Cardiomyopathy Flashcards
Diseases of the heart muscle
Classified based on structural and functional abnormalities of the heart
The heart muscle becomes ____,___,or_____
Can lead to _____,_____,or_____
cardiomyopathy
enlarged, thick, or rigid
heart failure, dysrhythmias, or sudden death
cardiomyopathy
pathophysiology
Series of events that lead to –
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
Classifications of cardiomyopathies
Non-ischemic:
Dilated cardiomyopathy (DCM)
Restrictive cardiomyopathy (RCM)
Hypertrophic cardiomyopathy (HCM)
Arrhythmogenic right ventricular cardiomyopathy
Unclassified cardiomyopathies (ex. Takotsubo)
Ischemic:
An enlarged heart caused by ___
Usually accompanied by ___
An enlarged heart caused by CAD
Usually accompanied by HF
Idiopathic cardiomyopathy
the cause is unknown
Presentation
Depends on which type:
if it affects systolic or diastolic function
the age of onset
genetic component
acute vs chronic
Most common
- Dilated cardiomyopathy (DCM)
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
ventricles
hypertrophy
systolic
Elevated
Less
More
HF
Valve
regurgitation
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 _____
familial genetics
echo & ECG
idiopathic
Dilated Cardiomyopathy (DCM):
Causes:
Pregnancy
Heavy alcohol use
Viral infections
Chemo medications
Persistent tachycardia
HTN
Myxedema (severe hypothyroidism)
Thyrotoxicosis (excess circulating thyroid hormone)
Signs & symptoms of DCM:
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
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
-
-
-
-
last
5 months
ACE inhibitors, beta blocker, and diuretics
Shortness of breath when lying flat
Edema
Weight gain
Increase in nighttime urination
fatigue
- 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
left ventricle or the ventricular septum
longer to relax
difficulty filling
Perpendicular
Vfib & Vtach
Coronary arteriole
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:
-
-
-
-
-
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)
Hypertrophic cardiomyopathy
Main cause of debilitating symptoms in HCM:
Presentation:
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)
- 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
thick and rigid
filling during diastole
Arrhythmias
Restrictive cardiomyopathy Causes:
- Infiltrative disease
-Amyloidosis
—Build up of abnormal proteins
—Affects the shape & function - Storage disease
-Hemochromatosis
—Body absorbs too much iron
—Excess deposited in your organs (such as the heart)
—Leads to stiffness in the heart - Non-infiltrative disease
-Scleroderma
—Hardening and tightening of skin and connective tissues - Endomyocardial
-Cancer treatments
—Radiation and chemo causing Endomyocardial damage
- 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:
Inherited
scar & adipose tissue
ECG
Cardiac MRI
Echocardiogram
Family history (1st degree relatives should have genetic testing)
- 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 __________________
Stress-related
women usually > 50 yrs
ACS
catecholamine
intense emotional or physical stressor
Takotsubo Cardiomyopathy
Clinical manifestations:
Hypotension
Syncope
Arrhythmias
Chest pain
ST elevation on ECG
Elevated cardiac enzymes
Dyspnea
Fatigue
Prognosis is:
Tx:
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.
Clinical manifestations of cardiomyopathy:Can be stable for many years without symptomsAs it progresses, you will start to see symptoms
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
Cardiomyopathy Diagnostic Studies
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
Compares the amount of blood in the heart to the amount pumped out:
What is normal?
ejection fraction
normal 50-70%
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
underlying cause
heart failure medications (nitrates, diuretics, ACE Inhibitors, beta blockers), antiarrhythmic, anticoagulation therapy, digitalis (afib)
physical activity and avoid weight gain
CPR
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:
low sodium diet; read product labels for sodium content
alcohol, caffeine, diet pills, and over-the-counter cold medicines that contain stimulants.
Advanced Therapy
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
Main cause of debilitating symptoms in hypertrophic cardiomyopathy
LVOT obstruction
- Dilated cardiomyopathy (DCM)
a.
b.
c.
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
- Peripartum dilated cardiomyopathy
Reversible if caught early enough, others are not.
Hard to diagnose because symptoms are similar to symptoms of pregnancy
- Hypertrophic cardiomyopathy
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)
- Restrictive cardiomyopathy
a. least common type of cardiomyopathy- Inherited or acquired
b. Muscle wall thick and rigid
- Ventricles don’t stretch
- Arrhythmogenic right ventricular cardiomyopathy (arvc)
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
- Takotsubo Cardiomyopathy
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
Least common type of cardiomyopathy
Restrictive cardiomyopathy
Myocardium infiltrated and replaced by scar & adipose tissue
Ventricular dilatation
Poor contractility
Arrhythmias
Arrhythmogenic right ventricular cardiomyopathy (arvc)
Transient cardiac syndrome mimics ACS
- Takotsubo Cardiomyopathy(stress-induced or broken-heart syndrome)
