Cardiomyopathies & Heart Failure Flashcards
1
Q
Primary cardiomyopathy
A
- disorder of heart muscle
2
Q
Secondary cardiomyopathy
A
- due to ischemia, HTN, valvular, pericardial disease
3
Q
Structures leading to cardiomyopathy
A
- macro: myocardium, pericardium, endocardium, conduction system
- micro: beta myosin heavy chains, myosin binding proteins, cardiac troponins, tropomyosin
4
Q
Myocardium cardiomyopathies (CMP)
A
- coronary artery disease: most common cause of CMP-ischemic CMP
- MI–ischemic CMP, severe CAD w/out MI–ischemic CMP
- myocarditis: viral
- infiltrative: amyloid, sarcoid, hemochromotosis
- toxins: ETOH, drugs or familial (genetic)
5
Q
Pericardial CMP
A
- VIRAL PERICARDITIS
- infection
- autoimmune
- post MI/cardiac surgery
- metabolic uremia, drugs, radiation
6
Q
Endocardial CMP
A
- endocarditis
- valvular disease
- AS, AI, MR: common and affect LV myocardium
- MS: less common effects LA, RV, RA, does not affect LV
- TR: affects RV, RA associated w/ left side valvular lesion & lung HTN
7
Q
Conduction system CMP
A
- tachycardia: A fib, A flutter, SVT, premature ventricular contraction (PVC)
- left bundle branch block(LBBB)
8
Q
Toxin induce CMP
A
- alcohol (>7 drinks/day for 5 years)
- cocaine: direct myocardial damage, accelerated CAD/MI
- radiation: accelerated CAD, valvular disease, constriction
- chemotherapeutic agents: anthracyclines (doxorubicin, daunorubicin)
9
Q
Peripartum CMP
A
- 1 month before to 6 months after delivery
- etiology: multifactorial; immune, inflammation, cytokines, myocarditis
- risk factors: pre/eclampsia, HTN, age>30
- prognosis: better than most, most partial recovery by 6 months
- avoid future pregnancy if no recovery
10
Q
Tachycardia CMP mechanism
A
- chronic tachycardia leads to LV dilation
- changes in myocardium may develop as early as 24 hrs
- may present w/ or w/out causative tachycardia
- reversible in most cases but may not be complete
11
Q
Constrictive CMP
A
- PERICARDIAL disease
- constrictive pericarditis: TB
- filling is affected: for of diastolic HF, diastolic function is normal
- diagnosis: imaging-CT, echo (pericardial disease), hemodynamics-ventricular discordance
12
Q
Restrictive CMP
A
- MYOCARDIAL disease, INFILTRATIVE disease
- filling is affected: diastolic HF, diastolic function is ABNORMAL
- diagnosis: imaging-TTE, CMR (disease of myocardium), hemodynamics-ventricular CONCORDANCE
13
Q
Amyloidosis CMP
A
- amyloid in heart myocardium/valves
- other organs INVOLVED
- exam: low BP, JVD, edema, ascites, pleural effusions, hepatomegaly
14
Q
Amyloidosis diagnosis
A
- ECG: low voltage, bradycardia, conduction abnormalities
- **Afib w/ slow ventricular rate & low voltage**
- echo: LVH w/out history of HTN
- labs: SPEP, UPEP
15
Q
Amyloid Types: AL
A
- AL: immunoglobulin light chains
- source: BONE MARROW - heart commonly involved
- rapidly progressive, worst prognosis
- treatment: chemo, heart transplant, BM transplant
16
Q
Amyloid Types: ATTR
A
- ATTR: familial autosomal dominant - mutant transthyretin
- source: LIVER
- no available chemo
- cardiac transplant, followed by liver transplant
17
Q
Amyloid Types: Senile
A
- wild type transthyretin, slow progression, elderly
18
Q
Amyloid Types: AA
A
- amyloid A, chronic inflammatory disorders
19
Q
Iron overload CMP
A
- can be primary or secondary
- hereditary hemochromatosis: autosomal recessive, deposition of iron in heart, joints, liver
- ferritin often >10,000 & iron/TIBC> 50%
- gold standard diagnosis w/ LIVE BIOPSY, CMR or EMB
- treatment: phlebotomy or chelation therapy
20
Q
Hypertrophic CMP
A
- most often genetic disorder
- ICD to prevent sudden death
- can be obstructive or non obstructive
21
Q
Hypertrophic CMP: obstructive & non-obstructive
A
- diastolic dysfunction
- myocardial ischemia
- arrythmias
- PH & RV failure
22
Q
Hypertrophic CMP: obstructive only
A
- dynamic LV outflow tract obstruction
- mitral regurgitation
23
Q
HCM- non obstructive treatment
A
- beta blocker, CCB
- heart transplant
24
Q
HOCM treatment
A
- avoid dehydration, vasodilators, cardiac stimulants
- beta blocker, CCB, dysopiramide
- myomectomy
- dual chamber pacing
- heart translant
25
Arrhythmogenic right ventricular cardiomyopathy (ARVC)
- fibro fatty infiltration of the RV myocardium
- ventricular arrythmias
- sudden cardiac death common
- ECG: incomplete RBBB, epsilon wave
- isoproterenol: provocative test for VT
26
Stress-Induced CM
- apical ballooning, broken heart, tako tsubo CM
- ECG: anterior MI
- echo: apical akinesis, distribution of wall motion abnormalities
- coronary angiogram: clear coronaries
- WOMEN>>>men: middle aged
27
CM with best prognosis
peripartum CM
28
CMP vs HF
- need cardiac imaging to diagnose CMP
| - HF is clinical diagnosis: NO need for any test to diagnose but testing is needed for etiology
29
Most common CM
diastolic CM
30
Dilated CM microscopic features: primary vs. secondary
- primary: hypertrophy, fibrosis
| - secondary: myocarditis, hemochromatosis
31
Pathology of HOCM
- subaortic fibrosis
| - mirror image of anterior MV leaflet
32
Amyloid restrictive CM pathology
- frim & waxy
- thick ventricles
- atria: normal or dilated, endocardial deposits
33
Arrhythmogenic RV CM
- fat deposition on anterior RV
34
Primary restrictive CM pathology
- gross: ATRIA DILATED
| - microscopic: interstitial fibrosis, myocyte hypertrophy
35
Cardiomyopathy: definition
- disease of myocardium, usually leading to HF
- contractility: pumping function
- relaxation: filling
