Cardiomyopathies Flashcards by Rahim Akram

Frederichs ataxia and WPW

Leading cause of sudden cardiac death in young athletes

S4. Mid EJECTION SYS MURMUR
Mitral regurg; concentric hypertrophy
BISFRIENS PULSE!!! JERKY PULSE!!!!

Which mutation?
TransThoracic Echo show? MR SAM ASH

Tx?

HOCM

BETA myosin heavy chain

MR/Sys Ant Motion/Asym Sys Hypertrophy

Amiodarone @ arrhythmia 
Beta block/CCB-verap
Cardiovert defibrillate implantable 
DC pacemaker implantable
Endocarditis proph
Surg = myomectomy

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Guys got 
Loefflers endocarditis, 
Amyloidosis, 
Radiotherapy, 
Sarcoidosis/scleroderma

Presents as RHF!!!

Restrictive cardiomyopathy - RestrRHF

Jvp high, ascites, HMeg

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Alcohol,
Beri beri wet B1 def
*Coxsackie Chagas (trypanosomacmv ebv parvo flu adeno hhv 6 hep c
Doxorubicin

Guys got most COMMON CMyopathy - 90%

LHF + RHF symptoms
S3 sys murmur; eccentric hypertrophy

Mitral regurg/Tricuspid regurg

Dilated cardiomyopathy LHF>RHF

HF Tx ie ABCDES!!

*all those fkn viruses cause myocarditis which leads to DCM

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Person had bereavement/breakup!!!

Patient just found a family member dies then

suddenly develops chest pain + HF

Apical ballooning of myocardium

Stress induced cardiomyopathy

Takotsubo - type of dilated CMyopathy

BROKEN HEART SYNDROME!!!

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Pregnancy:

Last five months

Five months postpartum

Peripartum cardiomyopathy

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Cyanotic congenital disease

Acyanotic congen diseases

TruncArt 1 vessel
TransGA 2 vessels
TricAtresia 3 vessels
ToF 4 vessels
TAPVR

VSD>ASD>PDA>coarctation

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TA fails to what?

TGA: blood =
RV -> ???
LV -> ???

What to give before TGA surgery and why?

TricAtresia: ???

TA fails 2 divide in 2 (pul art and aorta)

TGA: blood =
RV -> Aorta
LV -> Pul Art

Prostaglandins keeps it open @ TGA to allow some oxygenation before surgical fixing

TricAtresia: no tric valve + hypoplastic RV

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Features of ToF?

Baby cries and turns blue - tet spells

CXR shows boot shape. What does this mean?

What manoeure gets rid of cyanosis?

ToF:
Pul stenosis @ infund -> pushes blood through VSD #R->L shunt
RVH
Overiiding arota
VSD

boot shape = RVH

Valsalva =
SVR -> lower R->L shunt

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Whats PDA?

Why PDA legit in utero?

Why not need after born?

If persists whats the issue?

Similar to Aortic regurg, what kind of pulse you get?

Tx?

PDA= connection between pul art + aorta

inutero R->L shunt fine cos of pul HTN i.e. need it go through PDA

after born, dont need PDA cos Pul HTN gone.

If it persists, L->R shunt = RVH = corpulmonale EISENMENGER

COLLAPSING PULSE!! + continuous MACHINE

Tx = Indomethacin closes PDA!!
Prostaglandins keeps it open @ TGA to allow some oxygenation before surgical fixing

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Explain eisenmenger

Sx?

Ax?
____________

RBBB+RAD ?
RBBB+LAD ?

L->R shunt = PAH ->
RVH -> R->L shunt

@Eisenmenger = flow reverses –>
-murmur = disappears –> i
nfant becomes Cyanotic rather than shocked and pale.

CCPP:

cyanosis clubbing
polycythemia PAH

Ax = VSD, ASD, PDA.
_____________

ASD:

RBBB+RAD = secundum dx
-EMBOLUS SHOOT OFF -> STROKE!!!!!!

RBBB+LAD = primum dx

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Man/Turner’s girl = HTN in arms and R-F delay
Got TURNERS!!!

Mid ejection systolic @ LUSE through to
BACK!!

Explain pathology.

CXR = notched ribs cos of?

Coarctation

Aorta narrow near PDA ->

HTN in bracioceph + LSubclavian + R-F delay

CXR = notched ribs cos of collats eroding ribs

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Late MI complications

Early MI complications

Late

LV Aneurysm - persistent ST elevation!!

