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Module 1 > Cardiomyopathy > Flashcards

Cardiomyopathy Flashcards

1
Q

Diseases of the heart muscle

Classified based on structural and functional abnormalities of the heart

The heart muscle becomes ____,___,or_____

Can lead to _____,_____,or_____

A

cardiomyopathy

enlarged, thick, or rigid

heart failure, dysrhythmias, or sudden death

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2
Q

cardiomyopathy

pathophysiology
Series of events that lead to –

A

impaired cardiac output:
-Decreased stroke volume
-Stimulates sympathetic nervous system
-Stimulates Renin-angiotensin-aldosterone response
-Cause increased systemic vascular resistance & increased Na+ and fluid retention
-Causes an increased workload on the heart

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3
Q

Classifications of cardiomyopathies

Non-ischemic:

A

Dilated cardiomyopathy (DCM)
Restrictive cardiomyopathy (RCM)
Hypertrophic cardiomyopathy (HCM)
Arrhythmogenic right ventricular cardiomyopathy
Unclassified cardiomyopathies (ex. Takotsubo)

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4
Q

Ischemic:

An enlarged heart caused by ___

Usually accompanied by ___

A

An enlarged heart caused by CAD

Usually accompanied by HF

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5
Q

Idiopathic cardiomyopathy

A

the cause is unknown

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6
Q

Presentation

Depends on which type:

A

if it affects systolic or diastolic function

the age of onset

genetic component

acute vs chronic

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7
Q

Most common

A
  1. Dilated cardiomyopathy (DCM)
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8
Q

Dilated cardiomyopathy (DCM)

Most common

Significant dilation of ____
-Without _____
-poor ____ function (EF < 40%)

____ systolic & diastolic volumes in the ventricles

Structural changes cause
-____ blood being ejected
-____ blood remaining in ventricles
-Lead to __

___ dysfunction (_______)
-From an overstretched ventricle

A

ventricles
hypertrophy
systolic

Elevated

Less
More
HF

Valve
regurgitation

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9
Q

Dilated Cardiomyopathy (DCM):

30-50% linked to _____
_______ screening for all first-degree blood relatives

Early diagnosis & treatment is important in preventing or delaying significant symptoms & sudden death

20-30% are _____

A

familial genetics
echo & ECG

idiopathic

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10
Q

Dilated Cardiomyopathy (DCM):

Causes:

A

Pregnancy
Heavy alcohol use
Viral infections
Chemo medications
Persistent tachycardia
HTN
Myxedema (severe hypothyroidism)
Thyrotoxicosis (excess circulating thyroid hormone)

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11
Q

Signs & symptoms of DCM:

A

Fatigue
Heart murmurs
Shortness of breath (while lying down or during activity)
Edema (in legs, ankles, feet, and neck)
-Sometimes in the abdomen
Chest pain / discomfort
Palpitations, fast fluttering heartbeat
Inability to tolerate exercise
thrombi

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12
Q

Peripartum dilated cardiomyopathy:

Develops within the ___ month of pregnancy – and up to ______ after birth

Treatment:

Little known about it at this time

Can be fatal

-
-
-
-

A

last
5 months

ACE inhibitors, beta blocker, and diuretics

Shortness of breath when lying flat
Edema
Weight gain
Increase in nighttime urination
fatigue

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13
Q
  1. Hypertrophic cardiomyopathy

A. Asymmetrical thickening of the hearts ____ or the _____

Systole –
Diastole –

B. Hypertrophied cardiac muscle
Disorganized (______ to one another)
- Decreases effectiveness of contractions – and can increase risk of ________

C. _______ walls thickened
-Decreased diameter – restrict blood flow – ischemia and necrosis – impedes ventricular contraction

A

left ventricle or the ventricular septum

longer to relax
difficulty filling

Perpendicular

Vfib & Vtach

Coronary arteriole

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14
Q

Hypertrophic cardiomyopathy

A. Autosomal-dominant condition
Most common form of _________
yearly echo from12-18 years of age, then every 5 yrs in susceptible individuals

