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Clin Med Exam 1(Lauren) > Cardiomyopathies > Flashcards

Cardiomyopathies Flashcards

1
Q

Is an S3 gallop associated with systolic dysfunction or diastolic?

A

Systolic

Sys-tol-ic has 3 syllables = S3

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2
Q

Is an S4 gallop associated with a systolic or diastolic dysfunction?

A

Diastolic

Di-as-tol-ic has 4 syllables =S4

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3
Q

What is cardiomyopathy?

A

Your heart is fucked up NOT because of CAD, HTN, valve disease, or congenital heart disease

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4
Q

What is the leading cause of cardiac transplant?

A

Dilated cardiomyopathy

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5
Q

What is the #1 cause of sudden death in competitive athletes 35 and younger?

A

Hypertrophic cardiomyopathy

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6
Q

What are the 3 main types of cardoimyopathy?

A

Dilated

Hypertrophic

Restrictive

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7
Q

What is the most common cardoimyopathy?

A

Dilated

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8
Q

Once someone is having symptoms of dilated CM, do they have a good prognosis?

A

No, 50% will die within 5 years…..need a transplant

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9
Q

What happens with dilated CM?

A

Symmetric (stretches equally in every direction) LV dilation

Causes LV systolic dysfunction

Mayyyyy involve the RV

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10
Q

What kind of symptoms will someone with Dilated CM have?

A

Sx that are very similar to CHF!!!

Exertional intolerance with SOB and fatigue**

Crackles, JVP

Edema, ascites

Mitral/tricuspid regurgitation murmur

Arrhythmias

Systemic emboli

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11
Q

What is the most common etiology of dilated CM?

A

Idiopathic!

Other casues:
Familial

Infectious

Peripartum

Alcoholism

Cocaine or chemo

Tachycardia

Endocrine dysfunction

Nutritional deficiencies

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12
Q

If someone with dilated CM finds out that 2 of their relatives also had it, do they still have idiopathic dilated CM?

A

No, it is familial

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13
Q

What is the most common cause of infectious~ dilated CM in America?

What about in Latin America?

A

US- viral (influenza, herpes, parvo, CMV etc)

Latin America- Chagas’ disease (parasitic)

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14
Q

What is the gold standard for diagnosing infectious dilated CM?

A

Endomyocardial biospy

Very invasive, not always done

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15
Q

What kinds of risk factors may increase a woman’s risk of developing dilated CM?

A

Over 30

African American

Multiparous

Maternal cocaine abuse

4 wks+ of oral tocolytic (stops contractions)

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16
Q

What labs do you need to order if you suspect a woman has peripartum dilated CM?

A

BNP- will be increased (stretching…)

Echo- EF will be less than 45%

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17
Q

When will a pregnant woman develop peripartum dilated CM?

A

36wks pregnant to 1 month after delivery

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18
Q

How do you treat someone with alcoholic dilated CM?

A

They NEED to stop drinking. Big improvement

Give them the standard meds for CHF (loop diuretics, ACE/ARB, maybe Bblocker, maybe digoxin)

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19
Q

If someone with alcoholic dilated CM keeps drinking, what will happen?

A

50% die in 3-6 years

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20
Q

What do you think caused dilated CM in a young otherwise healthy person?

A

Cocaine

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21
Q

If someone has cocaine-related dilated CM, will it get better if they stop tooting the devils dandruff?

A

Yes may reverse it

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22
Q

Which chemo drug may induce dilated CM?

A

Adriamycin (Doxarubicin)

Severity depends on the dose

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23
Q

What is the most important part of diagnosing dilated CM?

A

A thorough H and P!

This was red, underlined, and had an exclamation point

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24
Q

Will ECG, CXR, or Labs show you specific changes to definitively diagnose Dilated cardiomyopathy?

A

No, all nonspecific changes

ECHO is the best test

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25
Q

What is the best test for diagnosing Dilated CM?

A

Echo

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26
Q

What wil you see on an echo of dilated cardoimyopathy?

A

Dilated ventricle(s)

Reduced LV systolic function

Decreased EF

(Will also help you rule out valve disease)

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27
Q

What is the first line medication for dilated cardiomyopathy?

A

ACE inhibitors ** was in red with stars

Reduces afterload

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28
Q

What mediations other than ACEs will help dilated cardiomyopathy?

A

Diuretics- reduce preload

B-Blockers- decrease O2 demand

Digoxin- increases contractility VERY helpful

Antiarrythmics- amiodarone if they have afib

Anticoagulants- if they have afib, other thrombi

29
Q

What is the definitive treatment for idiopathic dilated CM?

A

Heart transplant

30
Q

In general, how do you treat dilated cardiomyopathy?

A

Remove the offending agent that caused it (impossible in idiopathic so thats why they get transplants)

31
Q

What is the etiology of hypertrophic CM?

A

Familial

32
Q

What is the difference between non-obstructive HCM and obstructive HCM?

A

Non-obstructive- no blockage of aortic valve outlet

Obstructive-aortic outflow is obstructed

33
Q

What factors will worsen obstructive hypertrophic CM?

A

Tachycardia (athletes..)

Hypovolemia (dehydration)

Standing

Valsalva

Inotropes (things that make muscle contract harder)

Diuretics

Vasodilators

34
Q

What is the MAIN complaint of patients who present with symptoms of hypertrophic CM?