LV Rupture JVP high, muffled heart sounds, low BP

Early:

Pericarditis – Pleuritic chest pain eased sitting upright

Ventricular tachycardia – Guy develops broad complex tachycardia blood pressure drops

ventricular fibrillation – Guy goes into cardiac arrest dies

Papillary muscle rupture - Blood pressure drops and new mid-sys murmur

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Late:

persistent ST elevation!!

JVP high, muffled heart sounds, low BP

Early:

Pleuritic chest pain eased sitting upright

Guy develops broad complex tachycardia blood pressure drops

Guy goes into cardiac arrest dies

Blood pressure drops and new mid-sys murmur

Late

LV Aneurysm - persistent ST elevation!!

LV Rupture JVP high, muffled heart sounds, low BP

Early:

Pericarditis – Pleuritic chest pain eased sitting upright

Ventricular tachycardia – Guy develops broad complex tachycardia blood pressure drops

ventricular fibrillation – Guy goes into cardiac arrest dies

Papillary muscle rupture - Blood pressure drops and new mid-sys murmur

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Midsystolic crescendoed decrescendo murmur radiating to the carotids @ RUSE

Midsystolic murmur @ LUSE

fixed split?
s4?

Mid ejection syatolic murmur @ BACK

What is carcinoid assoc with?!
_________

Pansystolic @LLSE

blowing high pitched
harsh V2

Diastolic @ LLSE

Pansystolic @ apex

blowing high pitch
mid ejection systolic click

Diastolic @ apex = LHS hold breath + opening snap
____________

Pansystolic @LLSE

blowing high pitched
harsh V2

Diastolic @ LLSE

Pansystolic @ apex

blowing high pitch
mid ejection systolic click

Diastolic @ apex = LHS hold breath + opening snap

EJECTION MSys@RUSE Aortic Stenosis Sys-mid C-D

EJECTION Sys=MSys@LUSE= PS, ASD fixed split, ToF, HOCM S4, innocent!!!!

Late MESys @ back = coarctation

Carcinoid -> PUL STENOSIS/TricInsuff
___________

PSys LLSE = TR/VSD

Dias LLSE = TSten

PSys = MR/MP(actually is late sys)

Late Diastolic = MS = LHS Hold Breath, Opening snap
____________

PSys LLSE = TR/VSD

Dias LLSE = TSten

PSys = MR/MP(actually is late sys)

Late Diastolic = MS = LHS Hold Breath, Opening snap

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Pansystolic @LLSE

blowing high pitched
harsh V2

Diastolic @ LLSE

Pansystolic @ apex

blowing high pitch
mid ejection systolic click

Diastolic @ apex = LHS hold breath + opening snap

PSys LLSE = TR/VSD

Dias LLSE = TSten

PSys = MR/MP(actually is late sys)

Late Diastolic = MS = LHS Hold Breath, Opening snap

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AD - long QT + NO sensorineural deafness

AR - long QT + sensorineural deafness

AD Asian men pseudoRBBB + ST elevation (downsloping mostly V1-3ish). Risk? Tx? Gene?

Antiarryhtmics causing long QT?
Others?
Electrolytes?

CASQ2 and RYR2 encodes for?

Romano Ward, KCN(Q1+H2) fucked K channels

Jervell Nielsen

Brugada = tachy-arrhythmias, sudden cardiac death. ICD!! Gene SCN5A mutation -> fucked Na Channel

Not flecainide, amiodarone, procainamide, sotalol
SSRI/TCA; Typ»»Atyp APsych; Li; macrolides
Low Mg K Ca
HYPO FUCKING THERMIA!!!

CASQ2 = calsequestrin fucked -> Ca can’t bind -> Catecholaminergic Polymorphic VT (CPVT)
and RYR2 = ryanodine receptor -> CPVT also

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Some features of a Aortic stenosis?

Treatment

Common Ax <65 and >65

LVH = LAD LBBB
Pulse = narrow pressure/ slow rising
Apex = thrill
S4

Asymptomatic = observe
Asymptomatic >40/50mmHg + LV sys dx = surg

Symptomatic = valve replacement -> balloon valvuloplasty

<65 - bicuspid aortic valve
>65 - calcification

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Pulses paradoxes?

Slow rising/plateau?

Collapsing?

Pulsus alternans?

Bisfriens pulse?

