Cardiomyopathies

Question 1

what is the endocardium

Answer 1

innermost layer of the heart muscle
both endothelium and CT - has protective anti-thrombic properties
contiguous with vasculature and covers valvular structures

Question 2

what makes up the myocardium

Answer 2

striated cardiac muscle - oriented in a twisted formation for best squeeze and CO

Question 3

what layer of the heart is made up of the visceral layer of the pericardium

Answer 3

epicardium

Question 4

what layer are the coronaries underneath

Answer 4

the epicardium

Question 5

What is the cardiac output

Answer 5

heart rate x stroke volume

Question 6

what is the stroke volume

Answer 6

the amount of blood ejected from each ventricle with each contraction
usually about 70ml

Question 7

what is the average Cardiac output

Answer 7

4000-5000mL

Question 8

what is the preload

Answer 8

the venous return

Question 9

what affects the stroke volume

Answer 9

venous return (preload)
blood volume
SNS (contractility)
Peripheral resistance (afterload)

Question 10

what are factors that increase HR

Answer 10

SNS (norepi and epi)
increased thyroid
hypoxemia and acidosis
medications

Question 11

What factors decrease HR

Answer 11

Parasympathetic (ach)
Medications
Athletes

Question 12

What is ESV

Answer 12

end systolic volume
how much is left over after contraction
typically = 50mL

Question 13

What is EDV

Answer 13

end diastolic volume
amount in ventricle right before contraction
typically = 120mL

Question 14

What is the Ejection fraction equation

Answer 14

stroke volume / EDV

Question 15

what increases in relation to the preload

Answer 15

ventricular output

Question 16

what determines how much a myocyte can retract back to normal length, if this load is elevated, it will not be able to shorten adequately

Answer 16

afterload

Question 17

what is the frank-starling curve

Answer 17

represents the relationship between stroke volume and end diastolic volume.
states that the stroke volume of the heart increases in response to an increase in the volume of blood in the ventricles, before contraction, when all other factors remain constant.

Question 18

what is cardiomyopathy

Answer 18

disease process that changes the cardiac structure that affects the myocardium itself
m/c referencing disease process of the LV

Question 19

what is impaired with cardiomyopathy

Answer 19

cardiac function and may also alter the cardiac electrical conduction

Question 20

what are cardiomyopathies broken down into

Answer 20

hypertrophic
dilated (M/c)
arrhythmogenic
restrictive (least common)
unclassified

(genetic, mixed, acquired)

Question 21

what are genetic cardiomyopathies

Answer 21

hypertrophic cardiomyopathy
arrhythmogenic cardiomyopathy
Left ventricular noncompaction
conduction defects
mitochondrial myopathies
ion channel disorders

Question 22

what are acquired cardiomyopathies

Answer 22

takotsubo
myocarditis
peripartum
tachycardia induce

Question 23

what are mixed cardiomyopathies

Answer 23

dilated cardiomyopathies
restrictive cardiomyopathies

Question 24

What is MOGES classifcation

Answer 24

classification system gives information about the disease but also may be able to help risk stratify pts for potential future cardiovascular events

M: morphofunctional
O: Organ involvement
G: genetic predisposition
E: Etiological definition
S: functional status

Question 25

decreased contractility leading to reduced ejection fraction is caused by

Answer 25

systolic dysfunction

Question 26

what is systolic dysfunction

Answer 26

decreased contractility leading to reduced ejection fraction causes: dilated cardiomyopathy

Question 27

the inability for the ventricle to completely relax to allow for appropriate passive filling is caused by

Answer 27

diastolic dysfunction

Question 28

what is disastolic dysfunction

Answer 28

inability for the ventricle to completely relax to allow for appropriate passive filling

Question 29

what are the causes of diastolic dysfunction

Answer 29

hypertrophic cardiomyopathy restrictive cardiomyopathy

Question 30

what is the most common cardiomyopathy

Answer 30

dilated cardiomyopathy

Question 31

what is associated with an increase in filling volume

Answer 31

dilated cardiomyopathy

Question 32

what is increased with dilated cardiomyopathy

Answer 32

increased preload (EDV) will cause increased atrial pressure atrial dilation

Question 33

what is the most common cause of right sided heart failure

Answer 33

left sided heart failure

Question 34

what is activated within the body to increase the BP

Answer 34

renin-angiotensin-aldosterone system which is activated by decreased CO

Question 35

What is transient ballooning of the cardiac apex due to profound stress

Answer 35

Takotsubo - "broken heart" classically seen in postmenopausal women

Question 36

what is thought to be associated with a huge catecholamine surge, microvascular dysfunction and spasm of the coronaries

Answer 36

Takotsubo

Question 37

what is the presentation of dilated cardiomyopathy

Answer 37

symptoms of left sided heart failure S3 sounds dilation can change annulus can present with arrhythmia may see right sided HF depending on severity

Question 38

what is the presentation of left sided heart failure

Answer 38

pulmonary concerns - pulmonary edema

Question 39

what is the presentation of right sided heart failure

Answer 39

more edema and ascites fatigue, increased peripheral venous pressure distended jugular veins, Anorexia & GI distress weight gain

Question 40

what is hypertrophic cardiomyopathy

Answer 40

thickened myocardium leading to poor diastolic filling may lead to outflow obstruction

Question 41

what can cause hypertrophic cardiomyopathy

Answer 41

genetics: inherited (autosomal dominant) or mutations chronic HTN Aortic stenosis amyloidosis

Question 42

what presents with a more pronounced septum

Answer 42

hypertrophic cardiomyopathies

Question 43

What is HOCM

Answer 43

Hypertrophic Obstructive Cardiomyopathy - often causes sudden cardiac death in athletes occlusion of the outflow tract (aortic valve) which causes a vacuum with mitral valve and decreases CO

Question 44

what is the presentation of hypertrophic cardiomyopathy

Answer 44

systolic murmur S4 heart sounds HF Arrhythmia may also have findings of mitral regurgitation

Question 45

What is restrictive cardiomyopathy

Answer 45

fibrosis of the myocardium infiltrative disease - decreased compliance

Question 46

what is the pathophysiology of restrictive cardiomyopathy

Answer 46

fibrotic changes within the myocardium which decreases compliance of the ventricles this decreases ventricular filling capacity

Question 47

what can restrictive cardiomyopathy lead to

Answer 47

diastolic dysfunction RV HF and LV HF secondary to decreased compliance systolic murmur

Question 48

what are the causes of restrictive cardiomyopathy

Answer 48

endomyocardial fibrosis radiation fibrosis: secondary to radiation to the mediastinum amyloidosis sarcoidosis hemochromatosis

Question 49

What is endomyocardial fibrosis

Answer 49

autoimmune issue marked by eosinophilia which is an inflammatory reaction and fibrosis of the endocardial surfaces

Question 50

who are endomyocardial fibrosis most common in

Answer 50

children of developing countries

Question 51

What is amyloidosis

Answer 51

misfolded antibodies which are able to be deposited within the tissues - genetic cause leads to fibril deposition deposition within the tissues - chronic inflammation

Question 52

What is sarcoidosis

Answer 52

autoimmune disease - exact pathophysiology not completely understood hallmarked by non-caseating granuloma formation deposits within heart, joints, eyes, skin, lungs

Question 53

what is the granuloma in sarcoidosis made up of

Answer 53

macrophages and fibrotic tissues, centrally contains epitheloid cells

Question 54

what is hemochromatosis

Answer 54

excess iron due to poor protein modulation within the liver leads to increased absorption and release from the sleep iron deposits within the myocardium