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Cardiomiopatii Flashcards

1
Q

Cmp specifice

A 
Valvular
Hipertensiv
Ischemic
Toxic
Metabolic(K, Ca)
Inflamatoriu
Distrofii musculare
Peripartum
Boli de sistem(colagenoze, sarcoidoza)
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2
Q

Cmd histologic

A

Fibroza interstitiala si perivasculara

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3
Q

Etiologie cmd

A 
25% cei cu IC
50% idiopatic
Toxic
Ac antimiocard prin trigger viral
Post miocardita!!!!!! 
Citokine proinflamatorii(tnf alfa) endotelina
Genetic

Alcool doxorubicina(chimioterapic) cocaina hiv
Tahicardie
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4
Q

Tratament cmd

A

De insuf cardiaca
Pacemaker biventricular
Chirurgical
Exercitii fizice

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5
Q

Histologic miocardite

A

Infiltrat inflamator precedat de citoliza

Miocitoliza detectabila 7-10 zile

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6
Q

Etiologie miocardite

A 
Viral coxaki
Bacterii fungi tripanosoma
Doxorubicina si alergia cu eozinofile
Les tireotoxivoza polimiozita sarcoidoza
Etanol catecolamine iradiere
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7
Q

Markeri apoptoza miocardita

A

Proteaze
Caspaze
Citokine
(Raman crescute 80 de zile)

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8
Q

Clinic cmd

A 
Ic stanga+-dreapta
Zg 3, 4, regurgitare mitrala(secundara)
Cardiomegalie
Angina!!!!!!prin scaderea rezervei coronariene(vd scazut)
Ta normala sau scazuta
Embolii
Prin fibroza aritmii si sincope
Presiune puls scazut, ta normala, vb scazut
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9
Q

Clinic miocardita

A 
Asimtomatici
Embolii
Aritmii
Bloc 
Durere care mimeaza ima
Ic
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10
Q

Hisyologie cmh

A

Hipertrofie si dezorganizare fibre se poerde paralelismul si avem miocite inegale
Arterele cu lumen redus si hipertrofie a mediei=>reducere rezerva coronariana

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11
Q

Etiologie cmh

A

Autozomal dominant(cea mai frecventa)
Lant greu beta al miozinei
Proteina c de legare a miozinei
Troponina T

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12
Q

Fiziopat cmh

A

Sistolic anterior movement care scade tractul de ejectie
Valva mitrala are foite lungi si e impinsa de flux
Grafient subaortic
Scade rrlaxatea si distensibilitayea prin alteratea proteinelor
Apare ischemie prin scadere coronare si consum de o 2 credvut

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13
Q

Examen clinic cmh

A 
Sincopa
Asimpyomatic moarte subita
DISPNEE
Impuls apocal crescut
Puls carptidian bifid
Zgomot 4????
Suflu sistolic asemanator cu st aortica dar fara iradiere
Suflu sistolic apical
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14
Q

Tratament cmh

A 
Betablocante
Antagonisti calciu
Disopiramida
Amiodarona
Anticoagulante
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15
Q

Tratament miocardite

A

Nu stii ce sa i dai ca sa nu l iriti
Iec betabloc diuretic
NU digoxun NUinferferon NU imunosupresie
Vaccin

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16
Q

Definitie cardiomiopatii

A

Afectare directa miocard

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17
Q

Cmd dilatativ

A

Dioatatie si disfuntie sistolica
25% trec spontan
Frecv la barbati negri
DACA VD E AFECTAT ATUNCI PROHNOSTICUL E REZERVAT

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18
Q

Cauze cmd

A

Ic
Cardiopatia tahiaritmica
Genetic, post miocardita, toxic(coxakieb, covid) autoimun anticorpi anti miocard, citokine proinflamatorii, endotelina

Alcool(inhiba fosforilarea ocidativa), cocaina, hiv, doxorubicina, metabolic, citostatice

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19
Q

Clinic cmd

A 
Ic stanga 
Angina prin scaderea rezervei coronariene
Z3,4, suflu  de REGURGITARE MITRALA
Ta normala sau scazuta
Embolie tardiv
CARDIOMEGALIE IC>0,5
PRIN FIBRIZA APAR ARITMII
Initial e asimptomatic(frank starling si catecolamine activate)
20
Q

Rx cmd

A

Cord mare

Redistributie ptc pres venoasa e crescuta si se deschid vasele apicale

21
Q

Ekg cmd

A

Unde q de fibroza
Brs
Midif repolarizare
Tv

22
Q

Eco cmd

A 
Fe scazuta
Cavitati mari
Rm
Rt
Eco cu dobutamina(deschide vadele si vdm daca e hibernant sau e mort) dg dif bci
23
Q

Coronarografie cmd

A

Normale

Vasodil redusa

24
Q

Tratament cmd

A 
Al ic(grn cu fredusa)
Diuretic
Ieca
Betabloc
Spironolactona+-digoxin

Sport(in ideea ca e vasodilatatie pe vasele membrelor deci scade postsarcina si ii e mai usor)
Resincronizare
Chirurgie

