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CV > Cardiomyopathy > Flashcards

Cardiomyopathy Flashcards

1
Q

What is cardiomyopathy (CM)?

A

Morphologically and functionally abnormal myocardium WITHOUT any other disease

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2
Q

What are some specific diagnoses of cardiomyopathy?

A

Restrictive CM
Dilated CM
Hypertrophic CM
Arrhythmogenic RV CM and dysplasia
“Unclassified” CM

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3
Q

What occurs with systolic dysfunction?

A

Myocardial contractility is DECREASED which reduces LV Ejection Fraction

This causes compensatory mechanisms= LV enlargement and higher stroke volume

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4
Q

What is the Frank-Starling relationship? What kind of dysfunction do we see this in?

A

Higher stretch= Higher contractility

Can see this in Systolic Dysfunction

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5
Q

What occurs with diastolic dysfunction?

A

Abnormal LV relaxation and filling= elevated filling pressure

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6
Q

Which type of dysfunction usually manifests first?

A

Systolic, then diastolic usually follows

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7
Q

Which one is harder to catch on an echo, therefore is often missed? Systolic or Diastolic Dysfunction

A

Diastolic Dysfunction

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8
Q

Myocarditis aka

A

Inflammatory CM

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9
Q

What causes Myocarditis

A

Inflammatory & Infiltrative process due to infection or non-infectious causes

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10
Q

What does myocarditis progress to?

A

Necrosis of myocyte which will cause myocardial dysfunction and dilated CM

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11
Q

MCC of Myocarditis in North America

A

Viral
(usually Coxsackie B)

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12
Q

Age & sex MC impacted by Myocarditis

A

Men 20-50yo

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13
Q

Two main mechanisms of pathogenesis of Myocarditis

A

Host-mediated (cytotoxic process from causative agent)
or
AI-mediated (secondary immune response)

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14
Q

What are the two stages of Myocarditis? What occurs in each?

A

Acute (first 2 weeks-Myocyte death bc of causative agent)
then becomes
Chronic (after 2 weeks- overactive immune response)

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15
Q

How does Myocarditis present if it is due to infectious cause?

A

Develops days to weeks after onset of acute febrile/resp. infection

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16
Q

What are the classic symptoms of myocarditis?

A

SOB
Pleural/pericardial CP (pain worsens when laying back and is better when leaning forward)

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17
Q

T/F: Myocarditis will never present with Heart Failure

A

False! It can present with heart failure

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18
Q

What could cause heart failure from Myocarditis

A

Low Cardiac Output
Shock
LV systolic function severely depressed

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19
Q

What is the presentation for someone with myocarditis and arrhythmias?

A

Palpitations
Syncope
Sudden death may occur

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20
Q

How will myocarditis present on physical exam?

A

Pericardial friction rub
High HR
S3 or S4
If ventricular dilation is severe= Mitral or Tricuspid regurgitation
If heart failure= volume overload

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21
Q

What options do we have to workup myocarditis?

A

EKG
Cardiac biomarkers
Labs
CXR
Echo
Biopsy

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22
Q

What could we see on EKG with myocarditis?

A

Sinus tachycardia
Dysrhythmias
Ventricular ectopy
ST-T changes

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23
Q

What cardiobiomarkers would we see with myocarditis?

A

High Troponin

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24
Q

What serum labs would we see with myocarditis?

A

High: CRP, ESR, Eosinophil

If infectious- may check antibody titers
If AI- may check rheumatology
If Heart failure- check BNP

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25
Q

What would echo look like for myocarditis?

A

Inflamed myocardium and r/o other causes

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26
Q

When should we do Endocardial biopsy? (EMB)

A

ONLY if results would change treatment plan

(Just know general thoughts of pic)

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27
Q

When would we use a Cardiac MRI?

A

Test extent of inflammation, necrosis, scarring
Check ventricular size and shape

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28
Q

MCC of NONinfectious myocarditis

A

Medications
Illicit drugs
Toxic substances

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29
Q

If someone has myocardial injury from toxic agent and LVEF is >40%, what is treatment?