Jerky

J wave Osborn

Widespread/SADDLE ST elevation

PR depression?!

pericardial knock

Severe asthma/cardiac tamponade

Aortic stenosis

Aortic regurg/PDA/increased requirement (anaemia hyperthyroid/)Pregnancy/fever/exercise

Left ventricle failure

Mixed aortic valve disease/HOCM

Jerky = HOCM

J = hypothermia HyperCalcemia

Widespread ST elevate = pericarditis

PR depression = most sensitive for pericarditis!!!!!

pericardial knock = constr pericard

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Diastolic murmur @ LUSE

high pitched
Rumbling/SIT forward = MADCAT PAQ???

Ax??

Diastolic murmur @ LUSE
PR - Graham Steel murmur HighPitched
AR - Rumbling Austin Flint Sit forward!!!

Musset nodding, Austin Flint, Dariosz Fem

Corrigan carotid, Traube Pistol Fem

Pulse = collapsing/wide split;
Apex displaced;
Quincke nail bed hemorrhage

Ax of Aortic regurg =
Valve dx = SLE/infection (rheum+endo), RA
Aortic root dx =
Ank spond, Marf/EDanlos, ADiss/HTN, syphilis

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S1-4 sounds?

Wide split ??
Paradox split??
Fixed split??

S1 = mitral/tricuspid closing
soft @regurg
loud @MS

S2 = Aortic/pul closing
soft @ASten
Loud @ HTN, Hyperdymamic states, ASD-PulHtn

Wide s2-
delay RV empty(PS; PAH{MRegurg severe}; RBBB)

Paradox s2 - WPW-b, AS/LBBB, RVPacing, PDA

Fixed s2 - ASD

S4 = atria contract against STIFF ventricle
HOCM/HTN
ASten
(think about it this way, if it’s AS here, then S3 is opp ie mitral regurg )

S3 = diastolic filling of ventricle 
Const pericarditis - pericard knock, X+Y, X ✔️; 
Dilated CM, 
MRegug
NORMAL<30y

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Causes of first and second degree HB KIMBAD

Causes of third degree complete HB FASTI

Pericardial rub - ??
Pleural rub - ??
Pericardial knock - ??

First and second degree:
K+low; IHD; myocarditis;
Beta-blockers; Athletes; Digoxin

Third degree complete block:
Fibrosis; AS; Surg Trauma; IHD/Congen

Pericardial rub - pericarditis
Pleural rub - pneumonia/PE
Pericardial knock - C. Pericarditis

Causes of LBBB

RBBB causes?

Wide split ??
Fixed split??
Paradox split??

Causes of LBBB

RBBB causes?

LBBB=CM, HTN, AS, IHD

RBBB=PE, ASD, Normal

Wide -
delay RV empty(PS; PAH{MRegurg severe}; RBBB)

Paradox - WPW-b, AS/LBBB, RVPacing, PDA

Fixed - ASD

ST elevation Ax?

ST depression AX? VICD

T wave inversion Ax? DRILb

ST elevation =
MI/pericarditis

ST dep + T invert =
VHypert + Ischemia + Conduction dx + Digox

T invert =
ischemia/old 
Brugada 
VHypert*
Digoxin

What sign is and what’s it found in?!

BP/pulse drops on inspiration?

JVP rises on inspiration?

Pulsus paradoxus!!! Tamponade TampaX: ✔️; X

Kussmauls!!! Constrictive pericarditis X+Y; X; ✔️

ECG signs for: LVH, RVH, LAH, RAH

LVH: R>25mm V5+6 Inverted T @ V5+6, 1, VL LBBB+LAD RVH: R tall @ V1 Inverted T @ V1+2, RBBB+RAD LAH: BPM Bifid P-mitrale +/- AF = MS/R RAH: PPP Peaked P-pulmonale= TS>PS/PAH

White wash on CXR: What causes trachea: towards white wash away white wash

Towards: Pneumonectomy; hypoplasia; collapse Away: Pneumothorax; effusion; diaph hernia; tumour Normal: MESOTHELIOMA; pneumonia; pul oed

Ax LAD Ax RAD

RAD vs LAD A(R>S @ V1) - WWPW - B (S>>>R + Tinvert)+ VT AAAArm switch/dextrocardia RRRRVH - LVH Lat (circumflex) - MMMMI - Inf (RCA) TTTTall thin = RAD Left post fasicle - HHHHemiblock - left ant fasicle/(bifasicular) p176 ECG John Hampton book

Ax for increased troponin Non palpable apex Raised JVP

Sepsis shock PE/pericard RF MI/F+ ``` Non palp apex = COPD Obesity PEffusion(as well as percardial)/Px Dextrocardia ``` JVP inc = M-HF I - LNodes/CPericarditis C - SVCO E - Tamponade

Normally in V1 S>R. But why would R>S? Normally in V5/6, R<25mm. But why would R>25mm? Where can small Qs normally be found? Where can T inversion be normally found?

