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Cardio > Cardiomyopathies > Flashcards

Cardiomyopathies Flashcards

1
Q

What is cardiomyopathy

A

disease of heart muscle making it difficult for heart to pump to the rest of the body. Can lead to heart failure

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2
Q

Types of cardiomyopathy

A

Dilated
Hypertrophic
Restrictive

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3
Q

What is dilated cardiomyopathy? (DCM)

A

Ventricular chamber enlargement (>4cm) and systolic dysfunction

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4
Q

Primary causes of dilated cardiomyopathy

A

Genetics
Idiopathic (w/o FH)

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5
Q

What are some secondary causes of dilated cardiomyopathy?

A

MI, Heart valve disease, thyroid disease, myocarditis, alcoholism, autoimmune

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6
Q

Pathophysiology of dilated cardiomyopathy

A

Damage/death of myocytes (inflamm/toxic)
Eccentric fibrosis + vol ^
LV enlargement w/o ^ muscle mass due to fibrosis of the muscles
initially contractility is ok (frank-starling law)
Gradual over distension and systolic dysfunction
red. CO + ^EDV/EDP
Vol overload and congestive heart failure

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7
Q

Why does DCM lead to dyspnoea and cold, clammy extremities

A

red CO -> insufficient tissue O2

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8
Q

Why is there a displaced apex beat in DCM

A

Enlarged left ventricle

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9
Q

Why would a px with DCM experience fatigue

A

red CO/organ perfusion

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10
Q

What causes angina in cardiomyopathy

A

low coronary perfusion

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11
Q

What is a sign of pulmonary congestion

A

diffuse crackles

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12
Q

What can heart failure lead to

A

Pulmonary oedema

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13
Q

What is the presentation of dilated cardiomyopathy?

A

Dyspnoea, displaced apex beat, fatigue, angina, pulmonary congestion, low cardiac output

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14
Q

Investigations for the diagnosis of dilated cardiomyopathy

A

ECG
CXR
cardiac MRI/CT
Cardiac catheterisation
Echocardiography

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15
Q

What investigations would you carry out if you suspected familial/viral cause of dilated cardiomyopathy

A

Genetic testing
viral serology

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16
Q

What are the main types of management in dilated cardiomyopathy

A

counselling - irreversible
Alleviate the cause
Symptom relief

17
Q

What are the general areas of treatment for dilated cardiomyopathy?

A

Diet (fluid and Na+ restriction),
treat underlying conditions (immunosuppressants),
heart failure symptoms (ACE-i, beta blockers),
treat arrhythmias (atrial fibrillation),
thromboembolic events (anticoag)

18
Q

What is hypertrophic cardiomyopathy? (HCM)

A

Genetic CVD
^ LV wall thickness / interventricular septum thickness -> obstruction of flow through left ventricle

19
Q

Why does hypertrophic cardiomyopathy cause sudden death?

A

Often asymptomatic, first clinical presentation is ventricular fibrillation

20
Q

Pathophysiology of HCM

A

Genetic disease/disorders -> thickened LV myocardium/septum -> obstruction of flow
Disorganised myocytes disrupt signal conduction
Ventricular arrhythmia
Sudden cardiac death

21
Q

How does HCM present?

A

Sudden cardiac death, syncope, congestive heart failure, S4 sound, angina, ejection systolic murmur

22
Q

Why is there an S4 sound in HCM

A

Forceful atrial contraction into hypertrophic LV

23
Q

What causes syncope in HCM

A

red. CO to peripheries and head

24
Q

Why does a px with HCM feel fatigue

A

low CO and red. organ perfusion

25
Q

Why is a systolic murmur heard in HCM

A

Impaired passage of blood through to aorta

26
Q

Investigations to diagnose HCM

A

Echocardiogram
CXR
Cardiac MRI

27
Q

How would you manage HCM initially?

A

Beta blocker, verapamil if contraindicated

28
Q

What is the more severe management of HCM?

A

Mechanical therapy - pacemaker, septal myectomy or ablation (remove part of septum)

29
Q

What is restrictive cardiomyopathy? RCM

A

Rigid heart muscles restricts heart stretch/ventricular filling

30
Q

Describe the pathophysiology of restrictive cardiomyopathy

A

Deposition of abnormal substances (amyloids proteins, noncaseating granulomas) in heart tissue,
Infiltrates ventricular walls ->fibrosis/stiffening -> diastolic dysfunction.
Atrial enlargement in response
conductive abnormalities -> diastolic heart failureW

31
Q

What can advanced restrictive cardiomyopathy lead to

A

Adverse remodelling -> systolic dysfunction/ ventricular arrhythmias

32
Q

What causes ascites and peripheral pitting oedema in RCM

A

^ venous pressure -> right sided heart failure
(back pressure into systemic veins)

33
Q

Why is there hepatomegaly in RCM

A

Hepatic congestion due to RHF

34
Q

Why is S4 heard in RCM

A

atrium contracts to pump blood into stiff ventricle

35
Q

Why is there an increase in JVP in RCM

A

RHF means greater pressure in the veins

36
Q

What is the presentation of restrictive cardiomyopathy?

A

congestion (fluid in abdomen and lungs),
hepatomegaly,
increased jugular venous pressure,
reduced Pulse/SV/CO

37
Q

Investigations for the diagnosis of RCM

A

Serology
Amyloidosis check
CXR
ECG
Echocardiography
MRI

38
Q

What are the 5 management techniques for restrictive cardiomyopathy?

A

Heart failure meds,
antiarrhythmic therapy,
immunosuppression (steroids),
pacemaker,
cardiac transplantation

Cardio (10 decks)

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