Cardiomyopathies Flashcards
1
Q
How common is cardiomyopathy in US?
A
- 3rd most common form of heart disease
- 2nd most common cause of adolescent heart disease
- pt will have CHF (usually presents at late stage)
2
Q
CXR finding of cardiomyopathy?
A
- cardiomegaly
3
Q
How are cardiomyopathies classified?
A
- primary: due to idiopathic process effecting the myocardium
- secondary: related to specific heart muscle disease
4
Q
Functional classification of cardiomyopathies?
A
- dilated:( congestive, DCM, IDC) - ventricular enlargement and systolic dysfxn
(alcohol, postpartum/peripartum, viral, genetic) - hypertrophic: (IHSS, HCM, HOCM) - inapprop. myocardial hypertrophy in absence of HTN or aortic stenosis
- restrictive: infiltrative (amyloidosis), abnormal filling and diastolic function, won’t have cardiomegaly
5
Q
Definition of IDC?
A
- disease of unknown etiology that principally affects the myocardium
- LV dilation and systolic dysfunction
- pathology: increased heart size and wt, ventricular dilation, normal wall thickness, heart dysfunction out of portion to fibrosis
6
Q
Dilated cardiomyopathy etiologies? pathophys?
A
- ventricles stretched and become flabby and myocardium deteriorates
- cause often unknown (autoimmune)
- drug toxicty (alcohol, cocaine, catecholamines, chemotherapeutic agents), hypothyroidism, inflammation of the heart in some cases - CHF
- hearts attempt to work harder results in increasing levels of Ca in cardiac cells, this activates Ca sensitive enzyme initiating cascade which switches on genest that cause heart enlargement
- because ventricular contractility is impaired, CO is poor and condition progressive worsens
7
Q
Most common etiology of DCM, what groups affected the most?
A
- systolic dysfxn and pump failure with low cardiac output
- 50% idiopathic
- african americans and males have 2.5x increased risk
- most common age of dx: 20-50 years
8
Q
characteristics of DCMs, what is seen on EKG and echo
A
- impaired systolic function leads to cHF
- dilation of one or both ventricles
- often idiopathic
- ethanol, chemotherapy
- peripartum
- ekg: nonspecific ST-T wave changes
- echo: show ventricular dilation
9
Q
How tod tell difference b/t dilated cardiomyopathy and dilated left ventricle due to severe CAD?
A
- usually post MI: local dysfunction
- dilated myopathy: global dysfxn
seen on echo!!
10
Q
Clinical presentations of idiopathic DCMs?
A
- HF sxs: 75%
- anginal CP: 8-20%
- emboli: 1-4%
- syncope: less than 1%
- sudden cardiac death and arrhythmias
- hear systolic regurg murmur, rales and edema
11
Q
Dx tests presentation of DCMs?
A
- CXR: enlarged heart, biventricular enlargement and pulm vascular congestion (kerley B lines)
- EKG: LVH, LAE, Q waves, poor R wave progression, and afib
- echo: confrms dx, ventricular enlargement, increased systolic and diastolic volumes, decreased EF
12
Q
Management of DCM?
A
- limit activity based on fxnl status
- salt restriction
- fluid restricition
- initiate medical therapy:
ACEI, diuretics
digoxin
hydralazine/nitrate combo
anticoag
anti-arrhythmicas - consider transplant: tx with meds for 6 months to see if progress: echo
13
Q
Goals of DCM therapy? diseases that can be tx?
A
- tx congestive sxs: diuresis
- ID diseases that can be tx:
CA
thyroid disease
hemochromatosis
sarcoidosis
infections
ETOH
drugs (chemo: doxirubicin)
peripartum
14
Q
Alchohol induced cardiomyopathy is how common? why does it occur, can it be tx?
A
- 3-4% of DCM
- more common in men
- etiology: direct toxic effects of ETOH, malnutrition
- maybe a genetic predisposition
- IT is reversible!!!! - stop drinking
15
Q
Workup of pt with dilated cardiomyopathy?
A
- hx focused on HF
- lab eval: EKG, CXR, echo and coronary angiography (CAD?)
- if echo shows dilated ventricles - and LVEF is less than 40% and no severe disease -
- if rapidly progressive sxs overe one month or new ventricular tachycardia or conduction abnorm and or suspected cause of myocarditis - get bx
- if not: tx with conventional HF meds - if no improvement in 1 week - consider bx