R>S = RVH/posterior MI R>25mm = LVH Q - 1, aVL, V6 - lat side circumflex T-invert - 3, aVR, V1 + V2-3(Black)

``` Ax MR parcel MS crem AR smear AS RCC ```

MR: prolapse/appetite suppressants/rheum fever/Calcification;ChordaePapillaeDX/ Endocarditis/LVDilate - CM/Congen MS: congen/rheum fever/EndoFibroelastosis/malig carcinoid AR: syphilis/marfan ehlors/endocarditis/ADiss-HTN/Rheum fever/ology(2nd page of diseases in notes!!!) AS: rheum fever/calcified/congen

Clubbing Ax Cardio CoME Resp S(cote)IC GI CLIT

Cardio: COngen/Myxoma/Endocarditis Resp: suppurative (Collection abscess/outside empyema/Tubes bronchiectasis/Everywhere CF GI: cirrhosis/CDx; lymphoma; IBD; Thyroid graves acropachy

Oedema Ax Pitting CAN RICO MEN Npitting MICE Unilat DCP

Pitting Drugs = csteds/amytriptiline/NSAIDs VP inc = RF/immobility/CPericard/Obese OP dec = low albumin - malnutrition/exfoliative dermatitis/nephrotic+cirrhosis ``` NPitting M - milroys/Thyroid dx I - filariasis C - cancer E - RT/Node clearance ``` Unilat - DVT/cellulitis/PTSynd

Causes of HF: Preload high Pump failure Afterload high

Preload - Regurg(any valve)/overload/VSD Pump failure - CM/CPericard; IHD/Ionotrope neg; Arrhythmia Afterload - Stenosis (any valve)/HTN(periph/pul-corpulmonale) High output - Preg/Anemia/Thyrotoxicosis

Periph cyanosis Ax - blue fingers Central cyanosis - blue lips tongue LVHeave Ax

Periph: PVD/HF/Shock Raynauds Central: Shunts/Lung dx/MetHbemia LVHeave: HOCM/HTN; AS; Coarctation

Ecg Changes of digoxin?

Flat T AV block Short QT Tick-reverse = downslope ST

Action of adenosine? Which drugs enhances/reduces action of adenosine?

A1 receptor agonist @ AV node-> inhibits aCyclase -> reduce camp -> hyperpolarization Dipyramidole/Bupivicane = Enhances Action Aminopyhlline reduces action of adenosine

Pt had DE stent put in, on aspirin and ticagrelor. Gets breathless. What to do?

Sub ticag for clopi Cos ticag = stops adenosine clearance -> incr adenosine --> SOB sx

JVP a c v x y waves

A - atrial contraction - Large is atria pushing agasint resistance Absent in AF Cannon @ atria contract agasint closed vent eg at 3rd HB/arrhythmias C - tricuspid close V - passive filling of blood at diastole @ atrium agasint closed tric valve Giant at tric regurg X descent - Decr atrial pressure @ vent contraction Y descent - opening of tric valve

WPW A - which sided pathway ->?AD = dom R wave @ which lead?? B - which sided pathway ->?AD = dom R wave @ which lead?? Assoc:? Tx:? Avoid sotalol when? Why?

WPW A - left sided RAD = dom R wave @ V1 B - right sided LAD = no dom R wave @ V1 Assoc: MESH MVP, Ebstein anomaly, Secundum ASD, HOCM/HyperT Tx: radioFreq ablation of acc pathway FAPS Avoid sotalol @AF cos it prolongs refractory period @AVN -> inc rate of transmission through acc pathway -> Inc vent rate = VF

Most common cardiac tumour? Attached to what? Standard cancer symptoms, clubbing SOB In AF. echo shows?

Atrial myxoma Fossa ovalis Echo shows pedunculated mass.

