus tachy, and ectopy. LBBB is common
- CXR shows enlarged, balloon-like heart and pulmonary congestion
what are ways to treat symptoms of dilated cardiomyopathy? what is second line? what should be avoided?
diuretics, ACEIs/ARBs, beta-blockers, digoxin is second line agent
avoid CCBs in HF
when should anticoagulation be used to treat dilated cardiomyopathy?
use to decrease thrombus risk if AF or an intraventricular thrombus is present
when should ICD be considered in pt with dilated cardiomyopathy?
if EF<35%
A woman with HTN and prior MI has an examination notable for a displace PMI, an S3, a nonelevated JVP, and bibasilar rales. what is the next step in diagnosis?
this pt has evidence of dilated cardiomyopathy an ECHO would be the nxt best diagnosis step
how is hypertrophic cardiomyopathy defined? what parts of heart are involved what etiology (4)
impaired left ventricular relaxation and filling (non systolic dysfunction) due to thickened ventricular walls.
hypertrophy frequently involves the interventricular septum, leading to left ventricular outflow treat obstruction and impaired ejection of blood
caused by hypertrophy and HTN, and aortic stenosis, HCOM
describe congenital form of hypertrophic cardiomyopathy? inheritance pattern, % die, mc cause of death
HOCM hypertrophic obstructive cardiomyopathy
inherited as an autosomal dominant trait
50% of them die
it’s mc cause of sudden death in young healthy athletes in US
what are 5 symptoms of hypertrophic cardiomyopathy?
syncope, dyspnea, palpitations, angina, or sudden cardiac death
what PE findings are in hypertrophic cardiomyopathy? 3
sustained apical impulse, S4 gallop, systolic ejection murmur
describe PE maneuvers that change sound of HCOM murmur?
systolic ejection murmur that increases with decreased preload (eg Valsalva maneuver, standing) and decreases with increased preload (eg passive leg raise)
how is hypertrophic cardiomyopathy diagnosed?
ECHO=asymmetrically thickened septum and dynamic obstruction of blood flow
ECG may show signs of LVH
CXR may reveal left atrial enlargement (LAE) secondary to MR
how is hypertrophy cardiomyopathy treated? first line and second line
beta blockers are first line for symptomatic relief
CCBs are second line
what are surgical options for hypertrophic cardiomyopathy?
dual chamber pacing, partial excision, or alcohol ablation fo the myocardial septum, ICD placement, and mitral valve replacement
what should pts with hypertrophic cardiomyopathy avoid
intense athletic competition and training
what does S4 gallop signify?
a stiff, noncompliant ventricle and increased atrial kick and may be associated with hypertrophic cardiomyopathy
how is restrictive cardiomyopathy defined?
decreased elasticity of myocardium leading to impaired diastolic filing without significant dysfunction (a normal or near-normal EF)
what is restrictive cardiomyopathy caused by?
infiltrative disease (amyloidosis, sarcoidosis, hemochromatosis)
scarring
fibrosis (secondary to radiation)
what are signs/symptoms of restrictive cardiomyopathy
signs of left and right sided HF, right sided failure signs JVD, peripheral edema usually predominates
how is restrictive cardiomyopathy diagnosed? ECHO shows, what 3 tests are good for characterization, what does ECG show?
ECHO= rapid early filling and near-normal EF
CXR and MRI and cardiac cath are good for characterization
cardiac biopsy may reveal fibrosis
ECG shows LBBB and low voltages in amyloidosis
how is restrictive cardiomyopathy treated?
limited options, usually palliative
cautious use of diuretics for fluid overload and vasodilators to decrease filling pressure
