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MOHDIII - Unit 2 > Cardiomyopathies & Heart Failure > Flashcards

Cardiomyopathies & Heart Failure Flashcards

1
Q

Primary cardiomyopathy

A
  • disorder of heart muscle
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2
Q

Secondary cardiomyopathy

A
  • due to ischemia, HTN, valvular, pericardial disease
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3
Q

Structures leading to cardiomyopathy

A
  • macro: myocardium, pericardium, endocardium, conduction system
  • micro: beta myosin heavy chains, myosin binding proteins, cardiac troponins, tropomyosin
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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)
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5
Q

Pericardial CMP

A
  • VIRAL PERICARDITIS
  • infection
  • autoimmune
  • post MI/cardiac surgery
  • metabolic uremia, drugs, radiation
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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
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7
Q

Conduction system CMP

A
  • tachycardia: A fib, A flutter, SVT, premature ventricular contraction (PVC)
  • left bundle branch block(LBBB)
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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)
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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
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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
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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
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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
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13
Q

Amyloidosis CMP

A
  • amyloid in heart myocardium/valves
  • other organs INVOLVED
  • exam: low BP, JVD, edema, ascites, pleural effusions, hepatomegaly
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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
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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
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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
Q

Arrhythmogenic right ventricular cardiomyopathy (ARVC)

A
  • fibro fatty infiltration of the RV myocardium
  • ventricular arrythmias
  • sudden cardiac death common
  • ECG: incomplete RBBB, epsilon wave
  • isoproterenol: provocative test for VT
26
Q

Stress-Induced CM

A
  • 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
Q

CM with best prognosis

A

peripartum CM

28
Q

CMP vs HF

A
  • need cardiac imaging to diagnose CMP

- HF is clinical diagnosis: NO need for any test to diagnose but testing is needed for etiology

29
Q

Most common CM

A

diastolic CM

30
Q

Dilated CM microscopic features: primary vs. secondary

A
  • primary: hypertrophy, fibrosis

- secondary: myocarditis, hemochromatosis

31
Q

Pathology of HOCM

A
  • subaortic fibrosis

- mirror image of anterior MV leaflet

32
Q

Amyloid restrictive CM pathology

A
  • frim & waxy
  • thick ventricles
  • atria: normal or dilated, endocardial deposits
33
Q

Arrhythmogenic RV CM

A
  • fat deposition on anterior RV
34
Q

Primary restrictive CM pathology

A
  • gross: ATRIA DILATED

- microscopic: interstitial fibrosis, myocyte hypertrophy

35
Q

Cardiomyopathy: definition

A
  • disease of myocardium, usually leading to HF
  • contractility: pumping function
  • relaxation: filling

MOHDIII - Unit 2 (23 decks)

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