Cardiomyopathy Flashcards
Primary vs secondary cardiomyopathy
Primary - of heart muscle itself, genetic or aquired
Secondary - due to systemic disease incl infiltrative/inflammatory eg sarcoidosis, haemochromatosis, fabrys, endocrine etc
What is hypertrophic cardiomyopathy
Abnormal growth of myocardium >15mm LV and atrial septum
What is pathology of hypertrophic CM
- Thickened walls
→ reduced CO - Ejection fraction often preserved - total volume and output reduced equally so ratio is the same
- Less ventricular filling
Presentation of HCM
Often asymptomatic
OR
Exertional SOB
Anginal chest pain
Palpitations
Light headedness
Hypertrophic CM examination signs
Systolic ejection murmur worsened by valsalva manouvure
S4 heart sound
Atrial gallop
Forceful apex beat +/- double impulse
What can HCM cause
HF, arrhythmias, sudden death
Genetic inheritance of HCM
Genes -> cardiac sarcomere protein coding
60% single autosomal dominant mutation
Can be spontaneous
What murmur does a LV outflow tract obstruction cause
Mitral valve regurgitation
Asymmetrical septum growth - obstruct blood flow through aortic valve
When do you screen for HOCM and how
Strong FH >1 direct member or severe disease eg sudden cardiac death
Check for known fenes
If none ECG and ECHO regularly
Structural cahnges in dilated cardiomyopathy
Dilated and thin walls
Less contractility
Cardiomegaly but walls thinner and weaker -> HF
Causes of dilated cardiomyopathy
Idiopathic
Genetics
Alcohol
Chemotherapies
Viral myocarditis
AI disease
Pregnancy - peripartum CM
How to diagnose dilated CM
HF incidental often finsing
ECG, 48 hrs
Cardiac MRI
Treatment dilated CM
HF symptomatic treatment
Pacemaker/ICD if highrisk for arrythmias
Avoid risk factors
Structural chagnes in restrictive CM
Stiff walls
Less ventricular filling
Atria enlarged from abnormal protein infiltration or scarring
-> HF, angina, arrhtyhmias
Which CM is least common
Dilated
Causes of restrictive CM
Idiopathic
Amyloidosis
Sarcoidosis
Haemachromatosis
What is arrhythmogenic RV
Replacement of normal myocardium with fibrous fatty tissue w poor electrical condiction
-> life threatening arrhtyhmias
What are problems and management of arrhythmogenic R CM
Sudden cardiac death and HF later in life
Genetic caise often
Radio ablation can reduce number of VTs
Red flags for CM
Poor cardiac output symptoms - dyspnoea, angina, syncope (without warning)
Arrhtyhmias symptoms - palpitations
FH sudden cardiac death, unexplained HF, transplants or implants
Hypertrophic CM on ECG
LVH and deep narrow Q waves
Initial investigations for CM
ECG, BP
bloods - FBC, u+es, LFTs, TFTs, HbA1c, pro-BNP
Imaging - ECHO
Specialist investigations CM
Ambulatory ECG for arrhythmias
Exercise stress testing ECG
Cardiac MRI
Genetic testing
Complications of CM
Cardiac failure - Reduced CO
AF - 1/5
Arrhythmias - non sustained VT w risk of VF
Sudden cardiac death
What treat symptomatic LV tract obstruction with
Beta blockers
