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Clinical Medicine II > Cardiology: Cardiomyopathy > Flashcards

Cardiology: Cardiomyopathy Flashcards

1
Q

is cardiomyopathy a primary or secondary disorder?

A

primary

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2
Q

Does CAD, valvular disease, or HTN cause dilated cardiomyopathy?

A

no

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3
Q

The most common physiologic cause of DCM is…

A

LV systolic dysfunction

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4
Q

A patient presents with HF sxs , syncope and palpitations. on exam, you find…

S3 gallop
JVD
Basal crackles
Mitral/Tricuspid regurg murmur

What should you immediately suspect?

A

DCM

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5
Q

The most common type of DCM is…

A

idiopathic DCM

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6
Q

What is required for a Dx of familial DCM?

A

FHx of DCM in 2+ relatives

consider cardiac protein Abs

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7
Q

This cardiomyopathy occurs secondary to infectious or non-infectious causes…

A

infectious DCM

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8
Q

What is the most common cause of infectious DCM in the US?

A

viral

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9
Q

what is the MC cause of infectious DCM in latin america?

A

Chagas/parasitic

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10
Q

A 36wk gestation mother presents with dyspnea, orthopnea/PND, pedal edema, cough, hemoptysis.

These findings are indicative of what?

A

peripartum DCM

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11
Q

Peripartum DCM can occur when?

A

36 weeks gestation to 5 mo post-partum

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12
Q

An EF of ______ is diagnostic of DCM

A

Echo showing EF < 45%

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13
Q

what are the risk factors for peripartum DCM?

A

> 30

African descent

H/o preeclampsia, eclampsia, postpartum HTN

maternal cocaine abuse

> 4 week use of oral tocolytic

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14
Q

A patient has an EtOH hx of 6 drinks daily for the last 5-10 years. What heart condition is he at increased risk for?

A

alcoholic DCM

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15
Q

Alcoholic DCM will present with what sxs?

A

HF sxs

Signs of long-term EtOH use

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16
Q

Cocaine DCM reduces LV function by what percent in asymptomatic users?

A

4-9%

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17
Q

A patient is counseled for cocaine related DCM. He is worried that his drug use has permanently damaged his heart. What can you tell him?

A

stopping can reverse myocardial dysfunction

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18
Q

What chemotherapeutic class of drugs can cause chemotherapy-induced DCM?

A

anthracyclines including doxarubicin

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19
Q

In chemotherapy-induced DCM, it is important to get a baseline and continuing _______ to monitor ________.

A

get echo

measure EF

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20
Q

a sustained rapid ventricular rate of 130-200 can cause what cardiac condition?

A

tachycardia mediated DCM

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21
Q

In tachycardia mediated DCM, is tachycardia the cause of dysfunction?

A

no, tachy is a symptom, not the cause

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22
Q

Which conditions can cause endocrine dysfunction DCM

A

Diabetes

Thyroid dysfunction

Pheochromocytoma

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23
Q

Can cardiac dysfunction be reversed by correcting endocrine dysfunction?

A

yes

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24
Q

Which nutritional deficiencies can cause DCM? Is it correctable?

A

thaimine

carnitine

correctable

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25
Q

what provides definitive diagnosis of DCM?

A

echo showing dilated ventricle and reduced EF

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26
Q

What is the nonpharmacologiical tx of DCM?

A

treat/remove underlying cause

lifestyle modification

27
Q

What medications are DOC in DCM?

A

ACE-I

28
Q

Besides ACE-Is, what other medications can be considered in managing DCM?

A

diuretics

beta blockers

digoxin

29
Q

If a patient with DCM presents with afib, what can you give

A

amiodarone (antiarrhythmic)

anticoagulation

30
Q

What surgical interventions can be used to treat DCM?

A

implanted cardioverter defibrillator

cardiac transplant

31
Q

A histological assessment of cardiomyocytes shows the following. what are these findings a hallmark of?

Myocyte hypertrophy and disarray

interstitial fibrosis

A

LVH

32
Q

What differentiates non-obstructive and obstructive HCM?

A

obstruction of left ventricular outflow tract

33
Q

what is the most common cause of obstructive HCM?

