Cardiomyopathies Flashcards
what are the subtypes of cardiomyopathies
dilated
hypertrophic
restrictive
what is the most common cardiomyopathy
dilated cardiomyopathy
seen in M>F (3:1)
black patients at her risk
what are the causes of dilated cardiomyopathies
50% idiopathic
Genetic
infection
autoimmune (sarcoidosis)
toxic and overload (alcohol + cirrohosis)
drugs (chemo)
endocrine/metabolic (DM)
peripartum
what characterizes dilated cardiomyopathy
ventricular enlargement (LV>RV>Atria)
NO associated hypertrophy (normal wall thickness)
impaired systolic function (reduced contractility)
what are the common causes of infective dilated cardiomyopathy
enteroviruses and adenoviruses
what is the equation for stroke volume
EDV (preload) - ESV (afterload)
what is the equation for cardiac output
CO= HR x SV
what are symptoms of left sided HF
dyspnea on exertion
orthopnea
paroxysmal nocturnal dyspnea
cough
fatigue
AMS
what is paroxysmal nocturnal dyspnea
SOB that awakens patient from sleep, relieved with sitting up)
what are the signs of left sided HF
tachycardia
tachypnea
cyanosis
cardiomegaly
RALES
WHEEZES
S3 or S4 HEART SOUNDS
VALVULAR REGURGITATION
what are the symptoms of right sided HF
peripheral edema
RUQ pain (hepatic congestion)
Anorexia or reduced appetite
Bloating/weight
fatigue
what are signs of Right sided HF
peripheral edema
elevated JVP
Hepatomegaly
anasarca
ascites
weight gain
what is present on Chest XR with CHF
cardiomegaly
pulmonary congestion
- hilar fullness, cephalization, Kerley B lines
pleural effusion
widened mediastinum
what is the treatment for dilated cardiomyopathy
treat it like heart failure
control modifiable risk factors
diet and lifestyle change
daily weight monitoring
intensive case management
regular activity to preserve functional status
pharmacologic tx of HF
consider surgical interventions for end stage HF
how do you treat acute heart failrue
diuretics
- furosemide (lasix)
- bumetanide
- Torsemide
what is the pharmacologic treatment of heart failure
All should get a BB + ACEi
ARBs as second line option
what is the #1 cause of sudden cardiac death in young patients
HOCM (hypertrophic Obstructive Cardiomyopathy)
M>F
Genetic
what characterizes HOCM
myocyte disarray
LVH
impaired diastolic function
LV outflow obstruction
what is the presentation of HOCM
dsypnea - especially on exertion
angina (without CAD)
syncope
orthostatic hypotension
arrhythmias
what are exam abnormalities with HOCM
S4 heart sound (atrial kick)
double apical impulse (atrial kick)
exaggerated PMI
systolic crescendo-decrescendo murmur at left lower sternal border
mitral regurgitation murmur (improved with squatting, worse with valsalva, standing)
bifid carotid pulse (pulsus bisferiens)
what is the treatment for HOCM
Avoid strenuous exercise - SCD risk!
CCB (Verapamil or dilt)
BB
Avoid diuretics and nitrates
what is the treatment for refractory HOCM
surgical intervention
septal myectomy, ETOH ablation
what type of cardiomyopathy has the worse prognosis
restrictive cardiomyopahty
2-5 year average survival
highest rate of SCD
what is restrictive cardiomyopathy secondary to
either fibrosis or infiltrative process
- myocardium or endocardium
what are the causes of restrictive cardiomyopathy
idiopathic
scleroderma (fibrosis)
AMYLOIDOSIS (INFILTRATIVE)
Sarcoidosis (infiltrative)
hemochromatosis (infiltrative)
Hypereosinophilic syndrome(infiltrative)
tumors
radiation
what is restrictive cardiomyopathies characterized by
atrial enlargement
ventricular stiffness
MINIMAL ventricular hypertrophy
impaired diastolic dysfunction
what is the best diagnostic study for restrictive cardiomyopathies
Biopsy
congo red stain for amyloidosis
looking for infiltrative process or fibrosis
what is the treatment for restrictive cardiomyopathies
targeted at underling cause
salt restriction
diuretics PRN for pulmonary congestion or fluid overload
vasodilators less helpful (minimal systolic dysfunction)
manage arrhythmias - NSR
consider anticoagulation
treatmentof amyloidosis
what is the treatment of amyloidosis
immunomodulators
molecular/gene-targeted drugs
chemotherapy
stem cell or liver transplant