A

Dyspnea on exertion!!!*!! Over 90% have this

35
Q

In addition to dyspnea on exertion, what other complaints will patients with hypertrophic CM have?

A

Exertional angina

Fatigue

Fainting

Palpitations

36
Q

What kind of murmur will patients with hypertrophic CM have?

A

Harsh crescendo-decrescendo

Plus an audible S4 due to the atria contracting against a noncompliant ventricle

37
Q

What happens to the murmur of hypertrophic CM with valsalva and standing?

A

INCREASES

You are decreasing LV cavity size by reducing the amount of blood that goes in it, so you’re making it even worse

38
Q

What happens to the hypertrophic CM murmur with squatting and isometric handgrip?

A

DECREASES

You are increasing the LV cavity size by filling it with more blood, so the murmur gets better

39
Q

What is the best test to do to diagnose hypertrophic cardiomyopathy?

A

Echo

40
Q

What will you see on ECG of someone with hypertrophic CM?

A

LVH with strain

Supraventricular/ventricular arrhythmias

41
Q

What will you see on Echo of someone with hypertrophic CM?

A

Increased LV wall thickness (15mm+ is diagnostic)

+/- systolic anterior motion of mitral valve

Asymmetric septal hypertrophy

42
Q

Should you do an exercise stress test for young people who want to do sports?

A

Yes

43
Q

If you’re doing a sports physical for a teenager, and you hear a murmur, what should you do?

A

Take it very seriously and ask about family history, do a stress test, echo etc …

44
Q

Do patients with hypertrophic CM need to restrict their physical activity?

A

Yes. They need to avoid most competitive sports and high intensity noncompetitive sports.

Biking, swimming, doubles tennis, golf, and skating are probably OK

45
Q

What drugs should your patient with hypertrophic CM be on?

A

B-blockers **

Non-dihydropyridine CCB if the B blocker is not working (verapamil, diltiazem)

Antiarryhtimics if they have arrhythmia

46
Q

Would an ICD implantation be good for patients with hypertrophic CM?

A

Yes if they have high risk for sudden cardiac death or sustained ventricular arrhythmias

47
Q

Can you do surgery for hypertrophic cardiomyopathy?

A

Yes you can go in and scoop out the overgrown wall and maybe replace the mitral valve

48
Q

What happens with restrictive cardiomyopathy?

A

The ventricles are super rigid, which impairs filling

The atria enlarge

49
Q

Is systolic function preserved with restrictive cardiomyopathy?

A

Yes

50
Q

What is the least common cardiomyopathy?

A

Restrictive

51
Q

What is the most common cause of restrictive cardiomyopathy?

A

Amyloidosis-abnormal protein developing in the heart muscle

52
Q

What kinds of symptoms will somone with restrictive CM have?

A

Right heart symptoms most common:

Edema

Ascites

JVP

+/- Kussmaul’s sign (increased JVP with inspiration)

53
Q

What is Kussmaul’s sign and what type of cardiomyopathy may it be seen in?

A

Increased JVP on inspiration

May be seen with restrictive cardoimyopathy

54
Q

What is the pathognomic finding of cardiac amyloidosis?

A

Periorbital purpura with heart failure

55
Q

What will you see on echo of someone with restrictive cardiomyopathy?

A

Increased ventricular thickness

Bi-atrial enlargement

abnormal filling

56
Q

Does cardiac MRI help you diagnose restrictive cardiomyopathy?

A

Yes, will show you chamber size, wall thickness, fibrosis, inflammation

57
Q

What is the mainstay of treatment for restrictive cardiomyopathy?

A

Low dose loop diuretics (reduces fluid accumulations….remember they have ascites, edema, etc)

58
Q

What drugs other than loop diuretics should your restrictive cardiomyopathy pt be on?

A

Calcium channel blockers UNLESS they have amyloidosis (their myocytes work fine, they have amyloid proteins in them)

Anticoagulants

59
Q

What are the other names for Takotsubo Cardiomyopathy?

A

Stress cardiomyopathy

Apical ballooning syndrome

Broken heart syndrome

60
Q

What is stress cardiomyopathy/takotsubo?

A

Transieent LV systolic and diastolic dysfunction that is preceded by an emotional trigger.

61
Q

Who usually gets stress cardiomyopathy?

A

Postmenopausal women

62
Q

Does stress cardiomyopathy come on gradually or suddenly?

A

SUDDENLY

63
Q

What condition can stress cardiomyopathy mimic?

A

MI@

They will have substerbal chest ain, dyspnea, syncope, Levine’s sign, and symptoms of heart failure

64
Q

Will troponins be elevated in stress cardiomyopathy?

A

Yes

65
Q

What will you see on an ECG of someone with stress CM?

A

ST elevation

Deep anterior T-wave inversions

(This seriously looks like an MI)

66
Q

What will you see on echo of someone with stress cm?

A

Decreased EF

Possible LV outflow tract obstruction

67
Q

How fo you manage stress CM right there in the ER?

A

Do whatever you’d do with any acute MI. Including sendin them to cath lab.

68
Q

How do you manage long-term stress cardiomyopathy?

A

Resolve trigger

ASA, Bblocker, and ACE until LV recovers

If they have a thrombus, do warfarin for a 3 MONTH MINIMUM

69
Q

Is stress cardiomyopathy something they will deal with forever?

A

NO, most recover systolic function within 4 weeks

This is a transient issue

Clin Med Exam 1(Lauren) (8 decks)

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