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Clin Med - Cardio Exam #2 > Cardiomyopathies > Flashcards

Cardiomyopathies Flashcards

1
Q

Definition of Cardiomyopathy

A

Intrinsic disease of myocardium that causes hemodynamic dysfuction
-heart failure, L and/or R biventricular failure

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2
Q

What percentage of heart failure diagnosed in the US is cardiomyopathy?

A

5-10%

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3
Q

The cause of Cardiomyopathy is usually __________ although it can be secondary to multi vessel disease.

A

Non-ischemic

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4
Q

T/F cardiomyopathy can be related to valve disease, and/or systemic HTN

A

F!

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5
Q

What are the 2 categories of etiologies of cardiomyopathy?

A

Primary intrinsic

Secondary intrinsic

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6
Q

What causes Primary intrinsic cardiomyopathy?

A

Genetic disorders of myocardial fibers

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7
Q

What causes secondary intrinsic cardiomyopathy?

A

Sarcoidosis
Hemachromatosis
Chronic anemia

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8
Q

What are the three main PATTERNS of cardiomyopathy?

A

Dilated
Hypertrophied
Restrictive

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9
Q

Signs and symptoms of all cardiomyopathies

A

DOE (increased LV/LA/PA pressure)
Fatigue (decreased CO)
As disease advances so do symptoms

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10
Q

What is the most common type of cardiomyopathy?

A

dilated

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11
Q

Define dilated cardiomyopathy

A

enlarge LV with decreased systolic function and ejection fraction.

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12
Q

What must the ejection fraction be less than to consider dilated cardiomyopathy as diagnosis?

A

EF less than 50%

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13
Q

Epidemiology of dilated cardiomyopathy

A

Men more than women
Blacks more than whites
Age of onset 20-50

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14
Q

In dialated cardiomyopathy ______ failure is more pronounced than _______ failure

A

Systolic failure is more pronounced than diastolic failure

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15
Q

With dilated cardiomyopathy the heart can be enlarged _____ - _____ x normal weight

A

2-3X

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16
Q

Causes of intrinsic dilated cardiomyopathy

A 
Genetic (20-50%)
Idiopathic
CAD
RX's (ETOH, and chemo drugs)
Thyroid dz 
Peripartum 
infections
chronic tachy
sarcoidosis
amyloidosis
hemochromatosis
DM
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17
Q

Signs and symptoms of Dilated cardiomyopathy

A 
Pulmonary rales
Elevated JVD
Cariomegaly
S3 Gallop rhythm
Murmurs of mitral or tricuspid regurg. (systolic)
peripheral edema
ascites
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18
Q

What symptoms are present in severe heart failure secondary to dilated cardiomyopathy?

A

Cheyne-stokes breathing -
Pulsus alterans
Pallor
cyanosis

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19
Q

What diagnostic studies can be used in workup for dilated cardiomyopathy?

A

Echo
ECG
CXR

20
Q

What would you be looking for on Echo to confirm dil. Cmyop.

A

Presnence of dilated ventricle and reduced systolic function

EF less than 40%

21
Q

What would you be looking for on ECG to confirm dil. Cmyop.

A

Sinus tachy

Ventricular/atrial arrhythmias

22
Q

What would you be looking for on CXR to confirm dil. Cmyop.

A

Cardiomegaly
L and or right heart enlargement
Pleural effusion

23
Q

What 2 types of Hypertrophic Cardiomyopathies (HCM) exist?

A

Obstructive

Non-obstructive

24
Q

What is age of onset of HCM

A

any age but commonly seen post-puberty

25
Q

What is the most common genetic cause of cardiac death in young people including trained athletes?

A

HCM

26
Q

Definition of HCM

A

Increased LV hypertrophy without the presence of an underlying cause such as valve dz, volume overload or systemic HTN.

27
Q

What is the primary dysfunction of HCM

A

increased diastolic filling pressure from a stiff and small chambered hypertrophied LV

28
Q

In obstructive HCM (there is outflow track obstruction) there is characteristic ________ that can obstruct outflow by narrowing the LV outflow track and decreasing EF.

A

asymmetric interventricular septal hypertrophy

29
Q

Causes of intrinsic HCM

A

Genetic (50-80% of cases) MC genetic CV issue
Idiopathyic
IDMM (infants of diabetic mothers)

30
Q

Signs and symptoms of HCM

A 
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
31
Q

cardiac exam s/s of HCM

A 
Atrial ventricular arrhythmias
Sustained PMI
Lous S4 (stiffened hypertrophied ventricles)
Systolic ejection murmur
Bisferiencs carotid pulse (biphasic)
32
Q

What anomaly of the carotid pulse is characteristic of HCM

A

Bisferiens carotid pulse-

double peaked pulse of the carotid

33
Q

What will occur to the systolic ejection murmur of a pt with HCM if they squat down?

A

Decreases the sound (Increases LV filling)

34
Q

What will increase the sound of a systolic ejection murmur of a pt with HCM?

A

Valsalva and standing

decreases LV size and LV filling

35
Q

What diagnostic studies can be done to test for HCM?

A

Echo
Cardiac cath
ECG

36
Q

What is the definitive test for HCM?

A

Echo

37
Q

What will a echo that is positive for HCM show?

A

small hyper contractile LVH
Delayed relaxation and filling of LV in diastole
turbulent flow and pressure gradient in the outflow track and mitral regurgitation

38
Q

What is the benefit of doing a cardiac cath on a pt with HCM?

A

confirms echo

also rules out CAD

39
Q

What findings on an ECG might be consistent with HCM?

A

LVH in symptomatic pt’s

Atrial or ventricular fib

40
Q

Conservative tx and recommendations for HCM

A

avoid strenuous exercise
hydrate
screen all 1st degree relatives w/ echo
genetic testing

41
Q

Medical tx for HCM?

A 
BB-1st line
Verapamil 
Dysopyramide (adjunct)
diuretics
Surgical tx
42
Q

What surgical tx are available for a pt with HCM?

A

Myotomy-myomectomy

Mitral valve replacement

43
Q

what is the main cause of restrictive cardiomyopathy?

A

Amyloidosis

44
Q

In restrictive cardiomyopathy the walls of the ventricles become ____ but not necessarily _____.

A

stiff

Thickened

45
Q

What is the difference between restrictive cardiomyopathy and constrictive pericarditis?

A

Res cardiomyopathy-no pulsus paradoxus

Pericarditis-does have pulsus paradoxus

46
Q

s/s of restrictive cardiomyopathy

A

mostly due to elevated ventricular diastolic pressure that restricts filling:
Pulmonary and systemic venous pressure
DOE, orthopnea-pulmonary HTN
R sided Heart failure

47
Q

Tx for restrictive cardiomyopathy

A 
Tx underlying dz (amyloidosis)
Tx diastolic heart failure
BB
Loop diuretics
Thiazides
aldosterone antagonists

Clin Med - Cardio Exam #2 (12 decks)

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