``` For bioprosthetic valve: Inc risk of?? >age? get aortic one >age? get mitral one AC needed? give what antithrombotic Tx? ``` For mechanical valve: Inc risk of?? AC needed? And what else if IHD??

``` For bioprosthetic valve: Inc risk of calcification >65 get aortic one >70 get mitral one Long term AC not needed, give aspirin ``` For mechanical valve: Inc risk of thrombosis Give warfarin + aspirin if IHD.

Pts on warfarin who need emergency surgery: Can wait 6-8hrs = give?? Cant wait - PTC 25-50 units

Pts on warfarin who need emergency surgery: Can wait 6-8hrs = give 5mg Vit K Cant wait - PTC 25-50 units

Tropomyosin associates with actin in muscle fibres -> regulates muscle contraction by regulating the binding of myosin In MI: ?? is the first to rise. Mctal??

Tropomyosin is a protein which regulates actin. It associates with actin in muscle fibres and regulates muscle contraction by regulating the binding of myosin Myglobin 2hrs, CK MB 4hrs, Trop 6hrs, AST 1day, LDH 2 days

What investigation is most useful in predicting symptomatic response to cardiac resynchronisation therapy?

TTE and ECG

What meds exacerbate CCF? - CASP

Neg inotrope: CCB - verapamil Antiarryhtmic - flecainide Fluid retention: Steds/NSAIDs Pioglit

Explain RAAS and ANP/BNP

ANP/BNP regulates the dangerous effects of RAAS activation in heart failure. Pump fail -> reduced flow/Na -> RAAS -> Na + H2O retention and v.constriction -> Sympathetic nervous system and the action of ADH -> incr vent pre+afterload & incr wall stress -> incr ANP+BNP -> natriuresis + v.dilation + stop RAAS Atrial stretch = incr ANP = similar to BNP

Right side of heart sats =?% | Left side of heart sats = ?%

Right side of heart sats = 70% Left side of heart sats = 100% ASD RA RV PA LA LV Ao 85 85 85 100 100 100 ASD w/ Eisenmenger RA RV PA LA LV Ao 70 70 70 85 85 85 VSD RA RV PA LA LV Ao 70 85 85 100 100 100 VSD w/ Eisenmenger RA RV PA LA LV Ao 70 70 70 100 85 85 PDA RA RV PA LA LV Ao 70 70 85 100 100 100 PDA w/ Eisenmenger RA RV PA LA LV Ao 70 70 70 100 100 85

Aspirin Antiplatelet - inhibits the production of?? Clopidogrel Antiplatelet - inhibits ?? binding to?? Enoxaparin/Fonda Activates ?? -> potentiates the inhibition of ?? Bivalirudin Reversible ?? inhibitor Abciximab, eptifibatide, tirofiban ???

TxA2, ADP plt receptor, aAT3 stop f10a, DTi, gp2b3a blocker Aspirin Antiplatelet - inhibits the production of thromboxane A2 Clopidogrel Antiplatelet - inhibits ADP binding to its platelet receptor Enox/fonda Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa Bivalirudin Reversible direct thrombin inhibitor Abciximab, eptifibatide, tirofiban Glycoprotein IIb/IIIa receptor antagonists

exertional dyspnoea is classic exertional syncope, exertional chest pain, peripheral oedema and cyanosis raised JVP with prominent 'a' waves right ventricular heave, loud P2, tricuspid regurgitation mean pulmonary artery pressure of >=?? mHg Ix?? To measure what?? 1. Tx underlying condition eg chronic lung dx copd 2. Do what test? Aim? What to administer? Positive: give what?? Neg: give what?? progressive symptoms should be considered for a??

mean pulmonary artery pressure of >= 25 mHg Ix: cardiac catheterization to measure right heart pressures 1. Tx underlying condition eg chronic lung dx copd 2. Acute vasodilator testing aims to decide which pts have fall in PAP after vasodilators eg. IV epoprostenol/inhaled NO Positive: oral CCB Neg: Prosta-ilopr, Endo-bosentan, PDEi-sildenafil Prostacyclins: treprostinil, iloprost Endothelin receptor blockers: bosentan, ambrisentan - decrease pulmonary vascular resistance in PPHtn Phosphodiesterase inhibitors: sildenafil progressive symptoms should be considered for a heart-lung transplant.

HTN > 200/130 Headaches, n+v, visual dx, papilledema, Encephalopathy/seizures

Reduce diastolic < 100 within 12hrs Atenolol PO Nitroprusside/Labetalol IV