CARDIOMYOPATHY Flashcards
The term cardiomyopathy (literally, _______) by convention is used to describe _____ resulting from a __________
heart muscle disease
heart disease
primary abnormality in the myocardium.
In many cases, cardiomyopathies are idiopathic (i.e., of unknown cause)
T/F
T
well-defined myocardial diseases may, in the end, resemble those without known causes, both functionally and structurally.
T/F
T
Major advance in our understanding has given _____ of many myocardial diseases, previously considered idiopathic.
genetic basis
etiologic distinctions of cardiomyopathies have become somewhat blurred
T/F
T
Three clinical, functional, and pathologic patterns :
______ cardiomyopathy (______)
_______ cardiomyopathy (____)
________ cardiomyopathy
.
Dilated ; DCM
Hypertrophic; HCM
Restrictive
commonest (___ %) cardiomyopathy is ?????
________ cardiomyopathy- least prevalent.
90
Dilated cardiomyopathy (DCM)
Restrictive
_________ are used widely in the diagnosis of cardiomyopathies
Endomyocardial biopsies
Dilated cardiomyopathy (DCM):
Left ventricular ejection fraction: ___
Mechanisms of heart failure:____
Less than 40%
Impairment of contraction( systolic dysfunction)
Hypertrophic cardiomyopathy (HCM):
Left ventricular ejection fraction: ___
Mechanisms of heart failure:____
50-80%
Impairment of compliance ( diastolic dysfunction)
Restrictive cardiomyopathy:
Left ventricular ejection fraction: ___
Mechanisms of heart failure:____
45-90%
Impairment of compliance ( diastolic dysfunction)
DILATED CARDIOMYOPATHY
DCM is applied to a form of cardiomyopathy characterized by progressive cardiac ______,______, and _______ (______) dysfunction.
hypertrophy, dilation, and contractile
systolic
DILATED CARDIOMYOPATHY
It is sometimes called ______ cardiomyopathy.
congestive
DILATED CARDIOMYOPATHY
Myocarditis: Viral nucleic acids from ________ and other ____viruses have been detected in the myocardium of some patients, and sequential _____ biopsies have demonstrated progression from ——— to _______
coxsackievirus B
entero; endomyocardial
myocarditis to DCM
DILATED CARDIOMYOPATHY
Alcohol or other toxicity: Alcohol abuse is also strongly associated with the development of DCM, raising the possibility that __________ or ________ may be the cause of the myocardial injury.
ethanol toxicity or a secondary nutritional disturbance
DILATED CARDIOMYOPATHY
Pregnancy-associated: A special form of DCM, termed ______ cardiomyopathy, occurs (early or late?) in pregnancy or ____ to _____ ————.
peripartum
Late
several weeks to months
postpartum
The cause of peripartum cardiomyopathy is (well or poorly?) understood
F
The cause of peripartum cardiomyopathy is poorly understood but is probably multifactorial
DILATED CARDIOMYOPATHY
peripartum cardiomyopathy
Pregnancy-associated _______, ______ overload, ______ deficiency, other metabolic derangement, or as yet poorly characterized _______ reaction may be involved.
hypertension
volume
nutritional
immunologic
DILATED CARDIOMYOPATHY
Genetic : Genetic influences have been documented in some cases, particularly when _____________________
multiple members of a family are affected.
DILATED CARDIOMYOPATHY
DCM has a familial occurrence in ___ to ____ % of cases.
20 to 30
DILATED CARDIOMYOPATHY
MORPHOLOGY.
Nevertheless, because of the wall ______ that accompanies _____, the ventricular wall thickness may be ____________________________ than normal.
thinning
dilation
less than, equal to, or more
In DCM, the heart is usually not heavy
T/F
F
It’s heavy
DILATED CARDIOMYOPATHY
MORPHOLOGY.
In DCM, the heart is usually heavy, weighing _______ times normal, and large and ______, with ____ of ____ chambers.
two to three
flabby
dilation
all
DILATED CARDIOMYOPATHY
______ thrombi are common and may be a source of _______
Primary valvular alterations are (present or absent?)
mitral or tricuspid regurgitation when present are a result of ___________ (______ regurgitation).
Mural; thrombo-emboli.
Absent
left ventricular chamber dilation
functional
DILATED CARDIOMYOPATHY
The coronary arteries are usually ________________________, but any coronary arterial obstructions that do exist are (sufficient or insufficient?) to explain the degree of cardiac dysfunction.
free of significant narrowing
Insufficient
In DILATED CARDIOMYOPATHY
The coronary arteries are usually free of significant narrowing
T/F
T
DILATED CARDIOMYOPATHY: The histologic abnormalities in idiopathic DCM are :
-nonspecific
- usually reflect a specific causative agent.
T/F
T
F(usually do not reflect a specific causative agent.)
DILATED CARDIOMYOPATHY: The histologic abnormalities in idiopathic DCM
•Their severity reflects the degree of dysfunction
•the severity indicates the patient’s prognosis.
T/F
F
F
Their severity does not necessarily reflect the degree of dysfunction or the patient’s prognosis.
DILATED CARDIOMYOPATHY: The histologic abnormalities in idiopathic DCM
Most muscle cells are ______ with ______ nuclei, but many are _______ or _______
hypertrophied
enlarged
attenuated or stretched.
In DILATED CARDIOMYOPATHY
Interstitial and endocardial fibrosis of variable degree is present
Large subendocardial scars replace individual cells or groups of cells
T/F
T
F(small)
In DILATED CARDIOMYOPATHY
small subendocardial scars replace individual cells or groups of cells, probably reflecting ______________________ caused by ______- induced imbalance between ______ and ———
healing of previous secondary myocyte ischemic necrosis
hypertrophy
perfusion supply and demand.
DILATED CARDIOMYOPATHY
Clinical Features.
DCM may occur at any age
DCM Does not occur in childhood
T/F
T
F( it does)
DILATED CARDIOMYOPATHY
Clinical Features.
It presents with (slowly or rapidly?) progressive _________, but patients may slip precipitously from a _______ to _________ state.
Slowly
congestive heart failure
compensated to a decompensated functional
DILATED CARDIOMYOPATHY
Clinical Features.
In the end stage, patients often have ejection fractions of (more or less ?) than ___% .
Less
25
DCM commonly affects those ___-____ years old.
20 to 60
normal left ventricular ejection fraction is approximately ___ to ____%
50 to 65
DILATED CARDIOMYOPATHY
Fifty percent of patients die within ________, and only ___% survive longer than ___ years.
Death is usually attributable to progressive _______ or ______
2 years
25; 5
cardiac failure or arrhythmia.
Embolism from dislodgment of an intracardiac thrombus may occur in DCM
T/F
T
DILATED CARDIOMYOPATHY
___________ is frequently recommended as a fix
Cardiac transplantation