Cardiology - Cardiomyopathy Flashcards
Is Takotsubo Cardiomyopathy more common in females or males?
Females
Pathogenesis of Takotsubo Cardiomyopathy
- Transient LV ballooning
- thought to be related to catecholamine excess
Hallmark feature of a Takotsubo Cardiomyopathy…which part of the heart is affected?
There is wall motion abnormalities BEYOND a single territory
Brought on by acute emotional stressors
ECG features of Takotsubo Cardiomyopathy?
- ST elevation in precordial leads
- QT prolongation
- Widespread T wave inversion
Management of Takotsubo Cardiomyopathy?
Acute: ACE inhibitor and BB
Supportive treatment
Don’t give GTN
Natural progression of Takotsubo Cardiomyopathy
95% will have resolution of symptoms and LV recovery within 7 days
What is the leading cause of death in young athletes <35 years old?
HOCM
HOCM:
Inheritance pattern?
Autosomal dominant
HOCM:
Which genes are mutated usually?
Usually genes encoding BETA MYOSIN HEAVY CHAIN PROTEIN
Usually sarcomere genes:
- MYBPC3: cardiac myosin binding protein C
- MYH7: beta myosin heavy chain
What happens the FUNCTION of the heart in HOCM?
DIASTOLIC dysfunction and poor myocardial COMPLIANCE
What are the cardinal structural features of HOCM
Septal hypertrophy
and
Anterior displacement of the mitral valve
What kind of outflow problem happens in HOCM?
Dynamic LVOT in 66%
What WORSENS the outflow problem in HOCM?
Reduced preload (ie dehydration) Reduced afterload (ie vasodilators) Drugs that enhance outflow: digoxin and inotropes
Pulse in HOCM?
Rapid and bifid carotid upstroke (=pulsus bisferiens) if there is LVOT obstruction
And
‘Jerky’ pulse
JVP in HOCM
high ‘a’ wave if significant infundibular hypertrophy
Apex in HOCM
Sustained, localised and bifid or trifid
Extra heart sounds in HOCM?
S4 (especially if young)
Paradoxical splitting of S2 if significant LVOT obstruction
Murmur in HOCM?
- Mitral regurgitation
- systolic with ejection quality at LLSB
- INCREASES with valsalva (decreased preload)
- INCREASES with nitrates (decreased afterload
Other diseases associated with HOCM?
Freidreich’s ataxia
WPW
Complications of HOCM?
AF in 20 - 25%
Sudden cardiac death
Risk factors for Sudden Cardiac Death in HOCM?
- Family history of premature cardiac death
- Recurrent syncope
- Nonsustained VT (in adults)
- Severe LVH (septum >2.5 - 3cm)
- Severe obstruction
- Abnormal exercise BP response
- Level of myocardial fibrosis on MRI (contraversial)
- Genotype: Arg719Trp
What is the MOST SENSITIVE test to diagnose HOCM?
ECG
What ECG findings in HOCM?
LVH in 80 - 90%
Progressive T wave inversion
Deep Q waves
+/- AF
What echo findings in HOCM?
Systolic anterior motion of anterior mitral valve leaflet
and
Asymmetric hypertrophy
How do you quantify LVOT obstruction in HOCM? What makes it severe?
Severe LVOT obstruction if pressure gradient is:
>=30mmHg at rest
>=50mmHg at exertion/provocation
Why is MRI useful in HOCM?
Better for eccentric and apical atrophy