Cardiomyopathies Flashcards
1
Q
Types of Cardiomyopathies
A
-
Dilated: Enlargement of ALL Chambers (Atrial and Ventricular)
- Impaired Systolic Function
-
Hypertrophic : Thick LV
- Impaired Diastolic Function
-
Restrictive : Strained/ Restricted R&L Ventricular Walls.
- Impaired Diastolic Function
-
Takotsubo / Broken Heart Syndrome:
- Apical ballooning with NORMAL coronaries and wall motion abnormalities
2
Q
Diagnostic evaluation of CMP EKG and ECHO
A
- DILATED
- EKG
- NSSTC, AV Blocks, Ventricular Ectopy
- Echo
- Dilated LV, Low CO
- Reduced or Preserved EF
- Enlarged Atria
- MV Regurg or Insufficiency?
- CXR
- Cardiomegaly
- Pulmonary Edema
- Stress Echo/ Thallium
- Angiogram
- Labs – find the cause!
- BNP?
- EKG
- HCOM
- EKG
- LVH, NSSTC, Septal Q waves
- Echo
- LVH!
- Asymmetric Septal Hypertrophy
- Small LV Volume
- Diastolic Dysfunction
- CXR
- Not remarkable
- Cardiac MRI
- EKG
- RESTRICTIVE
- EKG
- Low Voltage non specific changes
- Echo
- Large RV, Stage 4 Diastolic Dysfunction
- Endomysial Biopsy
- EKG
3
Q
Dilated Cardiomyopathy (CMP)
A
- MOST COMMON in Heart Failure
- Ischemic/post-MI – most common CMP
- Hypertension
- Arrhythmias
- Myocarditis (viral)
- Alcohol – most common Non-Ischemic
- Chemotherapy
- Pregnancy
- Connective tissue disease
- Sepsis
4
Q
Symptoms and physical exam of cardiomyopathy
A
-
Dilated CMP
- Dyspnea : DOE / SOB
- Edema
- Orthopnea
- PND
- Fatigue
- S3
- MV Murmur
-
Restrictive
- Dyspnea on Exertion
- Symptoms of Right Heart Failure
- Fatigue
- S3 or S4
- Mitral Valve Regurg Murmur
-
Hypertrophic CMP (HOCM)
- Syncope
- Sudden Cardiac Death in Young Person
- Dyspnea
- Fatigue
- Angina
- Orthopnea
- Palpitations – Atrial Fib
- S4 on Physical Exam
5
Q
Sudden Cardiac Death
A
- Sudden death is a major complication of HCM
- Usually secondary to ventricular tachycardia or ventricular fibrillation
- Syncope may result from left ventricular outflow tract obstruction leading to decreased cerebral perfusion
- HCOM is the most common cause of SCD in young competitive athletes, estimated to be about 1:500.
- SCD can occur during any kind of activity, from sleep to very excessive exercise
- In the United States, basketball is the highest risk sport followed by football, swimming, lacrosse, and cross-country skiing
- In Europe, soccer has the highest incidence of SCD
- many of these patients might have no symptoms at all before the fatal outcome
6
Q
Treatment/Management of CMP
A
- DILATED
- Tx Heart Failure
- Tx Underlying Heart Disease/ Cause
- Abstain from ETOH and Sodium
- Severity of HF? – ?ICD/ LVAD/ Heart Transplant
- HCOM
- Beta Blockers or CCBs
- Surgical Myomectomy or Ablation
- ICD for prevention of SCD
- Valve Replacement (MVR) if indicated
- RESTRICTIVE
- Diuretics – symptom control
- PAH Drugs
- ( Sildenafil, Letairis, Tracleer, Flolan…etc)
- Heart Transplant
7
Q
Sports Preparticipation screening
A
- The European Society of Cardiology recommends a pre participation screening strategy that comprises family and personal history, physical examination, and 12-lead ECG
- The American Heart Association focuses on medical history (family and personal) and physical examination
- Recent data from the United States suggest that, in demographically similar regions of the United States and Italy, athlete sudden death rates have not differed significantly in recent years, despite different pre participation screening strategies
8
Q
HCOM (hypertrophic cardiomyopathy)
A
- Hypertrophic cardiomyopathy (HCM) is a common genetic cardiovascular disease that affects the left ventricle.
