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ICC1 > cardiomyopathies and myocarditis > Flashcards

cardiomyopathies and myocarditis Flashcards

1
Q

what is the most common cardiomyopathy ?

A

dilated congestive cardiomyopathy (DCM)

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2
Q

what is the pathology in dilated cardiomyopathy ?

A

progressive dilatation of all chambers , a big heart with very big chambers

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3
Q

what type of dysfunction is associated with dilated cardiomyopathy ?

A

systolic dysfunction

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4
Q

what are the causes of dilated cardiomyopathy ?

A

non genetic
genetic
idiopathic

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5
Q

what are the causes of DCM?

A

a bunch of stuff can cause cardiac dilatation

Alcohol abuse
Beriberi
Coxsackie
Cocaine
Chagas disease
Doxorubicin
peripartum cardiomyopathy
takutsobo cardiomyopathy
tachycardia cardiomyopathy

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6
Q

what are the genetic causes of DCM ?

A

Duchenne and Becker muscular atrophy

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7
Q

what are the treatments of DCM ?

A

conventional management of heart failure with thee option of cardiac resynchronization therapy and ICDs for patients with a score 3 in thee NYHA

cardiac transplantation

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8
Q

what is the pathology in hypertrophic cardiomyopathy ?

A

-massive myocardial hypertrophy without ventricular dilatation ( asymmetrical hypertrophy of the interventricular septum )

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9
Q

what is the echo finidings in hypertrophic cardiomyopathy ?

A

banana like ventricular cavity

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10
Q

what type of dysfunction is associated with HCM?

A

diastolic dysfunction

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11
Q

what is the gross picture of HCM ?

A

asymmetrical septal hypertrophy

asymmetrical left ventricular hypertrophy

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12
Q

what are the causes of HCM ?

A

distinct genetic disorder, where there is a defect in one of the genes encoding cardiac contractile proteins
is also a storage disease found in babies to diabetic mothers

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13
Q

what are the genes affected in HCM?

A

heavy chain myosin

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14
Q

what are the effects of HCM

A

commonest cause of sudden cardiac death in young during vigorous exercise
syncopal attacks on exercise

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15
Q

what is the treatment for HCM?

A

according to risk stratification
ICD insertion for patients with high risk of sudden death
risk is lower ? amiodarone

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16
Q

what is the most common cause of sudden death in adolescent during vigorous exercise ?

A

hypertrophic cardiomyopathy

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17
Q

what is the pathology in restrictive cardiomyopathy ?

A

infiltration of the myocardium resulting in a firm myocardium and eventually failure of relaxation

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18
Q

what are the causes of restrictive cardiomyopathy ?

A

RASH
radiation fibrosis
amyloidosis
sarcoidosis
hemochromatosis

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19
Q

what is amyloidosis ?

A

extracellular deposition of amyloid substance mainly of walls of blood vessels

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20
Q

what stain can be used with amyloid ?

A

congo red stain

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21
Q

what is seen on clinical examination with restrictive cardiomyopathy ?

A

1- elevated JVP with diastolic collapse - friedreich’s sign
2- elevation of venous pressure with inspiration (Kussmmaul’s sign )

right ventricular hypertrophy

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22
Q

what is the treatment of restrictive cardiomyopathy ?

A

medical
prevention of progression
cardiac transplantation

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23
Q

what is myocarditis ?

A

primary inflammation of the myocardium

24
Q

what are the causes of myocarditis ?

A

may be :
infectious causes
non-infectious causes
unknown

25
Q

what are the infectious causes of myocarditis ?

A 
cardioselective viruses (adenovirus)
non-selective viruses 
non-viral causes
26
Q

what are the non-infectious causes of myocarditis ?

A

immune reaction
post-viral
rheumatic heart disease
SLE

27
Q

what are the effects of myocarditis ?

A

-wide spectrum from totally asymptomatic to acute heart failure to sudden cardiac death via arrhythmia

28
Q

what is the treatment of myocarditis ?

A
  • supportive therapy

- appropriate antimicrobials

29
Q

how to differentiate between cardiomyopathies and other cardiac problems ?

A

myocardial disease due to intrinsic defect if it is due to HTN, coronary artery disease or valvular heart disease or inflammation its not cardiomyopathy

30
Q

what are the signs in HCM ?

A

double apical pulsation
jerky carotid pulse
ejection systolic murmur
pansystolic murmur

31
Q

what are the signs seen in HCM ?

A

jerky carotid pulse
double apical pulsation

32
Q

what are the manoeuvres that decrease afterload ?

A

standing
valsalva

33
Q

what manoeuvres increase afterload ?

A

squatting

34
Q

what type of murmur is associated with left ventricular outflow obstruction ?

A

ejection systolic murmur

35
Q

what are the common causes of LV outflow obstruction ?

A

aortic stenosis
HCM

36
Q

what happens as a result of the systolic anterior motion which happens in HCM ?

A

mitral regurg - pansystolic murmur

37
Q

s4 cannot coexist with what heart condition ?

A

atrial fibrillation

38
Q

when is s4 heard ?

A

with LV hypertrophy

39
Q

what investigation can be used to differentiate between HCM and infiltrative cardiomyopathies ?

A

CMR

40
Q

in patients with HCM who have significant left ventricular outflow obstruction , what is the management ?

A

dual-chamber pacing
plus disopyramide

41
Q

what class of drugs should be avoided in HCM ?

A

vasodilators

42
Q

what waves are specifically seen in arrhythmogenic right ventricular cardiomyopathy ?

A

epsilon waves

43
Q

what is the first line treatment for patients with non life threatening arrhythmias ?

A

beta blockers

44
Q

management for refractory or life threatening arrhythmia ?

A

ICD

45
Q

diagnostic testing for arrhythmogenic right ventricular cardiomyopathy ?

A

genetic testing

46
Q

what is the presentation of takotsubo CM ?

A

middle aged woman
history of stressful event
apical ballooning

47
Q

what are the features of peripartum cardiomyopathy ?

A

affects women in the llast trimesster
or within 5 mmonths of preegnancy

48
Q

what condition is peripartum cardiomyopathy associated with ?

A

preeclampsia

49
Q

what is the prognosis of peripartum CMM ?

A

half of the patients will recover to normal function within 6 months
other half may develop heart failure and sudden death

50
Q

what is the cause of tachycardia cardiomyopathy ?

A

prolonged periods of supraventricular or ventricular tachycardia

51
Q

what is the management for tachycardia cardiomyopathy ?

A

cardioversion and ablation

52
Q

what is characteristic for cardiac amyloidosis ?

A

voltage mass-mismatch
ground glass appearance of the myocardium
macroglossia
bruising around the eye

53
Q

what is the novel therapy for patients with familial amyloidosis ?

A

tafamidis
liver transplantation

54
Q

what is the appearance of left ventricular noncompaction ?

A

congenital cardiomyopathy
sponge like appearance of the left ventricle and excessive trabeculations

55
Q

what is the next diagnostic step for patients with amyloidosis ?

A

TTE

ICC1 (50 decks)

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