A

Monitor

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30
Q

If someone has myocardial injury from toxic agent and LVEF <40% or Heart Failure is present, what is treatment?

A

Refer- Cardiology
ACEI, BB, NSAIDs
Abx is bacteiral cause
If severe enough, transplant

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31
Q

T/F: IVIG and antivirals have shown benefit to treating myocarditis

A

FALSE

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32
Q

What is the MC CM?

A

Dilated CM

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33
Q

Who is dilated CM MC in?

A

Black population

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34
Q

What defines Dilated CM?

A

LVEF<40% WITHOUT CAD or Valvular dx

(Has dilation and impaired contraction)

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35
Q

What is the #1 reason for heart transplant?

A

Dilated Cardiomyopathy

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36
Q

MCC of Dilated CM?

A

Idiopathic

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37
Q

What are some infectious causes of Dilated CM?

A

Viral
Bacterial
Chagas Disease (protozoa)
Lyme Disease

38
Q

If Dilated CM is due to a genetic cause, is it dominant or recessive?

A

Dominant usually

39
Q

T/F: Myocarditis can cause Dilated CM

A

True

40
Q

T/F: Tachycardia can induce Dilated CM

A

True

41
Q

T/F: Peripartum CM cannot cause Dilated CM

A

False

42
Q

How does Dilated CM present?

A

S/Sx of right and left heart failure

43
Q

Physicial Exam of Dilated CM

A

Rales
High JVP
S3 gallop
Mitral or Tricuspid regurg
Peripheral edema
Ascites
Pulsus alternans
LBBB

44
Q

Can Dilated CM cause sudden death?

A

Yes

45
Q

How to diagnose Dilated CM?

A

BNP or NT-proBNP- will tell us prognosis and severity
Echo- will confirm ventricular dilation, low LV systolic function, or pulm HTN

46
Q

Dilated CM Treatment

A

Tx underlying cause
Manage Heart Failure
Prevent Sudden cardiac arrest
Heart transplant

47
Q

Restrictive CM is characterized by what?

A

NON-dilated ventricle with impaired filling

48
Q

What is wrong with the ventricular walls with Restrictive CM?

A

Fibrotic or infiltrated by something

49
Q

What kind of dysfunction occurs in Restrictive CM? Systolic or Diastolic?

A

Diastolic Dysfunction

50
Q

T/F: Restrictive CM is common in United States

A

False

51
Q

What are possible etiologies for Restrictive CM?

A

Infiltrative Dx:
Amyloidosis, Sarcoidosis, Fat Build-up

Storage Dx:
Hemochromatosis(excess iron storage)
Fabry Disease (X-linked dx causing excess lipid deposition)

Radiation, Chemo, Carcinoid Heart Dx, Hypereosinophilic Syndrome

52
Q

How does Restrictive CM present?

A

Right Heart Failure
-JVD
-Edema
-Ascites
-Hepatic enlargement
-Kussmaul’s sign

53
Q

How to diagnose with Restrictive CM?

A

Echo or Cardiac MRI
(Biopsy can be considered)

54
Q

How to treat Restrictive CM?

A

Tx underlying cause
Diuretics to Reduce Pulm & systemic congestion

55
Q

Hypertrophic CM is caused by what?

A

Sarcomere gene mutations

56
Q

Hypertrophic CM is characterized by what?

A

LVH NOT caused by pathologic loading disease (like HTN or Aortic stenosis)

57
Q

Hypertrophic CM is commonly seen in who?

A

Young athletes having cardiac arrest during practice

58
Q

What part of the heart is most involved in Hypertrophic CM?

A

Interventricular septum is huge which causes LV outflow obstruction= impaired filling =decreased systemic blood flow

59
Q

How does Hypertrophic CM present?

A

SAD! Syncope, Angina, Dyspnea

60
Q

What murmur may be heard with Hypertrophic CM?

