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Medicine > Cardiomyopathies➡️Hypertension > Flashcards

Cardiomyopathies➡️Hypertension Flashcards

1
Q

Define cardiomyopathies

A 
Myocardial disorder (structural or functional) 
Rule out CAD, VALVULAR HEART DS, HTN, CONGENITAL HEART DS, BEFORE DIAGNOSING CARDIOMYOPATHIES
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2
Q

Disease under cardiomyopathies

A 
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Arrhythmogenic Right Ventricle Dysplasia 
LV Non compaction
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3
Q

Most common cardiomyopathy

A

Dilated cardiomyopathy

25% causes of heart failure

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4
Q

Most common cause of dilated cardiomyopathy

A

70% are genetically inherited

Autosomal dominant mc

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5
Q

Gene involved in DCM in
Autosomal dominant
Autosomal recessive
X linked

A

Titin
Desmosome
Tafazzin

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6
Q

Other name for stress induced cardiomyopathy

A

Takotsubo cardiomyopathy
Broken heart syndrome
Tachycardia induced cardiomyopathy
LV apical ballooning syndrome

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7
Q

Clinical features of DCM

A 
Dilated LV 
Biventricular dilatation
LV systolic dysfunction
LV diastolic dysfunction
Global hypokinesia
Cardiomegaly
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8
Q

Symptoms due to decrease cardiac output in DCM

A

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

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9
Q

Complications of DCM

A

Arrhythmia A fib

Thromboembolism (LV mural thrombosis)

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10
Q

Investigation in DCM

A

Mri

Angiography in every case of DCM

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11
Q

When does peripartum cardiomyopathy can occur
Important risk factor
Prognosis
Ejection fraction?

A

Occurs in last trimester>first 6month after preg
RISK FACTOR– Age of pregnancy>HTN
BEST PROGNOSIS
LV systolic dysfunction EF LESS THAN 49%

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12
Q

CARDIOMYOPATHY WITH WORST PROGNOSIS

Causative factors?

A 
Drug induced cardiomyopathy
Drugs-
Doxorubacin 
Trastuzumab
Cyclophosphamide
VEGF inhibitor Bevacizumab
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13
Q

Holiday heart syndrome

A

A fib after binge drinking in structurally normal heart

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14
Q

Factor responsible for alcohol induced cardiomyopathy

A

Acetaldehyde involved

Genetic predisposition- ACE polymorphism

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15
Q

Clinical features of takotsubo cardiomyopathy

And incidence

A

Middle aged female
Acs like features- chest pain, dyspnea
Trop I elevated
ST elevated

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16
Q

Echo finding of takotsubo cardiomyopathy

A

Regional wall motion abnormalities
Lv systolic dysfunction
Apical contraction
Due to catecholamine induced transient myocardial stunning

17
Q

Other name for myocarditis

Pathogenesis and causes

A

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
18
Q

Clinical features of myocarditis
Ecg
Enzyme
Histo

A

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

19
Q

Causes of RESTRICTIVE Cardiomyopathy

A

Mc amyloidosis primary systemic

20
Q

Ecg change in RCM due to amyloidosis

Echo finding

A

Low voltage QRS Complex

Thickened vent wall with hyperrefractile glittering of myocardium

21
Q

Other causes of RCM

A

Storage disorder-
hemochromatosis
Fabry disease (concentric lamellar inclusion)

Fibrotic disease
Scleroderma

Endomyocardial
Tropical endomyocardial fibrosis
Loeffler endocarditis
Carcinoid syndrome

22
Q

Clinical features of rcm

A

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

23
Q

Progression of disease RCM

A

Initially subtle exercise intolerance- diastolic dysfunction
Later pt will have RV failure
Finally CO DECREASE (BURN OUT PHASE)

24
Q

OTHER NAME FOR HYPERTROPHIC CARDIOMYOPATHY

A

Assymetrical septal hypertrophy
Idiopathic hypertrophic subaortic stenosis
Muscle subaortic stenosis
HOCM

25
Q

Mc genetic CVS disease

Mutation occurs in? Mc

A 
HOCM 
Autosomal dominant
Mutation in sarcomere
MC- myosin heavy chain 
Myosin binding protein C
26
Q

Incidence of HOCM

Prognosis

A 
Male = female
Prognosis poor in female
Age of onset 40 yrs 
95% stable
5% atrial fib, Sudden cardiac death
27
Q

Assymetrical hypertrophy in HOCM leads to?

A

Left more than right
Diastolic dysfunction,
Dyspnea on exertion, orthopnea, pnd

28
Q

Septal anterior motion is?

A

During mid systole in hocm

Mitral valve leaflet motion leads to dynamic obstruction and syncope

29
Q

Complications of HOCM

A

Prog failure
Arrhythmia
SCD

30
Q

Why nitrate, diuretic are avoided in HOCM

A

SAM

Preload decreases, cavity size decrease, obstruction increases, gradient increases, intensity of murmur increases

31
Q

Why exercise is avoided in HOCM

A

Contractility increases, SAM increases, obstruction increases and intensity of murmur increases

32
Q

Gold standard investigation in HOCM

A

Transthoracic echocardiography
Diameter more than 15mm

Dagger signal in doppler

33
Q

Pulse findings of HOCM

A

Normal,
Bisferiens
Brockenbrough sign

34
Q

Brockenbrough sign

A

In ventricular premature contraction,
Inspite of increase in pulse volume due to obstruction pulse volume decrease in ventricular premature contraction in HOCM

35
Q

Mgt of HOCM

A

Beta blocker -2mg/kg
CCB -Verapamil
Add on if symptoms still persist - Disopyramide

36
Q

In case of resistant HCM , treatment

A

Septal myomectomy,

If unfit alcoholic septal ablation

Medicine (11 decks)

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