Cardiomyopathy Flashcards
1
Q
- What is the simple definition of cardiomyopathy?
- Which ventricle is predominantly involved?
- What types of presentations does cardiomyopathy have?
A
- Disease of the myocardium
- Left ventricle
- Can vary from asymptomatic to decompensated congestive heart failure to cardiac arrest
2
Q
- How are cardiomyopathies categorized?
- What are the diagnostic imaging modalities that can be used to detect and diagnose cardiomyopathy?
- Which modality is the study of choice?
- What types of dysfunction can occur as a result of cardiomyopathy? (very generally speaking)
A
- By cause and pathophysiology
- Echocardiography, nuclear imaging, coronary angiography with left ventriculography, cardiac MRI
- Echocardiography
- Transient and permanent
3
Q
-What are the different ways to classify cardiomyopathies?
A
- Intrinsic vs extrinsic
- Primary vs secondary
- Ischemic vs non-ischemic
4
Q
-What are the WHO/ISFC classes of cardiomyopathy?
A
- Dilated cardiomyopathy (DCM)
- Hypertrophic cardiomyopathy (HCM)
- Restrictive cardiomyopathy (RCM)
- Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)
- Unclassified
5
Q
- What is systolic dysfunction?
- What are the compensatory mechanisms for systolic dysfunction?
- What eventually happens to these mechanisms?
A
- A decrease in myocardial contractility and a reduction in left ventricular ejection fraction
- Left ventricular enlargement (resulting in higher stoke volume), Frank-Starling relationship
- They eventually fail and heart failure ensues
6
Q
- What is diastolic dysfunction?
- What is the relationship between this and ventricular dysfunction?
- Why is diastolic dysfunction often missed or underestimated?
A
- Left ventricular relaxation and filling are abnormal resulting in elevating filling pressures
- There is non, diastolic may occur with or without systolic dysfunction
- It is very difficult to quantitate on echocardiography
7
Q
- What is the most common type of heart failure in the US?
- What does the lack of O2 in the myocardium cause?
- What is the main cause of ischemic cardiomyopathy?
- What other causes are there?
- Which type of dysfunction characterizes ischemic cardiomyopathy?
A
- Ischemic
- Myocardial damage, hibernation and death
- CAD
- Cocaine, vasospasm, thrombus
- Systolic dysfunction that can be transient or permanent, and predominantly involves the LV, but can include the RV too
8
Q
- What is the clinical presentation of ischemic cardiomyopathy?
- What will an echocardiogram show?
- What imaging study is recommended if the cause of LV dysfunction is unknown?
A
- CHF symptoms (edema, dyspnea); EKG may indicate old MI; chest xray may show pulmonary edema
- Reduced LVEF and regional wall motion abnormality
- Coronary angiography
9
Q
- How do you manage ischemic cardiomyopathy?
- Why should a nuclear viability study be considered?
A
- Revascularization of the myocardium with PCI or CABG, especially during acute ischemia/infarction
- To determine if myocardial dysfunction is due to scar or hibernating myocardium
10
Q
- How do you prevent sudden cardiac arrest in patients with ischemic cardiomyopathy?
- Which patients should get cardiac rehab?
A
- External wearable defibrillator, implanted cardioverter-defibrillator
- Post MI patients; extremely important, physical therapy with a telemetry monitor (raise heart rate to 85% of max)
11
Q
- What is the most common form cardiomyopathy?
- What are the characteristics of dilated cardiomyopathy?
- What are the clinical presentations of dilated cardiomyopathy?
- What type of surgery is this cardiomyopathy the primary indication for?
A
- Dilated cardiomyopathy
- Dilation and impaired contraction of one or both ventricles, predominantly in the left ventricle, with LVEF
12
Q
- What is the etiology of dilated cardiomyopathy?
- What is the most common type of infectious DCM? Caused by?
- How is the cause of DCM confirmed?
- What is the mechanism of pathology of infectious DCM?
- What are the bacterial causes of DCM?
A
- Commonly unknown, idiopathic but can be infectious, genetic, caused by toxins or systemic disorder, or occur peripartum, as a result of endocrine dysfunction or be tachycardia induced
- Viral: Parvovirus B19, herpes, coxsackievirus, influenza, adenovirus, CMV, HIV
- Biopsy
- Unknown, but direct cytotoxicity to cardiac myocytes and adverse autoimmune response are both possibilities
- TB, Meningococcal, Pneumococcal
13
Q
- What are two diseases that may cause dilated cardiomyopathy?
- Where is Chagas disease the leading cause of DCM?
- How does DCM resulting from lyme disease manifest?
A
- Chagas disease caused by protozoan infection; and Lyme disease
- Central and South America
- Usually as a conduction abnormality, but may cause myocardial dysfunction due to myocarditis; also arrhythmias, AV blocks and effusions
14
Q
- Is genetic DCM predominantly autosomal dominant or recessive?
- What is the mechanism of pathology of genetic DCM?
- Which inherited syndromes can lead to DCM?
- Which systemic disorders can include DCM?
A
- Autosomal
- Involves antibodies to a variety of cardiac proteins
- Muscular dystrophies, hemochromatosis, thalassemias
- Sarcoidosis, SLE, celiac disease, scleroderma, RA
15
Q
- What are the typical “toxins” that can lead to DCM?
- Which meds in particular?
- How does alcohol cause DCM?
A
- Alcohol, cocaine, Meds
- Adriamycin, Trastuxamab, Lithium
- Poorly understood, occurs with excessive consumption, and abstinence can result in improvement in LVEF
