Cardiomyopathy Flashcards
Cardiomyopathy
Any condition leading to an abnormally functional morphological abnormal myocardium
3 Cardiomyopathies
Dilated
Restrictive
Hypertrophic
How do most cardiomyopathies present?
Like heart failure
Best diagnostic modality for cardiomyopathy
ECHO!!!
Systolic dysfunction
Can’t contract the ventricles and empty them like we used to - ventricles pump harder - going to eventually have diatolic dysfunction
Diastolic dysfunction
LV can’t stretch - Ventricle made of glass
Myocarditis
Infectious or non-infectious process leads to necrosis. May lead to dilated cardiomyopathy
Two main mechanisms of cardiomyopathy
Autoimmune or infectious
Acute phase of myocarditis
Substernal, pleuritic chest pain
First 2 weeks
Fever
Chronic phase of myocarditis
Autoimmune - after the first two weeks
4 infectious causes of myocarditis
Adenovirus
COVID-19
Coxsackie virus
Cytomegalovirus
3 noninfectious causes of myocarditis
Alcohol
Cocaine
Anthracyclines
Myocarditis presentation
Acute febrile illness
SOB, Pleural chest pain, may present with HF, arrhythmias
No hx of heart problems
Best position to hear pericardial friction rub
Leaning forward
Four Initial tests for myocarditis
EKG - Sinus tachy, dysrhythmia, ST-T changes
Cardiac biomarkers - Elevated troponins (may have to cath)
CXR - Enlarged cardiac silloette
Increased/Reduced uptake of dye on cardiac MRI
Only true way to diagnose myocarditis -gold standard
A heart biopsy - only get if it will change presentation - patient decompensating rapidly and we have no idea what is going on
NSAIDs and IHD
NOT indicated
Dilated cardiomyopathy
Big, dilated left ventricle with low ejection fraction, #1 reason for a heart transplant
Systolic dysfunction
Presentation of dilated cardiomyopathy on PE
Valvular disorders
Arrhythmias
Pulsus alternans d/t limited emptying
S3 gallop
HF symptoms
Etiologies of dilated cardiomyopathy
Pregnancy - usually go back to baseline
Lyme
Chagas
Alcohol
AF, SVT, AVNRT
DCM etiolology mneumonic
Alcohol
Beri beri
Coxsackie
Cocaine
Chagas
Doxirubicin toxicity
Diagnosis for DCM
Echo and BNP/pro-BMP
Treatment for DCM
CHF management
Heart Transplant
Defibrillator
Restrictive cardiomyopathy
Fibrosis leading to a DIASTOLIC dysfunction
Bi-atrial enlargement
6 Etiologies of restrictive cardiomyopathy
Amyloidosis
Sarcoidosis
Hemochromatosis
Fabry disease
Radiation
Fatty infiltration
Diagnosis and treatment for restrictive cardiomyopathy
Echo or MRI, may consider Biopsy
Treat HF and Underlying cause
Hypertrophic cardiomyopathy
Typically a genetic issue
Septal buildup of myocytes - block the aortic valve
Worse with exercise, standing, valsalva
DIASTOLIC dysfunction
Presentation of hypertrophic cardiomyopathy
Fatigue, chest pain, aortic stenosis like murmur - worse with valsalva, better with squatting
Sudden death
Diagnostics of hypertrophic cardiomyopathy
LVH on EKG
ECHO with LV wall over 1.5 cm thick
Management of hypertrophic CM non invasive
Activity restriction
BB or Verapamil
Avoid diuretics or vasodilators
Invasive management of hypertrophic cardiomyopathy
Septal myectomy or alcohol septal ablation
Screening of HTCM
Screen first degree relatives - annual echo until 20, then Q5 years
MCC of HF in US
Ischemic cardiomyopathy
Ischemic cardiomyopathy
Characterized by systolic dysfunction
Presentation - CHF
Usually LV dysfunction
Regional wall abnormality on Echo - akinetic
Management of ischemic cardiomyopathy
Nuclear viability scan for hibernation
Revascularization
Manage CHF
ICD/Wearable defibrillator
Arrhythmogenic right ventricular cardiomyopathy
RV free wall myocardium is replaced by fibrous/fatty tissue
Sudden death in YAs
More common in europe
Left ventricular noncompaction
Congenital - CHF, etc. at birth
Heart wall looks like spongy bone
Usually need a heart transplant
Stress induced/Takutsobu Cardiomyopathy
Broken heart syndrome
STEMI in the absence of CAD
Due to an intense psychological stressor
MC patient for stress induced cardiomyopathy
Postmenopausal women
Diagnosis and tx for stress induced cardiomyopathy
LV apical ballooning!!! on echo or LV angiography
Almost all patients recover in a few weeks - BB for 1 year
Key sign for stress induced cardiomyopathy
LV apical ballooning