A

Mid-systolic, harsh 3/4 intercostal
is LOUDER with valsalva (bc we have decrease blood flow and septum is in the way)
is QUIETER with squatting (bc gets interventricular septum out of the way and gives blood more room to leave the ventricle)

61
Q

How to diagnose Hypertrophic CM?

A

1) Echo= LV wall>1.5cm thick

EKG= LVH pattern

62
Q

How to treat Hypertrophic CM?

A

Avoid volume depletion
Restrict Activity
Beta Blocker or Verapamil (relaxes contractility)
Surgery- septal myectomy or alcohol septal ablation

Also screen 1st degree relatives

63
Q

What medications should we avoid with Hypertrophic CM?

A

Diuretics
Vasodilators

64
Q

MCC of Heart Failure in United States

A

Ischemic Cardiomyopathy

65
Q

What causes Ischemic CM?

A

Reduced Oxygen causing damage/death of myocardium

66
Q

MCC of Ischemic CM

A

CAD

(Can also be caused by cocaine, vasospasm or thrombus)

67
Q

Ischemic CM is characterized by what dysfunction?

A

Systolic dysfunction- usually LV

68
Q

How does Ischemic CM present?

A

CHF- edema, dyspnea, JVD

69
Q

How to diagnose Ischemic CM?

A

First-Line: Coronary angiography

Echo- low LVEF, regional wall motion abnormality

70
Q

What could possibly be on EKG with Ischemic CM?

A

Q waves

71
Q

What may present on CXR for Ischemic CM?

A

Pulm edema

72
Q

How to treat Ischemic CM

A

Revascularize with PCI or CABG
Heart Failure tx if needed
Prevent Sudden Cardiac Attack
-External defibrillator
-Implanted defibrillator

73
Q

What could we do if we want to know what is causing myocardial dysfunction in Ischemic CM?

A

Nuclear viability study
Will tell us if it is due to scarring or hibernating myocardium

74
Q

What characterizes Arrhythmogenic RV CM?

A

Inherited Dominant trait causing Ventricular arrhythmia

75
Q

What happens to the RV in Arrhythmogenic RV CM?

A

RV free wall myocardium replaced by fibrous or fatty tissue with causes RV dilation and myocardial thinning

76
Q

Average age of presentation of Arrhythmogenic RV CM

A

30yo

77
Q

Presentation of Arrhythmogenic RV CM

A

Palpitations, syncope, CP, Dyspnea, Suddent Cardiac Arrest

(Can be asymptomatic)

78
Q

MC arrhythmia with Arrhythmogenic RV CM

A

Ventricular Tachycardia with LBBB pattern

79
Q

How do diagnose Arrhythmogenic RV CM?

A

Echo and cardiac MRI

80
Q

How to treat arrhythmogenic RV CM

A

Antiarrhythmics, ablation or Implanted defibrillator
Manage heart failure sx
Transplant if severe

81
Q

Left Ventricular Noncompaction cause

A

Congenital issue causing altered myocardial wall

82
Q

T/F: Left ventricular noncompaction is common

A

False! Very rare

83
Q

How does LV Noncompaction present?

A

CHF, Thromboembolism, Ventricular arrhythmia

84
Q

How to diagnose LV Noncompaction

A

Echo to check
Confirm with Cardiac MRI

85
Q

How to treat LV Noncompaction

A

Consider heart transplant

86
Q

Stressed Induced CM aka

A

Broken Heart Syndrome :(
Takotsubo CM

87
Q

What causes Stressed Induced CM?

A

Surge of catecholamine because of psychological or physical stress

88
Q

Who typically experiences Stressed Induced CM?

A

Post menopausal women

89
Q

How to diagnose Stress Induced CM?

A

Echo or LV angiography which show LV apical ballooning

90
Q

Treatment for Stressed Induced CM

A

Beta blockers for 1 year
Usually will recover in a few weeks

CV (6 decks)

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