25
Miocardite def
Inflamatia miocardului 20%msc sunt date de ea In faza acuta aritmii si mor
26
Miocardite histologic si timp
Miocitoliza si dupa infiltrare 0-4 miocitoliza si macrofage 4-14 infiltrare cel nk, t,b Progresie=> cmd
27
2 variante de progresie miocardita
Efect direct agresiune virala Raspuns imun persistent ptc seama virusul cu miozina-coxsackie (Persista particulele virale+sistem imun inactivat Sau Raspuns imun persistent+-persistenta virala) Apoptoza: proteaze viral mediate, calea caspazei, citikine>80z
28
Miocardite clinic
``` Asimptomatic+ekg Ic+dilatare Aritmii, blocuri Durere mimeaza ima Embolii(citokinele au efect procoagulant) ```
29
Etiologie miocardite
``` Coxakie trypanodoma Alcool doxorubicina Bacterii fungi Lupus tireotoxicoza sarcoidoza Catecolamine iradiere ```
30
Paraclinic miocardite
Rx cord normal, mare si posibil redustributie Leucocitoza,vsh, ckmb, troponuna, anticorpi(sarvolema, mitocondrii), citokine(tnf, il6) Eco peretii vs sunt ingrosati ptc edem, disfuncie vs Rmn duper bun!!!!!!contrast tardiv subepicardic!!!!! (Ca ischemia e subendo iar miocardita r subepi) Biopsie-criterii dallas, genom viral, imunohistochimie Ekg modif st nespecibife, bav1-3
31
Cardiopatii def
Afectare directa a miocardului
32
Test de stres cu dobutamina
La cmd si la sao low flow low gradient Ma gandesc ca poate are bci prim care s a dilatat Ideea e ca acolo e miocard hibernant la bci si gen daca i vadodilat atunci o sa mi dau seama daca brusc ii creste contractia(asa mi dau seama ca nu i cocatrice ci e cord viabil si merita i coronarigrafie)
33
Prognosticul in miocardita fulminanta
F prost initial si f bun oe termen lung Fulminanat e aia cu edem, disfuntie grava vs Ii pui device de asistare si astepti sa se vindece
34
Cmh
Hipertrofie neadecvat, fara motiv(in general motivul de stenoza aortica sau hta) Afecteaza septul Cu fct sistolica hiperdinamica Gradient de presiune dinamic-se inchide asa ca intr o stenoza(subvalvulara gen) DISF DIASTOLICA Da mcs
35
Etiologie cmh
Lant beta miozina Troponina t Proteina c de legate a miozinei
36
Forme clinice
Adolescent Adulc Faza finala cmpd Forma atipica japonia cu unde t negative gigante in deriv precordiale (asemanator cu obstr pe desc anterioara)
37
Sdr wellance
Obstructie pe descendenta anterioara Prognostic f prost T negative din v1-v6
38
Cmh fiziopat
Ischemie: afectare intramurale si cons ox crescut Diastola: relaxare lenta si distensibilitate scazuta Sistola Tractul de ejectie e ingustat e un fel de stenoza subaortica, fluxul se accelereaza, fenomen venturi=>valva mitrala, pe masura ce sistola se desfasoara o atrage din ce in ce mai mult=>tractul dr ej app total obstr la finalul ejectie. Sam=sistolic anterior movement(are si niste foite mai lungi) Gradient subaortic Impingere flux
39
Clinic cmh
Asimpt care face mcs Dispnee(disf diastolica) Angina pectorala Sincopa(progn prost la tineri)-aritmii sau scade debitu
40
exam obiectiv cmh
Impuls apical crescut Puls carotidian bifid Zg4 Suflu sistolic parasternal stang NU iradiaza pe carotide(creste la valsalva su ortostatism) (scade la ridicare mb inf, contractie izometrica mana) Suflu sistolic apical(reg mitr)
41
Paraclinic cmh
Ekg Rx Eco Rmn-si aici e f bun ca deosebeste de amiloidoza Cate(contractilitate-daca o cresc creste cmgradientul, presarcina scazuta acc gradientul ptc e cordul mai gol deci iar se ingusteaza, postsarcina scazuta gradient scade ptc se contracta mai bn)
42
Stratificare risc | E de la cmh dar oresuoun ca e pt mcs
Clinic Eco Holter Test de efort
43
Cardiomiopatia restrictiva | Disf diastolica
Primar idiopatic sau fibroza Secundara alimoidoza sarcoidoza hemocromatoza metastaze glicogenoze Histo: fibroza/infiltrare Compl redusa=> umplere la presiuni mari=> avem simptome legate de pres mare din circ sistemica si circ pulmonara(gen presiunile in inima sunt f mari si inteleg ca atunci cand intra in inima dep efort, in rest debitul e mic) Cavitati reduse ca s ingrosati peretii, la fel si vol bataie
44
Clinic cardiop restrictiva
Debit mic astenie fatigabilitate hipotens Congestie efeme hepatomegalie ascita vene jug turb Impuls apical palpabil(conteaxa ptc are multe chestii la ekg similare cu pericardita cred ca constructiva) Z3 z4
45
Paraclinic restrrictiva
Ekg st, t MICROVOLTAJ eco norma sau hvs, disf diastolica-aia restrictiva grava Cateterism SEMN RADICAL, DIP AND PLATEAU Ct rmn dg dif pericardita constructiva Biopsie endomiocardita
46
Cateterism dip amd plateau sau radical
Umplere initial f rapida si dupa aia se opreste brusc, creste rpd pres si se egaleaza cu aia din atriu sindupa un mic damn cand se contracata atriul E pt pericardita constrictiva si pt cardiomiopatia restrictiva
47
Arvd
Vd Afectarea jonctiunii intercelulare Boala naxus Infiltrare grasime Ic, asimpt, aritmii, msc Simptome sincopa palpitatii oprire cardiaca, ca la miocardita, ic sau daca e afectat si vs mimeaza cmd

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