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Clinical Medicine > Cardiomyopathies > Flashcards

Cardiomyopathies Flashcards

1
Q

What is Cardiomyopathies (CMPs)?

A
  • Diseases of the heart muscle
  • Manifest with various structural and functional abnormalities
  • Frequently genetic
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2
Q

Types of Cardiomyopathy?

A
  1. Dilated cardiomyopathy (DCM)
  2. Restrictive cardiomyopathy (RCM)
  3. Hypertrophic cardiomyopathy (HCM)
  4. Hypertrophic obstructive cardiomyopathy (HOCM)
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3
Q

What is Dilated cardiomyopathy (DCM)?

A

-Dilatation and impaired contraction of one or both ventricles
-Impaired systolic function
(Ejection Fraction (EF) <40%)
-Often develop heart failure
-Possibly conduction abnormalities, arrhythmias
-Prevalence 36 per 100,000

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4
Q

Causes of Dilated cardiomyopathy?

A
  1. Idiopathic (most common – often familial/gene mutations)
  2. Infections (i.e. viral myocarditis, Chagas disease)
  3. Toxins (drugs, meds, alcohol)
  4. Tachycardia induced CMP
  5. Stress (takotsubo) – sometimes considered “unclassified”
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5
Q

Factors of Infectious cardiomyopathy?

A
  • Begins as infectious myocarditis, nflammation of the myocardium secondary to infection
  • Viral – most common
  • Bacterial (Lyme, Mycoplasma)
  • Protozoan (Chagas Disease)
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6
Q

Clinical Manifestations of Dilated Cardiomyopathy that end up being infectious myocarditis?

A
  • Fever, myalgias, muscle tenderness
  • Heart palpitations/Arrhythmias
  • Heart block
  • Chest pain
  • Pre-syncope, syncope
  • Heart failure
  • Clinical syndrome ranges from subclinical to fulminan
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7
Q

What is Chagas disease?

A
  • Protozoan infection (Trypanosoma cruzi)
  • Leading cause of DCM in Central and S. America.
  • Acute myocarditis
  • Cardiac enlargement
  • Nonspecific EKG abnormalities
  • Left ventricular apical aneurysms
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8
Q

Clinical manifestation of Chagas disease?

A

-Heart failure
-Arrhythmias & heart blocks (all types)
-Thromboembolism (right or left ventricular mural thrombi)
(Pulmonary Embolism,
Cerebrovascular accident) (CVA) = stroke
-Chest pain

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9
Q

Diagnosis of Chagas Disease?

A
  • Serologic test that detects IgG antibiodies to T. cruzi
  • CXR with cardiomegaly
  • EKG with RBBB or LBBB and ST-T changes (non-specific)
  • Echocardiography – cardiac structure and function abnormalities
  • Cardiac MRI – detects myocardial fibrosis
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10
Q

Treatment of Chagas Disease?

A
  • Antitrypanosomal drugs for acute disease & indeterminate disease (not useful in chronic condition)
  • Standard treatment of heart failure
  • Implantable cardiac pacer +/- defibrillator
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11
Q

Toxic Cardiomyopathy causes?

A

Alcohol (*most common toxic CMP)
Cocaine
Medications

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12
Q

What is Alcohol induced cardiomyopathy?

A
  • Correlated to amount and duration of daily drinking

- Abstinence can lead to improved cardiac function if diagnosed early

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13
Q

Whats Tachycardia induced cardiomyopathy?

A
  • Afib with RVR
  • AVNRT
  • Preexcitation syndromes
  • Mechanism unclear
  • Reduced myocardial contractility
  • Abnormalities in myocardial architecture
  • Decrease in calcium responsiveness
  • Treatment of arrhythmia results in reversal of myocardial dysfunction
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14
Q

Stress-induced cardiomyopathy (takotsubo)?

A
  • Precipitated by intense psychological stress induced (i.e. death of loved one) “broken heart syndrome.”
  • Post-menopausal women
  • Left ventricular apical ballooning
  • ST elevation without CAD
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15
Q

Restrictive Cardiomyopathy?

A
  • Non-dilated ventricles with impaired ventricular filling
  • Hypertrophy is typically absent (normal wall thickness)
  • Rigid ventricular walls resulting in diastolic dysfunction
  • Systolic function usually remains normal
  • Biatrial enlargement
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16
Q

Causes of Restrictive Cardiomyopathy?

A
  • Familial
  • Infiltrative (amyloidosis, sarcoidosis)
  • Storage diseases (rare inherited disorders)
  • Scleroderma
  • Endomyocardial fibrosis
17
Q

Hypertrophic cardiomyopathy (HCM)?

A
  • Genetically determined heart muscle disease
  • Interventricular septum typically more prominently involved than the LV free wall
  • LV volume is normal or reduced, diastolic dysfunction is usually present
18
Q

Hypertrophic obstructive cardiomyopathy (HOCM)

A
  • Hypertrophy of the ventricular septum
  • Significant left ventricular outflow tract (LVOT) obstruction
  • Teenagers and young adults who collapse and lose consciousness during exercise
  • Can cause sudden death (most common cause of sudden death in young people)
  • Harsh crescendo-decrescendo systolic murmur
19
Q

Common symptoms of Hypertrophic obstructive cardiomyopathy (HOCM)?

A

fatigue, dyspnea, chest pain, palpitations, presyncope or syncope

20
Q

Manifestations of HCM?

A
  • LV outflow obstruction (HOCM)
  • Diastolic dysfunction
  • Myocardial ischemia
  • Mitral regurgitation
  • Systolic dysfunction (end-stage)
  • Heart failure
  • Supraventricular and ventricular arrhythmias
  • Sudden death
21
Q

Management of Hypertrophic Cardiomyopathy?

A
  • Stay hydrated
  • Restrict intense physical exertion
  • Medical therapy to treat chest pain and dyspnea
  • Medical therapy to treat arrhythmias
  • Invasive procedures to improve LV outflow tract (alcohol septal ablation or septal myectomy)
22
Q

Arrhythmogenic right ventricular cardiomyopathy (ARVC)?

A
  • Myocardium of right ventricle is replaced by fibrous and/or fibro-fatty tissue
  • Genetically determined
  • Ventricular arrhythmias (V-tach)
  • Right ventricular function is abnormal with regional akinesis or dyskinesis
  • Global right ventricular dilation and dysfunction in severe cases
  • Sudden cardiac death in young adults
23
Q

Symptoms of ARVC?

A
  • May be silent
  • Palpitations
  • Syncope
  • Atypical chest pain
  • Dyspnea
24
Q

Diagnosing for ARVC?

A
  • Echocardiogram
  • Cardiac MRI
  • Genetic testing
  • Endomyocardial biopsy
25
Q

Treatment for ARVC?

A
  • Implantable cardiac defibrillator (ICD)
  • Antiarrhythmic drugs if not a candidate for ICD or as adjunct to ICD
  • Patients should not participate in competitive sports
  • Cardiac transplant if progressive and debilitating conditions after optimal use of other treatments

Clinical Medicine (23 decks)

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