- 100% Genetic Disorder
- HCM can appear at any age, with the majority of the patients remaining clinically stable.
- When patients complain of symptoms, these include: dyspnea, dizziness, syncope and angina. HCM can lead to sudden cardiac death (SCD), mainly due to ventricular tachyarrhythmia or ventricular tachycardia. High-risk patients benefit from implantable cardioverter-defibrillators.
- Left ventricular outflow tract obstruction is not a rare feature in HCM, especially in symptomatic patients, and procedures that abolish that obstruction provide positive and consistent results that can improve long-term survival.
- Sudden cardiac death is estimated to occur in about 1 percent of people with HCM each year. Hypertrophic cardiomyopathy can cause heart-related sudden death in people of all ages, but the condition most often causes sudden cardiac death in people under the age of 30.
9
Q
common causes of sudden cardiac death in athletes
A
- hypertrophic cardiomyopathy
- arrhythmogenic right ventricular cardiomyopathy
- idiopathic dilated cardiomyopathy
- myocaditis
- coronary artery anomalies
- aortic dissection
- commotio cordis
- Arrhythmic hear disease (including Wolff-Parkinson-White syndrome, long QT syndrome, short QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia
10
Q
Restrictive Cardiomyopathy (RCMP)
A
- WORST PROGNOSIS
- Infiltrative disease : Amyloidosis, Sarcoidosis
- Non-dilated, non-hypertrophic, impaired filling
- Familial
- Hemochromatosis, Scleroderma
- Cancer
11
Q
Common causes of sudden cardiac death in masters athletes
A
- CAD
- Dilated cardiomyopathy
- hypertensive heart disease
- myocarditis
12
Q
Takotsubo/Broken Heart CMP
A
- (broken heart syndrome, stress-induced cardiomyopathy or Takutsubo cardiomyopathy)
- Takotsubo cardiomyopathy (TTC) is an increasingly recognized, reversible cardiomyopathy with a clinical presentation that mimics an acute coronary syndrome (ACS).
- TTC is estimated to represent 1% to 2% of patients presenting with suspected ACS, most commonly manifests in postmenopausal women, and is precipitated by emotional or physical stressors in a majority of cases.
- Typical presentation involves chest pain and/or dyspnea, transient ST-segment elevation on the electrocardiogram, and a modest increase in cardiac troponin.
- Cardiac imaging demonstrates wall-motion abnormalities that generally extend beyond the territory of a single epicardial coronary artery, and the absence of obstructive coronary lesions. Echo may show apical ballooning.
- Supportive treatment typically leads to spontaneous, rapid recovery of ventricular function within weeks.
- Ex) angiogram with normal arteries and sxs of ACS with transient ST elevation
- Theres nothing to treat, everything is normal
- Breakdown of a Broken Heart (Tako tsubo, by the way, are octopus traps that resemble the pot-like shape of the stricken heart.)
13
Q
Hypertrophic Cardiomyopathy (HCM)
A
- Genetic – LV thickens, obstructs blood flow.
- Inherited Autosomal Dominant Gene
14
Q
Cardiovascular screening history for preparticipation examinations: critical questions
A
- Exertional chest pain or discomfort, or shortness of breath?
- Exertional syncope or near-syncope, or unexpected fatigue?
- Past detection of cardiac murmur or systemic hypertension?
- Known family history of hypertrophic cardiomyopathy, other cardiomyopathies, long QT syndrome, Marfan syndrome, significant dysrhythmias?
- Family history of premature death or known disabling cardiovascular disease in a first- or second-order relative younger than 50 years? (More concern if younger than 40 years.)
