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Clin Med - Cardiology > Cardiomyopathies > Flashcards

Cardiomyopathies Flashcards

1
Q

What are the three key types of cardiomyopathy?

A

Dilated Hypertrophic Restrictive

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2
Q

What kind of cardiomyopathy involves increased left ventricular volume, decreased ejection fraction and systolic dysfunction?

A

Dilated Cardiomyopathy aka Congestive Heart Failure

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3
Q

What type of cardiomyopathy involves thick cardiac muscle, decreased ventricular volume and decreased compliance?

A

Hypertrophic Cardiomyopathy

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4
Q

What type of cardiomyopathy involves myocardial and/or pericardial stiffness and decreased compliance?

A

Restrictive Cardiomyopathy

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5
Q

What is the pathophysiology of dilated cardiomyopathy?

A
  • Genetic factors which can lead to DNA mutation and Altered immune system
  • Viral infection which can lead to myocarditis
  • The above factors can lead to altered myocardial function
  • Which leads to dilated cardiomyopathy
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6
Q

What are some causes of dilated cardiomyopathy?

A
  • Idiopathic
  • Infections such as myocarditis, coxsackie, parvo
  • Ischemia: MI leading to scar tissue
  • Toxins from alcohol, uremia, cobalt, chemo
  • Peripartum (7th month of preg to 3 mos after)
  • Metabolic Ds: Diabetes, Beriberi
  • Arrhythmogenic RV Dysplasia
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7
Q

What are the Signs/Sx of dilated cardiomyopathy?

A

SOB and exercise intolerance, rales

tachycardia, S3, holosystolic murmur, JVD, displaced PMI, precordial heave

pallor, cyanosis, cachexia

ascites, hepatomegaly

Decreased cardiac output

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8
Q

What do you see on a CXR re dilated cardiomyopathy?

A

Bilateral pulmonary edema

Large heart silhouette

Enlarged ventricles

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9
Q

How do you treat dilated cardiomyopathy (CHF)?

A

Diuretics (Sx only, no increased survival)

Inotropes to increase contractility

ACEi and ARBs to decrease afterload to decrease work

Beta Blockers to increase LV systolic fcn and increase survival

Hydralazine + Nitrates for African Americans

NOTE: No beta blockers if in decompensated heart failure!!

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10
Q

What is hypertrophic cardiomyopathy?

A

Genetic form of hypertrophy of the heart

that is without an underlying cause.

Due to mutation of sarcomeric proteins

Prevalence: .26%

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11
Q

What is the most common cause

of sudden death in athletes?

A

Hypertrophic cardiomyopathy (44%)

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12
Q

How do you Dx hypertrophic cardiomyopathy?

A

Heart has thick muscle, decreased volume and decreased compliance

Myocardial fiber disarray

Asymmetrical LV hypertrophy (large septum)

LV outflow obstruction

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13
Q

What are the Signs/Sx of hypertrophic cardiomyopathy?

A

Often no Sx but FHx of sudden death at young age

Syncopy, chest pain, dyspnea

Prominent apical pulse

Grade 2/6 midsystolic murmur at left sternal border

Possible arrhythmia

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14
Q

What would you find in an Echocardiogram of

hypertrophic cardiomyopathy?

A

Thick muscle

Large septum

Tiny heart chamber

Possible valve problems

High velocity of blood

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15
Q

How do you treat hypertrophic cardiomyopathy?

A

NO inotropes or diuretics!

CCB and B blockers to increase size of ventricle and decrease obstruction

Septal myotomy/myectomy or nonsurgical septal ablation

Implanted defibrillator

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16
Q

What is the pathophysiology

of restrictive cardiomyopathy?

A
  • Myocardial infiltration or hypertrophy leading to decrease myocardial compliance
  • Pericardial effusion leading to increased intrapericardial pressure
  • Pericardial constriction leading to decreased pericardial compliance
  • All of the above leading to increased ventricular diastolic pressure
  • Leading to elevated diastolic pressure and suboptimal ventricular filling
17
Q

What are some causes of myocardial infiltration?

A

Idiopathic

Amyloidosis, Sarcoidosis

Fibrosis

Tumor(s)

Radiation

Heart transplant

18
Q

What are two causes of pericardial stiffness?

A

Pericardial effusion

Pericardial constriction

19
Q

How do myocardial infiltration and myocardial hypertrophy differ in terms of voltage?

A

Both conditions result in a large, stiff heart but…

Myocardial hypertrophy causes high voltage on an EKG (high amplitude) because the increased size is muscle

Myocardial infiltration causes low voltage because the increased size is due to infiltrates like sarcoid.

20
Q

What is Tako-Tsubo Cardiomyopathy?

A

aka Broken Heart Syndrome

Temporary condition where the heart muscle is suddenly weakend or stunned resulting in apical ballooning

It is a form of stress cardiomyopathy

21
Q

What are Epidemiology, Sx, Dx, Tx

of Tako-Tsubo Cardiomyopathy?

