Cardiomyopathies➡️Hypertension Flashcards
Define cardiomyopathies
Myocardial disorder (structural or functional) Rule out CAD, VALVULAR HEART DS, HTN, CONGENITAL HEART DS, BEFORE DIAGNOSING CARDIOMYOPATHIES
Disease under cardiomyopathies
Dilated cardiomyopathy Hypertrophic cardiomyopathy Restrictive cardiomyopathy Arrhythmogenic Right Ventricle Dysplasia LV Non compaction
Most common cardiomyopathy
Dilated cardiomyopathy
25% causes of heart failure
Most common cause of dilated cardiomyopathy
70% are genetically inherited
Autosomal dominant mc
Gene involved in DCM in
Autosomal dominant
Autosomal recessive
X linked
Titin
Desmosome
Tafazzin
Other name for stress induced cardiomyopathy
Takotsubo cardiomyopathy
Broken heart syndrome
Tachycardia induced cardiomyopathy
LV apical ballooning syndrome
Clinical features of DCM
Dilated LV Biventricular dilatation LV systolic dysfunction LV diastolic dysfunction Global hypokinesia Cardiomegaly
Symptoms due to decrease cardiac output in DCM
Fatigue ,cachexia, narrowpulse pressure, dicrotic pulse, dyspnea, cool extremities
Cognitive dysfunction due to decrease blood supply
Renal failure due to decrease blood supply to kidney
Complications of DCM
Arrhythmia A fib
Thromboembolism (LV mural thrombosis)
Investigation in DCM
Mri
Angiography in every case of DCM
When does peripartum cardiomyopathy can occur
Important risk factor
Prognosis
Ejection fraction?
Occurs in last trimester>first 6month after preg
RISK FACTOR– Age of pregnancy>HTN
BEST PROGNOSIS
LV systolic dysfunction EF LESS THAN 49%
CARDIOMYOPATHY WITH WORST PROGNOSIS
Causative factors?
Drug induced cardiomyopathy Drugs- Doxorubacin Trastuzumab Cyclophosphamide VEGF inhibitor Bevacizumab
Holiday heart syndrome
A fib after binge drinking in structurally normal heart
Factor responsible for alcohol induced cardiomyopathy
Acetaldehyde involved
Genetic predisposition- ACE polymorphism
Clinical features of takotsubo cardiomyopathy
And incidence
Middle aged female
Acs like features- chest pain, dyspnea
Trop I elevated
ST elevated
Echo finding of takotsubo cardiomyopathy
Regional wall motion abnormalities
Lv systolic dysfunction
Apical contraction
Due to catecholamine induced transient myocardial stunning
Other name for myocarditis
Pathogenesis and causes
Acute dilated cardiomyopathy
Any sys infections lead to cytokine storm and depression of LV function
Cause - Infections chagas disease mc Non infectious Sarcoidosis, polymyositis, giant cell arteritis
Clinical features of myocarditis
Ecg
Enzyme
Histo
Chest pain following febrile infection
Global/LV systolic dysfunction
New onset heart failure
Refractory hypotension
Ecg tachycardia, non specific ST/T changes, low voltage QRS
TropI elevated
Histo - DALLAS criteria
Causes of RESTRICTIVE Cardiomyopathy
Mc amyloidosis primary systemic
Ecg change in RCM due to amyloidosis
Echo finding
Low voltage QRS Complex
Thickened vent wall with hyperrefractile glittering of myocardium
Other causes of RCM
Storage disorder-
hemochromatosis
Fabry disease (concentric lamellar inclusion)
Fibrotic disease
Scleroderma
Endomyocardial
Tropical endomyocardial fibrosis
Loeffler endocarditis
Carcinoid syndrome
Clinical features of rcm
Restriction to filling leading to severe diastolic dysfunction and increase in LV filling pressure
Both atria dilated and massively enlarged
End diastolic pressure high
Right heart affected more, S3 when RV failure
S4 present
Progression of disease RCM
Initially subtle exercise intolerance- diastolic dysfunction
Later pt will have RV failure
Finally CO DECREASE (BURN OUT PHASE)
OTHER NAME FOR HYPERTROPHIC CARDIOMYOPATHY
Assymetrical septal hypertrophy
Idiopathic hypertrophic subaortic stenosis
Muscle subaortic stenosis
HOCM
Mc genetic CVS disease
Mutation occurs in? Mc
HOCM Autosomal dominant Mutation in sarcomere MC- myosin heavy chain Myosin binding protein C
Incidence of HOCM
Prognosis
Male = female Prognosis poor in female Age of onset 40 yrs 95% stable 5% atrial fib, Sudden cardiac death
Assymetrical hypertrophy in HOCM leads to?
Left more than right
Diastolic dysfunction,
Dyspnea on exertion, orthopnea, pnd
Septal anterior motion is?
During mid systole in hocm
Mitral valve leaflet motion leads to dynamic obstruction and syncope
Complications of HOCM
Prog failure
Arrhythmia
SCD
Why nitrate, diuretic are avoided in HOCM
SAM
Preload decreases, cavity size decrease, obstruction increases, gradient increases, intensity of murmur increases
Why exercise is avoided in HOCM
Contractility increases, SAM increases, obstruction increases and intensity of murmur increases
Gold standard investigation in HOCM
Transthoracic echocardiography
Diameter more than 15mm
Dagger signal in doppler
Pulse findings of HOCM
Normal,
Bisferiens
Brockenbrough sign
Brockenbrough sign
In ventricular premature contraction,
Inspite of increase in pulse volume due to obstruction pulse volume decrease in ventricular premature contraction in HOCM
Mgt of HOCM
Beta blocker -2mg/kg
CCB -Verapamil
Add on if symptoms still persist - Disopyramide
In case of resistant HCM , treatment
Septal myomectomy,
If unfit alcoholic septal ablation