A

asymmetric septal wall thickening

34
Q

Symptomatic HCM is indicative of what subtype of HCM?

A

obstructive HCM

35
Q

What sxs can be expected from someone with obstructive HCM?

A

HF sxs

syncope

palpitations

36
Q

The following physical exam findings are consistent with what condition?

Brisk, bifid carotid pulse

audible S4

crescendo-decrescendo systolic ejection murmur

A

HCM with LVOT obstruction

37
Q

Valsalva and standing will _______ the murmur of HCM, while __________ will decrease it.

A

increase: valsalva and standing
decrease: squat and isometric handgrip

38
Q

An Echo is a preferred diagnostic for HCM. What should be seen on echo to make a dx of HCM?

A

increased LV wall thickness 15mm or greater

39
Q

What diagnostic can be added to the general workup to help evaluate HCM?

A

Stress/Exercise echo

40
Q

Patients with the following characteristics are at increased risk for what?

prior sustained VT

non sustained VT

< 30 yo

FHx of sudden death

30mm or greater LVH

unexplainable syncope

Brady arrhythmias

A

sudden cardiac death

41
Q

How do you manage asymptomatic HCM

A

monitor

42
Q

How should symptomatic HCM be treated?

A

beta blockers DOC, or non-dihydropyridine CCBs

43
Q

for whom is ICD implantation recommended for in HCM?

A

high risk of SCD or sustained VT

44
Q

A patient with symptomatic LVOT obstruction with advanced HF refractory to medical therapy can be treated with what procedures?

A

surgical septal myectomy

EtOH ablation

Mitral valve surgery

45
Q

What type of cardiomyopathy occurs due to the following?

non-dilated, rigid ventricles

HFpEF

R and L atrial enlargement

A

restricted cardiomyopathy

46
Q

RCM can mimic what condition?

A

constrictive pericarditis

47
Q

what is the most common cause of RCM?

A

amyloidosis

48
Q

Broadly, what etiologies cause RCM?

A

Infiltrative processes

Storage disease

idiopathic, scleroderma, secondary fibrosis

49
Q

what is the least common cardiomyopathy?

A

RCM

50
Q

What sxs are expected in RCM?

A

RHF sxs

angina, syncope, dyspnea

51
Q

A physical exam has the following findings, which suggests what condition?

S3 gallop

prominent JVD

kussmaul’s sign

MR/TR murmur

A

RCM

52
Q

S3 gallop is heard in RCM, but isn’t heard in what similarly presenting condition?

A

constrictive pericarditis

53
Q

What condition presents with the following sxs?

Elevated JVD

Hepatomegaly/ascites

periorbital purpura

HF

A

Cardiac amyloidosis

54
Q

What is a pathognomonic presentation for cardiac amyloidosis?

A

periorbital purpura with HF

55
Q

TOC for RCM is _______. The expected findings are…

A

Echo showing:

bi atrial enlargement

normal to small ventricular cavity

normal EF

56
Q

How is RCM managed?

A

tx underlying cause

low dose loop diuretics

consider heart transplant

57
Q

Does RCM have a good or poor prognosis?

A

poor

58
Q

A condition presents with transient LV systolic and diastolic dysfunction in the absence of CAD.

What condition is this?

A

takotsubo cardiomyopathy

59
Q

A patient presents to the clinic with the following hx and sxs… What should be included in you list of DDx?

Postmenopausal woman

Husband died a week ago

Abrupt onset

Substernal chest pain

dyspnea

syncope

A

TCM. Sxs mimic ACS

60
Q

What should immediate treatment of TCM include?

A

acute MI tx…

cath lab

61
Q

A patient with TCM is ready for discharge. what treatment should be considered?

A

ASA, beta blocker, ACE-I until LV recovery

62
Q

The general workup for cardiomyopathy should include…

A

Thorough 3-4 generation FHx and Hx

CBC, CMP, Thyroid, BNP, Cardiac enzymes

EKG

Echo

+/- Cardiac MRI, endomyocardial biopsy

63
Q

What conditions would endomyocardial biopsy be helpful?

A

RCM

Cardiac amyloidosis

Infectious DCM (gold standard)

Clinical Medicine II (31 decks)

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