A

Epidemiology: 90% women, thought to be due to estrogen conversion to catecholamines and glucocorticoids

Sx: chest pain, SOB, collapse (palpitations, N/V)

Dx: EKG, blood test, angiogram, Echo, cardiac MRI

Tx: just monitor w serial echos

22
Q

What are the ETX, Sx, Dx and Tx

of infectious myocarditis?

A

ETX: viruses, URI, Lyme

SX: SOB upon exertion 7-10 days post infection, nocturnal dyspnea, fatigue, palpitations, chest pain/pressure, edema, (lightheadedness, arrhythmias, loss of consciousness)

Can lead to dilated cardiomyopathy

DX: EKG, CXR, Echo, cardiac MRI, heart biopsy

Tx: rest, decreased salt, steriods,

If severe: pacemaker, defibrillation

23
Q

What are the Signs/Sx, ETX and Tx of

Acute Pericarditis?

A

Signs/Sx: sudden onset, sharp, anterior chest pain (<6 wks), worse with inspiration and coughing or lying down,

better if sit forward

Pericardial friction rub at Left sternal border (“squeaky”)

ETX: idiopathic/viral (90%), CT dz (SLE), cancer

Tx: NSAIDs, colchicine, corticosteriods

Pericardiocentesis is severe

24
Q

What are two complications of acute pericarditis?

A

Cardiac Tamonade

Constrictive Pericarditis

25
Q

What are the ETX of

Pericardial Effusion?

A

ETX: idiopathic or infectious pericarditis, trauma,

neoplasm (breast, lung, lymphoma, melanoma),

metabolic dz (uremia, hemorrhagic states, myxedema)

problems from contiguous areas (aortic dissection, myocardial rupture, hemopericardium from anticoags)

26
Q

What are the Sx, Dx and TX of

Pericardial Effusion?

A

Sx: chest pain/pressure

(Dyspnea, decreased BP and muffled heart sounds

if moving toward cardiac tamponade)

Dx: waterbottle sign (looks like a flask on CXR)

Tx: NSAIDs, colchicine, corticosteriods

Pericardiocentesis if severe

27
Q

What is pericardial/cardiac tamponade?

A

Hemodynamic compromise of diastolic filling due to compressive intrapericardial pressue from pericardial effusion

28
Q

What are the Sx, Etx, and Tx of cardiac tamponade?

A

Sx: JVD, muffled heart sounds, decreased BP

pulsus paradoxus, tachycardia, tachypnea,

patient looks terrified!

EKG: ST elevation on nearly every lead

CXR: HUGE pericardium

Echo: dark space around heart with collapsing chambers

Tx: pericardiocentesis

(or pericardiotomy/pericardial window or pericardiectomy)

29
Q

What are some causes of constrictive pericarditis

aka pericardial constriction?

A

Idiopathic

Infectious (viral, TB)

CT diseases (RA, SLE, scleroderma)

Neoplasm: Primary (mesothelioma, sarcoma), or secondary

Trauma (penetrating or not)

Radiation

Post Pericardiotomy from CABG

Uremia

30
Q

What are some Sx and Tx of Constrictive Pericarditis?

A

Sx: fatigue, dyspnea, JVD, ascites, peripheral edema, hepatomegaly, Kussmaul’s sign, pleural effusion,

pericardial knock

EKG: low voltage

Chest CT: thick pericardium

CXR: pericardial calcification, small heart, pleural effusion

Tx: Pericardial stripping (entire pericardium removed)

31
Q

What is bacterial/infective endocarditis?

A

Bacteria enter the blood stream

and settle in the heart lining, valves or blood vessels

Bacteria comes mainly from the mouth re poor dental hygeine

Acute: (days) sudden, life threat

Subacute/chronic: (months) less serious

32
Q

What are Sx of bacterial endocarditis?

A

Fever, chills, night sweats, fatigue, tachycardia,

aching muscles and joints,

cough, pedal edema, ascites, weight loss, anemia

33
Q

What are the risk factors for bacterial endocarditis?

A

Cardiac birth defects such malformed valves or septal defect

Valve surgery

Dental or medical procedures

Narcotics

34
Q

What are the longterm sequelae of acute bacterial endocarditis?

A

Vegetations break loose and travel to the

brain, lungs, abdominal organs, kidneys, limbs

causing heart murmur, valve damage, HF,

stroke, seizure

PE, kidney damage, splenomegaly

paralysis

abscesses in heart, brain, lungs

Can cause hypertrophic cardiomyopathy

35
Q

How do you treat bacterial endocarditis?

A

2-6 weeks of IV antibiotics!

36
Q

What is the similarities and differences

between hypertrophic cardiomyopathy

and hypertensive heart disease?

A

Both: ventricular hypertrophy and decreased chamber size

Hypertrophic cardiomyopathy is genetic and causes asymmetrical hypertrophy with a large septum

Hypertensive heart disease is caused by long-standing hypertension and causes symmetrical hypertrophy. Associated with Heart Failure with preserved Ejection Fraction HFpEF

Clin Med - Cardiology (17 decks)

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