Cardiomyopathies Flashcards
What is cardiomyopathy?
This is disease of the cardiac muscle tissue that leads to heart failure
What is cardiomyopathy?
This is disease of the cardiac muscle tissue that leads to heart failure
What are the different types of cardiomyopthy?
- Dilated cardiomopathy
- Restrictive cardiomyopathy
- Hypertrophic cardiomyopathy
- Arrythmogenic right ventricular cardiomyopathy
What is the causes of dilated cardiomyopathy?
- Idiopathic
- Genetic-hemochromatosis
- Secondary
- coronary heart disease
- arterial hypertension
- peripartum cardiomyopathy
- infection: Chaga’s disease, Rheumatic heart disease, HIV, Coxsackie B virus
- SLE: sarcoidosis
- Toxic substnaces: alcohol use,cocaine
- malnutrition: wet beriberi
- valvular heart disease
- endocrinopatholohies: acromegaly, hyperthyroidism
What is the ABCCCDD menumonic for dilated cardiomyopathy?
- alcohol use
- beriberi
- chagas
- coxsackie b virus
- cocaine
- Doxorubicin(chemotherapy drugs)
What is are the symptoms of patients with dilated cardiomyopathy?
- Exertional dyspnea
- Ankle oedema
- Ascites
- Angina pectoris
What is the causes of dilated cardiomyopathy?
- Idiopathic
2. Secondary
What special investigations would you do for this patient?
- Bloods: brain natriuretic peptide which increases in heart failure due to stretching of ventricles
- ECG-atrial/ventricular dilation
- Chest Xray: left sided hypertrophy with balloon appearance and pulmonary edema
What will you find on physical examination of this patient?
- Mitral regurgitation or tricuspid regurgitation
- S3 gallop
- Raised JVP
- Peripheral oedema
- Rales over the lungs
- Displaced apex beat
How do we treat patients with dilated cardiomyopathy?
- lifestyle changes: stop drinking and smoking, avoid cardiotoxic agents
- Avoid sodium by reducing salt intake
- ACE Inhibitors, beta blockers, aldosterone receptor antagonists
- Anticoagulants like warfarin in the case of intraventricular thrombus or arial fibrilation
- If medical treatment fails consider heart transplant
What is the pathophysioloy of dilated cardioyopahy?
Basically it is biventricular heart failure because the sarcomeres increase in series(eccentric hypertrophy) and causes thinning of the myocardium but the ventricle will be dilated leading to decreased stroke volume to the body and the lungs causing signs of heart failure
What is the pathophysioloy of dilated cardioyopahy?
Basically it is biventricular heart failure because the sarcomeres increase in series and causes thinning of the myocradium but the ventricle will be dilated leading to decreased stroke volume to the body and the lungs causing signs of heart failure
What is restrictive cardiomyopathy?
This is when the ventricles are restricted and do not pump the blood out to the body easily
- decreased elasticity of the myocardium
- decreased ventricular compliance
What is restrictive cardiomyopathy?
This is when the ventricles are restricted and do not pump the blood out to the body eaily
What are the clinical features of restrictive cardiomyopathy?
- Jugular venous distension
- hepatomegaly
- ascites
- peripheral edema
What special investiation s do you do in restrictive cardiomyopathy?
- Echocardiography
- signs of diastolic function - ECG
- low voltage
- left bundle branch block and other conduction disorders - Chest Xray
- hilar lymphadenopathy in sarcoidosis - Cardiac catherterisation
- endo or myocardium biopsy
- shows fibrosis
What is the treatment of cardiomyopathy?
- Often palliative
- diuretics
- Treat underlying cause
- Calcium channel blockers
What is hypertrophic cardiomyopathy?
- Left ventricular hypertrophy and left ventricular outflow obstruction due to asymmetrical septal hypertrophy
What is the frank starling?
the increase in end diastolic volume(preload) leads to and increase in stroke volume which leads to reduced cardiac output
What are the causes of hypertrophic cardiomyopathy?
- Genetic:
- autosomal dominant inheritance
- mutations of the sarcomeric protein genes - Secondary
- chronic hypertension
- aortic stenosis
- amyloidosis
What is the most common cause of sudden death in young people?
hypertrophic cardiomyopathy
-it is the second most common type of cardiomyopathy
What is the pathophysiology of HCM?
-It generally occurs with left ventricular hypertrophy with asymmetical septal involvement which causes decreased diastolic filling, decreased stroke volume and cardiac output and eventual heart failure
What is the symptomatic features of hypertrophic cardiomyopathy?
- frequently asymptomatic
- Exertional dyspnea
- Palpitations, cardiac arrythmias
- Dizziness, syncope
What are the physical examination findings you would find in a patient with HCM?
- systolic ejection murmur (creshendo-decreshendo)
- which increases with he Vasalva maneovre, or with standing
- decreases with hand grip, squatting - Possible holosystolic murmur from mitral regurgitation
- S4 gallop
- Pardoxical split of S2
How do we diagnose HCM?
- Transthoracic echocardiogram with doppler
- ECG
- Deep Q waves
- ECG signs of LVH - Chest X-RAY
enlarged left atrium only occurs in mitral regurgitation
What are the treatment options for HCM?
- Lifestyle: avoid strenuous exercise
- Automated implantable cardioverter defribrillator
- Pharmacological: beta-blockers
- surgical septal myomectomy