B. Most common cause for:

-
-
-
-
-

A

inherited heart disease

Most common cause for sudden cardiac death (SCD) in young competitive athletes

12-lead EKG
Echocardiogram
Physical examinations
Genetic testing for those at risk or suspected
Negative (does not rule out completely)
Positive (1st degree relatives should be tested)

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15
Q

Hypertrophic cardiomyopathy

Main cause of debilitating symptoms in HCM:

Presentation:

A

LVOT obstruction (Left ventricular outflow tract obstruction)

Breathlessness with activity
Fainting or near fainting
Palpitations
Chest pain with activity
Lightheadedness (with or after exercise/activity)

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16
Q
  1. Restrictive cardiomyopathy

Muscle wall ____ and ____
- Ventricles don’t stretch

-Impaired ________
-Least common type of cardiomyopathy
-_____ are common
- Inherited or acquired

S&S:
dyspnea
Nonproductive cough
Chest pain

A

thick and rigid

filling during diastole

Arrhythmias

17
Q

Restrictive cardiomyopathy Causes:

A
  1. Infiltrative disease
    -Amyloidosis
    —Build up of abnormal proteins
    —Affects the shape & function
  2. Storage disease
    -Hemochromatosis
    —Body absorbs too much iron
    —Excess deposited in your organs (such as the heart)
    —Leads to stiffness in the heart
  3. Non-infiltrative disease
    -Scleroderma
    —Hardening and tightening of skin and connective tissues
  4. Endomyocardial
    -Cancer treatments
    —Radiation and chemo causing Endomyocardial damage
18
Q
  1. Arrhythmogenic right ventricular cardiomyopathy (arvc)

_____ heart disease
Uncommon
Myocardium infiltrated and replaced by _________
Ventricular dilatation
Poor contractility
Arrhythmias
Right ventricle (initially)
Progression (entire heart affected)

S&S
Palpitations and syncope (develop between age 15-40)
Sudden cardiac death
Arrhythmias (may benefit from an ICD)

Diagnostics:

A

Inherited

scar & adipose tissue

ECG
Cardiac MRI
Echocardiogram
Family history (1st degree relatives should have genetic testing)

19
Q
  1. Takotsubo Cardiomyopathy(stress-induced or broken-heart syndrome

_______ syndrome

More common in _________

Transient cardiac syndrome mimics ____

Stress-induced _____ release, with toxicity to and
subsequent stunning of the myocardium.

Usually preceded by __________________

A

Stress-related

women usually > 50 yrs

ACS

catecholamine

intense emotional or physical stressor

20
Q

Takotsubo Cardiomyopathy

Clinical manifestations:
Hypotension
Syncope
Arrhythmias
Chest pain
ST elevation on ECG
Elevated cardiac enzymes
Dyspnea
Fatigue

Prognosis is:

Tx:

A

Cardiac cath (no significant CAD), echo, ECG

typically excellent, with nearly 95% of patients experiencing complete recovery within 4-8 weeks.

heart failure medications such as beta blockers, ACE inhibitors, and diuretics.

21
Q

Clinical manifestations of cardiomyopathy:Can be stable for many years without symptomsAs it progresses, you will start to see symptoms

A

Fatigue
DOE (dyspnea on exertion)
Cough
PND (paroxysmal nocturnal dyspnea)
Orthopnea
Chest pain
Murmurs / extra heart sounds
Thromboembolism
Sudden cardiac death
Palpitations
Dizziness
Nausea
Syncope with exertion
Fluid retention
Peripheral edema
arrhythmias

22
Q

Cardiomyopathy Diagnostic Studies

A

Echocardiography: ejection fraction

Chest X-ray: cardiomegaly, pleural effusions, pulmonary congestion

ECG: Possible arrhythmias & conduction disturbances

Lab Studies: BNP, electrolytes

Cardiac Cath: obtain heart pressures; confirm EF; rule out CAD

Endomyocardial biopsy to identify infectious organisms

23
Q

Compares the amount of blood in the heart to the amount pumped out:

What is normal?

