Cardiomyopathies & Heart Failure Flashcards
Primary cardiomyopathy
- disorder of heart muscle
Secondary cardiomyopathy
- due to ischemia, HTN, valvular, pericardial disease
Structures leading to cardiomyopathy
- macro: myocardium, pericardium, endocardium, conduction system
- micro: beta myosin heavy chains, myosin binding proteins, cardiac troponins, tropomyosin
Myocardium cardiomyopathies (CMP)
- 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)
Pericardial CMP
- VIRAL PERICARDITIS
- infection
- autoimmune
- post MI/cardiac surgery
- metabolic uremia, drugs, radiation
Endocardial CMP
- 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
Conduction system CMP
- tachycardia: A fib, A flutter, SVT, premature ventricular contraction (PVC)
- left bundle branch block(LBBB)
Toxin induce CMP
- 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)
Peripartum CMP
- 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
Tachycardia CMP mechanism
- 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
Constrictive CMP
- 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
Restrictive CMP
- MYOCARDIAL disease, INFILTRATIVE disease
- filling is affected: diastolic HF, diastolic function is ABNORMAL
- diagnosis: imaging-TTE, CMR (disease of myocardium), hemodynamics-ventricular CONCORDANCE
Amyloidosis CMP
- amyloid in heart myocardium/valves
- other organs INVOLVED
- exam: low BP, JVD, edema, ascites, pleural effusions, hepatomegaly
Amyloidosis diagnosis
- ECG: low voltage, bradycardia, conduction abnormalities
- **Afib w/ slow ventricular rate & low voltage**
- echo: LVH w/out history of HTN
- labs: SPEP, UPEP
Amyloid Types: AL
- AL: immunoglobulin light chains
- source: BONE MARROW - heart commonly involved
- rapidly progressive, worst prognosis
- treatment: chemo, heart transplant, BM transplant
Amyloid Types: ATTR
- ATTR: familial autosomal dominant - mutant transthyretin
- source: LIVER
- no available chemo
- cardiac transplant, followed by liver transplant
Amyloid Types: Senile
- wild type transthyretin, slow progression, elderly
Amyloid Types: AA
- amyloid A, chronic inflammatory disorders
Iron overload CMP
- 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
Hypertrophic CMP
- most often genetic disorder
- ICD to prevent sudden death
- can be obstructive or non obstructive
Hypertrophic CMP: obstructive & non-obstructive
- diastolic dysfunction
- myocardial ischemia
- arrythmias
- PH & RV failure
Hypertrophic CMP: obstructive only
- dynamic LV outflow tract obstruction
- mitral regurgitation
HCM- non obstructive treatment
- beta blocker, CCB
- heart transplant
HOCM treatment
- avoid dehydration, vasodilators, cardiac stimulants
- beta blocker, CCB, dysopiramide
- myomectomy
- dual chamber pacing
- heart translant
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
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
CM with best prognosis
peripartum CM
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
Most common CM
diastolic CM
Dilated CM microscopic features: primary vs. secondary
- primary: hypertrophy, fibrosis
- secondary: myocarditis, hemochromatosis
Pathology of HOCM
- subaortic fibrosis
- mirror image of anterior MV leaflet
Amyloid restrictive CM pathology
- frim & waxy
- thick ventricles
- atria: normal or dilated, endocardial deposits
Arrhythmogenic RV CM
- fat deposition on anterior RV
Primary restrictive CM pathology
- gross: ATRIA DILATED
- microscopic: interstitial fibrosis, myocyte hypertrophy
Cardiomyopathy: definition
- disease of myocardium, usually leading to HF
- contractility: pumping function
- relaxation: filling
