Cardiomyopathies Flashcards
Organic solvent that causes DCM
Toluene
3 chemo therapies that can cause DCM
Daunoribicin Doxorubicin Sunitinib Trastuzumab Cyclophosphamide Bleomycin
Party drugs that can cause DCM
ETOH
Cocaine
Heavy metals that can cause DCM
Mercury
Lead
Cobalt
Antiretrovirals that can cause DCM (3)
Zidovudine
Didanosine
Zalcitabine
Time frame for peripartum CM
Last month of pregnancy to 5 mo’s after
Risk factors for peripartum CM
Age> 30 Multiparity AA h/o preeclampsia or postpartum HTN cocaine
Drug of choice in pregnant women instead of ACEI
hydralazine
Population at risk of Takotsubo
Percent risk of ventricular arrhythmias?
Postmenopausal women
15%
Recurrence rate for Takotsubo
4%
Bugs causing HIV focal myocarditis
HIV CMV EBV coxsackie Toxoplasma
Inheritance pattern of muscular dystrophies.
Which is worse (Becker’s or Duchenne’s) for CM?
X-linked
Becker’s
When should you suspect anthracycline induced CM (daunorubicin)?
Risk factors
Dose dependent> 550mg/m2
3-12 months after.
Can occur upto 10y later
DM, HTN,
If high doses of daunorubicin needed,what med to give to avoid CM?
Dexrazoxane, ACEI, BB
Difference in LVEDD b/w HCM and athlete
HCM: LVEDD <45
What type of activity is OK with HCM?
Low level
3 factors making SAM worse in HOCM
Increased contraction
Decreased resistance (vasodilator)
Decreased volume
Preferred Rx in HOCM (myomectony vs. septal ablation)
Myomectony
LV wall thickness in HOCM
> 1.5cm
7 risk factors are needed to place ICD in HOCM. Not including VT/VF/SCA, what are the 5 other risk factors?
Fam hx of SCD LV thickness > 3cm Recent unexplained syncope NSVT BP drop w/ exercise
Do steroids help for myocarditis
NO!
Treatment for myocarditis with reduced LV function
ACEI
BB
Will you see myofiber necrosis on biopsy of myocarditis?
Yes
8 common viral Pathogens causing myocarditis
CMV Coxsackie B Hep C Echo Adeno Parvovirus Influenza
Which biomarkers are more sensitive in myocarditis?
Trops
What do you see on MRI of myocarditis
Late gad
Do you do routine bx for myocarditis?
No
Rx and followuo of myocarditis
HF meds
Echo at 1, 6, and 12
Giant cell myocarditis is progressive and often fatal, Rx?
Thymoglobulin
Corticosteroids
Calcineurin inhibitors
Giant cell myocarditis- which immune cell?
Is biopsy high yield?
T cell
Yes
Acute phase treatment of chagas HF?
Nitrofurtimox
3 cardiac issues Lyme will cause
DCM
HB (arrhythmias)
Myocarditis
Lyme carditis bug and treatment and serologies
IgM
Ceftriaxone
Bordelaise burgdorferi
2 things to remember about lupus CM
Can wax and wane- treat the lupus flare
Systolic and diastolic dysfxn
What does cardiac bx show in lupus?
Mononuclear cells
Fever, rash, peripheral eos and eos on cardiac bx.
Dx and Rx?
Hypersensitivity Myocarditis
Remove any offending meds and give steroids
Hoarseness, macroglossia, neuropathy, proteinuria, swallowing disorder, RUQ tenderness. Exam: JVD w/ prom x and y descent, pleural effusions, hepatomegaly, edema, KUSSMAUL’s and S3 & S4. Dx, echo, EKG, Bx findings.
Cardiac amyloid
Speckled appearance, LVH
low voltage
Apple green birefringence
Management of transthyretin gene mutant cardiac amyloid
Family genetic testing
Live transplant
Which amyloid has better prognosis (senile or AL)?
Senile
2 studies that are high yield to diagnose amyloid
MRI (late gad)
Bx
Nuclear and echo findings with cardiac sarcoid
Regional WMA
perfusion defect
Do you get late gad enhancement on MRI with cardiac sarcoid?
Yes
Exact treatment for cardiac sarcoid
Corticosteroids 1mg/kg we’d x 3 months
Low threshold for ICD
Common secondary cause for cardiac hemochromatosis
Multiple transfusions
How to diagnose cardiac hemochromatosis? Rx?
T2* MRI
chelation/phlebotomy