Cardiomyopathies, Pericarditis, & Myocarditis Flashcards
What is cardiomyopathy?
disease of the heart muscle that causes loss of muscle contractility; can be sudden or slow, & multiple causes (BAD thing)
What is myocarditis?
Infection/inflammation of heart muscle and conduction system, without evidence of MI (BAD thing)
What is pericarditis? What two things can it cause?
infection/inflammation of pericardium (heart muscle is ok) that can cause inflammatory CP & possible pericardial effusion with muffled heart sounds- usually not a bad thing
What is one major thing a cardiomyopathy can cause?
Sudden, severe CHF
what is a dilated cardiomyopathy? what is its major etiology?
dilation of ventricles with thinning of the walls leads to blood being pumped ineffectively (decreased contractility)
50% of DCM are idiopathic
What test can diagnosis DCM?
Echo, not much can be done by the time its detected though
What is the best “treatment” we have for DCM?
Medical treatment only helps so much: reduce workload & increase contractility (ACEI’s, BB, diuretics)
Treat the associated heart failure and see if cardiomyopathy gets better
Heart transplant is usually only suitable Tx
If you get heart failure with DCM, what type is it?
heart failure with reduced ejection fraction (HFrEF)
What are signs/symptoms of DCM?
dyspnea, orthopnea, weakness, fatigue, ascites, edema, generally rapidly evolving
What two valve problems could you see with DCM?
mitral and tricuspid regurgitation (expansion of valvular ring)
What is hypertrophic obstructive cardiomyopathy? Is it genetic? What population does it usually affect?
its an abnormal thickening of myocardium (mostly in the septum) that affects DYASTOLIC function of left ventricle
yes, its autosomal dominant (50% chance of passing to offspring)
Affects teens/young adults/athletes the most
What part of the heart will have increased pressure from HOCM?
Left ventricle outflow tract is obstructed (from hypertrophic septum) and this results in elevated left atrial pressures
What are usual signs/symptoms for HOCM?
patient has positive family Hx for sudden cardiac death
afib- often related to sudden cardiac death
dyspnea, CP, exertional syncope
What is the best test to confirm HOCM?
ECHO
see a thickened septum, Left ventricle hypertrophy, abnormal MV (usually mitral regurg)
Muscle fibers are disorganized compared to normal
What is the medical and surgical treatment for HOCM?
BB to reduce arrhythmias & improve diastolic function
Implantable defibrillator if fatal arrhythmia should occur (STANDARD OF CARE)
myotomy/myectomy- incising or removing part of the septum
What is a restrictive cardiomyopathy? what is a common cause of this?
restriction of ventricular filling because of ridged walls; impaired systolic & diastolic function, spared muscle cell function
cause: myocardium is filled with amyloid or sarcoid buildup that stiffened muscle (but DOESNT thicken it)
What are symptoms of restrictive cardiomyopathy?
dyspnea, paroxysmal nocturnal dyspnea, orthopnea, peripheral edema, ascites, fatigue, and weakness
How do you detect and diagnosis a restrictive cardiomyopathy?
detect by echo and diagnosis with biopsy of muscle
What is the tx for a restrictive cardiomyopathy?
transplant
What is a tako-tsubo cardiomyopathy also called?
neurogenic myocardial stunning; “broken heart syndrome”
Describe T-T cardiomyopathy: what does it result from, who normally gets it, talk about LV function
results from high catecholamine stress
most common in postmenopausal women
LV balloons out like a tako-tsubo pot
LV function is usually spared
what does an echo show for t-t cardiomyopathy
LV apical akinesis (lack of ventricular wall/distal apex motion; looks like its not contracting)
what does T-T cardiomyopathy present like?
anterior wall acute MI, usually mild elevations in troponin and ST elevations on EKG
Tx for T-T cardiomyopathy
supportive tx: recovery within a few weeks; occasionally fatal
what is peripartum cardiomyopathy?
idiopathic dilated cardiomyopathy occurring 1 month before or 5 months after delivery
What is the prognosis for peripartum cardiomyopathy?
half get better within 6 months with good prognosis; some rapid fatalities or HF, high risk with subsequent pregnancies
What usually causes myocarditis
usually a viral infection
How does myocarditis present? Name other signs and symptoms for myocarditis
can present as sudden severe CHF or sudden death
onset with flu like syndrome with malaise, low fever, and tachycardia (more elevated than you think); often hx of GI or GU infection
Prognosis for myocarditis
50% infection lasts a short time and recovery is about a month; rest vary from sudden death to chronic CHF
What is tx for myocarditis?
reduce cardiac workload with rest until infection resolves, tx CHF if it remains
what is the etiology of pericarditis?
usually viral or idiopathic
small % from neoplasia, TB, or autoimmune
what is the clinical presentation for pericarditis? What does the EKG show?
Chest pain: sudden onset, sharp, pleuritic, IMPROVED by sitting up & leaning forward
pericardial friction rub (along LSB)
maybe pericardial effusion
EKG shows ST elevation (signifies general inflammation) or PR depression
What labs/imaging do you do for pericarditis?
not much is helpful
Echo is normal (unless effusion)
CXR is normal
Troponins might be elevated (1/3 of people)
General inflammatory labs (ESR, CRP, leukocytosis)
what is the Tx for pericarditis?
usually supportive: NSAIDS, maybe steroids, consider non viral causes & their tx
may do pericardiocentesis for constant effusions (can send this fluid for culture)
course is almost always benign
What are some types of high risk pts who might require hospitalization for pericarditis?
pt with significant fever pt with tamponade/large effusion immunosuppressed on warfarin (bleeding can cause tamponade) as a result of trauma poor response to NSAID within 7 days elevated troponins
