Cardiology: Cardiomyopathy Flashcards
is cardiomyopathy a primary or secondary disorder?
primary
Does CAD, valvular disease, or HTN cause dilated cardiomyopathy?
no
The most common physiologic cause of DCM is…
LV systolic dysfunction
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?
DCM
The most common type of DCM is…
idiopathic DCM
What is required for a Dx of familial DCM?
FHx of DCM in 2+ relatives
consider cardiac protein Abs
This cardiomyopathy occurs secondary to infectious or non-infectious causes…
infectious DCM
What is the most common cause of infectious DCM in the US?
viral
what is the MC cause of infectious DCM in latin america?
Chagas/parasitic
A 36wk gestation mother presents with dyspnea, orthopnea/PND, pedal edema, cough, hemoptysis.
These findings are indicative of what?
peripartum DCM
Peripartum DCM can occur when?
36 weeks gestation to 5 mo post-partum
An EF of ______ is diagnostic of DCM
Echo showing EF < 45%
what are the risk factors for peripartum DCM?
> 30
African descent
H/o preeclampsia, eclampsia, postpartum HTN
maternal cocaine abuse
> 4 week use of oral tocolytic
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?
alcoholic DCM
Alcoholic DCM will present with what sxs?
HF sxs
Signs of long-term EtOH use
Cocaine DCM reduces LV function by what percent in asymptomatic users?
4-9%
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?
stopping can reverse myocardial dysfunction
What chemotherapeutic class of drugs can cause chemotherapy-induced DCM?
anthracyclines including doxarubicin
In chemotherapy-induced DCM, it is important to get a baseline and continuing _______ to monitor ________.
get echo
measure EF
a sustained rapid ventricular rate of 130-200 can cause what cardiac condition?
tachycardia mediated DCM
In tachycardia mediated DCM, is tachycardia the cause of dysfunction?
no, tachy is a symptom, not the cause
Which conditions can cause endocrine dysfunction DCM
Diabetes
Thyroid dysfunction
Pheochromocytoma
Can cardiac dysfunction be reversed by correcting endocrine dysfunction?
yes
Which nutritional deficiencies can cause DCM? Is it correctable?
thaimine
carnitine
correctable
what provides definitive diagnosis of DCM?
echo showing dilated ventricle and reduced EF
What is the nonpharmacologiical tx of DCM?
treat/remove underlying cause
lifestyle modification
What medications are DOC in DCM?
ACE-I
Besides ACE-Is, what other medications can be considered in managing DCM?
diuretics
beta blockers
digoxin
If a patient with DCM presents with afib, what can you give
amiodarone (antiarrhythmic)
anticoagulation
What surgical interventions can be used to treat DCM?
implanted cardioverter defibrillator
cardiac transplant
A histological assessment of cardiomyocytes shows the following. what are these findings a hallmark of?
Myocyte hypertrophy and disarray
interstitial fibrosis
LVH
What differentiates non-obstructive and obstructive HCM?
obstruction of left ventricular outflow tract
what is the most common cause of obstructive HCM?
asymmetric septal wall thickening
Symptomatic HCM is indicative of what subtype of HCM?
obstructive HCM
What sxs can be expected from someone with obstructive HCM?
HF sxs
syncope
palpitations
The following physical exam findings are consistent with what condition?
Brisk, bifid carotid pulse
audible S4
crescendo-decrescendo systolic ejection murmur
HCM with LVOT obstruction
Valsalva and standing will _______ the murmur of HCM, while __________ will decrease it.
increase: valsalva and standing
decrease: squat and isometric handgrip
An Echo is a preferred diagnostic for HCM. What should be seen on echo to make a dx of HCM?
increased LV wall thickness 15mm or greater
What diagnostic can be added to the general workup to help evaluate HCM?
Stress/Exercise echo
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
sudden cardiac death
How do you manage asymptomatic HCM
monitor
How should symptomatic HCM be treated?
beta blockers DOC, or non-dihydropyridine CCBs
for whom is ICD implantation recommended for in HCM?
high risk of SCD or sustained VT
A patient with symptomatic LVOT obstruction with advanced HF refractory to medical therapy can be treated with what procedures?
surgical septal myectomy
EtOH ablation
Mitral valve surgery
What type of cardiomyopathy occurs due to the following?
non-dilated, rigid ventricles
HFpEF
R and L atrial enlargement
restricted cardiomyopathy
RCM can mimic what condition?
constrictive pericarditis
what is the most common cause of RCM?
amyloidosis
Broadly, what etiologies cause RCM?
Infiltrative processes
Storage disease
idiopathic, scleroderma, secondary fibrosis
what is the least common cardiomyopathy?
RCM
What sxs are expected in RCM?
RHF sxs
angina, syncope, dyspnea
A physical exam has the following findings, which suggests what condition?
S3 gallop
prominent JVD
kussmaul’s sign
MR/TR murmur
RCM
S3 gallop is heard in RCM, but isn’t heard in what similarly presenting condition?
constrictive pericarditis
What condition presents with the following sxs?
Elevated JVD
Hepatomegaly/ascites
periorbital purpura
HF
Cardiac amyloidosis
What is a pathognomonic presentation for cardiac amyloidosis?
periorbital purpura with HF
TOC for RCM is _______. The expected findings are…
Echo showing:
bi atrial enlargement
normal to small ventricular cavity
normal EF
How is RCM managed?
tx underlying cause
low dose loop diuretics
consider heart transplant
Does RCM have a good or poor prognosis?
poor
A condition presents with transient LV systolic and diastolic dysfunction in the absence of CAD.
What condition is this?
takotsubo cardiomyopathy
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
TCM. Sxs mimic ACS
What should immediate treatment of TCM include?
acute MI tx…
cath lab
A patient with TCM is ready for discharge. what treatment should be considered?
ASA, beta blocker, ACE-I until LV recovery
The general workup for cardiomyopathy should include…
Thorough 3-4 generation FHx and Hx
CBC, CMP, Thyroid, BNP, Cardiac enzymes
EKG
Echo
+/- Cardiac MRI, endomyocardial biopsy
What conditions would endomyocardial biopsy be helpful?
RCM
Cardiac amyloidosis
Infectious DCM (gold standard)
