Cardiomyopathies Flashcards
Definition of Cardiomyopathy
Intrinsic disease of myocardium that causes hemodynamic dysfuction
-heart failure, L and/or R biventricular failure
What percentage of heart failure diagnosed in the US is cardiomyopathy?
5-10%
The cause of Cardiomyopathy is usually __________ although it can be secondary to multi vessel disease.
Non-ischemic
T/F cardiomyopathy can be related to valve disease, and/or systemic HTN
F!
What are the 2 categories of etiologies of cardiomyopathy?
Primary intrinsic
Secondary intrinsic
What causes Primary intrinsic cardiomyopathy?
Genetic disorders of myocardial fibers
What causes secondary intrinsic cardiomyopathy?
Sarcoidosis
Hemachromatosis
Chronic anemia
What are the three main PATTERNS of cardiomyopathy?
Dilated
Hypertrophied
Restrictive
Signs and symptoms of all cardiomyopathies
DOE (increased LV/LA/PA pressure)
Fatigue (decreased CO)
As disease advances so do symptoms
What is the most common type of cardiomyopathy?
dilated
Define dilated cardiomyopathy
enlarge LV with decreased systolic function and ejection fraction.
What must the ejection fraction be less than to consider dilated cardiomyopathy as diagnosis?
EF less than 50%
Epidemiology of dilated cardiomyopathy
Men more than women
Blacks more than whites
Age of onset 20-50
In dialated cardiomyopathy ______ failure is more pronounced than _______ failure
Systolic failure is more pronounced than diastolic failure
With dilated cardiomyopathy the heart can be enlarged _____ - _____ x normal weight
2-3X
Causes of intrinsic dilated cardiomyopathy
Genetic (20-50%) Idiopathic CAD RX's (ETOH, and chemo drugs) Thyroid dz Peripartum infections chronic tachy sarcoidosis amyloidosis hemochromatosis DM
Signs and symptoms of Dilated cardiomyopathy
Pulmonary rales Elevated JVD Cariomegaly S3 Gallop rhythm Murmurs of mitral or tricuspid regurg. (systolic) peripheral edema ascites
What symptoms are present in severe heart failure secondary to dilated cardiomyopathy?
Cheyne-stokes breathing -
Pulsus alterans
Pallor
cyanosis
What diagnostic studies can be used in workup for dilated cardiomyopathy?
Echo
ECG
CXR
What would you be looking for on Echo to confirm dil. Cmyop.
Presnence of dilated ventricle and reduced systolic function
EF less than 40%
What would you be looking for on ECG to confirm dil. Cmyop.
Sinus tachy
Ventricular/atrial arrhythmias
What would you be looking for on CXR to confirm dil. Cmyop.
Cardiomegaly
L and or right heart enlargement
Pleural effusion
What 2 types of Hypertrophic Cardiomyopathies (HCM) exist?
Obstructive
Non-obstructive
What is age of onset of HCM
any age but commonly seen post-puberty
What is the most common genetic cause of cardiac death in young people including trained athletes?
HCM
Definition of HCM
Increased LV hypertrophy without the presence of an underlying cause such as valve dz, volume overload or systemic HTN.
What is the primary dysfunction of HCM
increased diastolic filling pressure from a stiff and small chambered hypertrophied LV
In obstructive HCM (there is outflow track obstruction) there is characteristic ________ that can obstruct outflow by narrowing the LV outflow track and decreasing EF.
asymmetric interventricular septal hypertrophy
Causes of intrinsic HCM
Genetic (50-80% of cases) MC genetic CV issue
Idiopathyic
IDMM (infants of diabetic mothers)
Signs and symptoms of HCM
Can range from mild to severe Sudden death (need for good family hx) Progressive DOE Anginal CP Presyncope/syncope after valsalva maneuver or exercise, palpitations Cardiac failure
cardiac exam s/s of HCM
Atrial ventricular arrhythmias Sustained PMI Lous S4 (stiffened hypertrophied ventricles) Systolic ejection murmur Bisferiencs carotid pulse (biphasic)
What anomaly of the carotid pulse is characteristic of HCM
Bisferiens carotid pulse-
double peaked pulse of the carotid
What will occur to the systolic ejection murmur of a pt with HCM if they squat down?
Decreases the sound (Increases LV filling)
What will increase the sound of a systolic ejection murmur of a pt with HCM?
Valsalva and standing
decreases LV size and LV filling
What diagnostic studies can be done to test for HCM?
Echo
Cardiac cath
ECG
What is the definitive test for HCM?
Echo
What will a echo that is positive for HCM show?
small hyper contractile LVH
Delayed relaxation and filling of LV in diastole
turbulent flow and pressure gradient in the outflow track and mitral regurgitation
What is the benefit of doing a cardiac cath on a pt with HCM?
confirms echo
also rules out CAD
What findings on an ECG might be consistent with HCM?
LVH in symptomatic pt’s
Atrial or ventricular fib
Conservative tx and recommendations for HCM
avoid strenuous exercise
hydrate
screen all 1st degree relatives w/ echo
genetic testing
Medical tx for HCM?
BB-1st line Verapamil Dysopyramide (adjunct) diuretics Surgical tx
What surgical tx are available for a pt with HCM?
Myotomy-myomectomy
Mitral valve replacement
what is the main cause of restrictive cardiomyopathy?
Amyloidosis
In restrictive cardiomyopathy the walls of the ventricles become ____ but not necessarily _____.
stiff
Thickened
What is the difference between restrictive cardiomyopathy and constrictive pericarditis?
Res cardiomyopathy-no pulsus paradoxus
Pericarditis-does have pulsus paradoxus
s/s of restrictive cardiomyopathy
mostly due to elevated ventricular diastolic pressure that restricts filling:
Pulmonary and systemic venous pressure
DOE, orthopnea-pulmonary HTN
R sided Heart failure
Tx for restrictive cardiomyopathy
Tx underlying dz (amyloidosis) Tx diastolic heart failure BB Loop diuretics Thiazides aldosterone antagonists