A

ejection fraction

normal 50-70%

24
Q

Treatment of Cardiomyopathy

Identify and mange ___________

Treat w/ meds:

Dietary modifications

May need to limit _____ and avoid ____

Teach _____ to family members

Smoking cessation

Reducing stress

Other: biventricular pacing, surgery, ablation

Genetic testing for family members

A

underlying cause

heart failure medications (nitrates, diuretics, ACE Inhibitors, beta blockers), antiarrhythmic, anticoagulation therapy, digitalis (afib)

physical activity and avoid weight gain

CPR

25
Q

Pt. instruction: taking care of self

Take all medications as prescribed

Follow a ______ diet

Adhere to fluid restriction if ordered

Maintain weight and avoid large meals

Avoid:

A

low sodium diet; read product labels for sodium content

alcohol, caffeine, diet pills, and over-the-counter cold medicines that contain stimulants.

26
Q

Advanced Therapy

A

Implanted Cardioverter-Defibrillator (ICD)

LVOT surgery (myectomy)
- Removal of a portion of the enlarged septum

Ventricular Assist Device (VAD): Bridge or Destination Therapy
Left ventricular assist device

Heart Transplantation

27
Q

Main cause of debilitating symptoms in hypertrophic cardiomyopathy

A

LVOT obstruction

28
Q
  1. Dilated cardiomyopathy (DCM)
    a.
    b.
    c.
A

a. Most common

b. Dilation of the ventricles w/o hypertrophy
. Poor ejection fraction < 40%
Valve dysfunction (regurgitation) from overstretched ventricle
c. Echo and ECG for all first degree relatives

29
Q
  1. Peripartum dilated cardiomyopathy
    Reversible if caught early enough, others are not.
    Hard to diagnose because symptoms are similar to symptoms of pregnancy
A
30
Q
  1. Hypertrophic cardiomyopathy
A

a. Most common form of inherited heart disease / Most common cause for sudden cardiac death (SCD) in young competitive athletes

b. Asymmetrical thickening of the hearts left ventricle or the ventricular septum
Hypertrophied cardiac muscle-
-Disorganized (Perpendicular to one another)
Decreases effectiveness of contractions – and can increase risk of Vfib & Vtach
Coronary arteriole walls thickened
-Decreased diameter – restrict blood flow – ischemia and necrosis – impedes ventricular contraction

c. yearly echo from12-18 years of age, then every 5 yrs in susceptible individuals
a. 12-lead EKG
b. Echocardiogram
c. Physical examinations
d. Genetic testing for those at risk or suspected
i. Negative (does not rule out completely
ii. Positive (1st degree relatives should be tested)

31
Q
  1. Restrictive cardiomyopathy
A

a. least common type of cardiomyopathy- Inherited or acquired

b. Muscle wall thick and rigid
- Ventricles don’t stretch

32
Q
  1. Arrhythmogenic right ventricular cardiomyopathy (arvc)
A

a. uncommon/ inherited

b. Myocardium infiltrated and replaced by scar & adipose tissue
Ø Ventricular dilatation
Ø Poor contractility
Ø Arrhythmias
• Right ventricle (initially)
Progression (entire heart affected

c. Diagnostics
- ECG
- Cardiac MRI
- Echocardiogram
- Family history (1st degree relatives should have genetic testing

33
Q
  1. Takotsubo Cardiomyopathy
A

a. More common in women usually > 50 yrs

b. Transient cardiac syndrome mimics ACS
• Stress-induced catecholamine release, with toxicity to and subsequent stunning of the myocardium.

c. Cardiac cath (no significant CAD), echo, ECG

34
Q

Least common type of cardiomyopathy

A

Restrictive cardiomyopathy

35
Q

Myocardium infiltrated and replaced by scar & adipose tissue
Ventricular dilatation
Poor contractility
Arrhythmias

A

Arrhythmogenic right ventricular cardiomyopathy (arvc)

36
Q

Transient cardiac syndrome mimics ACS

A
  1. Takotsubo Cardiomyopathy(stress-induced or broken-heart syndrome)

Module 1 (11 decks)

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