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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
What would echo look like for myocarditis?
Inflamed myocardium and r/o other causes
26
When should we do Endocardial biopsy? (EMB)
ONLY if results would change treatment plan (Just know general thoughts of pic)
27
When would we use a Cardiac MRI?
Test extent of inflammation, necrosis, scarring Check ventricular size and shape
28
MCC of NONinfectious myocarditis
Medications Illicit drugs Toxic substances
29
If someone has myocardial injury from toxic agent and LVEF is >40%, what is treatment?
Monitor
30
If someone has myocardial injury from toxic agent and LVEF <40% or Heart Failure is present, what is treatment?
Refer- Cardiology ACEI, BB, NSAIDs Abx is bacteiral cause If severe enough, transplant
31
T/F: IVIG and antivirals have shown benefit to treating myocarditis
FALSE
32
What is the MC CM?
Dilated CM
33
Who is dilated CM MC in?
Black population
34
What defines Dilated CM?
LVEF<40% WITHOUT CAD or Valvular dx (Has dilation and impaired contraction)
35
What is the #1 reason for heart transplant?
Dilated Cardiomyopathy
36
MCC of Dilated CM?
Idiopathic
37
What are some infectious causes of Dilated CM?
Viral Bacterial Chagas Disease (protozoa) Lyme Disease
38
If Dilated CM is due to a genetic cause, is it dominant or recessive?
Dominant usually
39
T/F: Myocarditis can cause Dilated CM
True
40
T/F: Tachycardia can induce Dilated CM
True
41
T/F: Peripartum CM cannot cause Dilated CM
False
42
How does Dilated CM present?
S/Sx of right and left heart failure
43
Physicial Exam of Dilated CM
Rales High JVP S3 gallop Mitral or Tricuspid regurg Peripheral edema Ascites Pulsus alternans LBBB
44
Can Dilated CM cause sudden death?
Yes
45
How to diagnose Dilated CM?
BNP or NT-proBNP- will tell us prognosis and severity Echo- will confirm ventricular dilation, low LV systolic function, or pulm HTN
46
Dilated CM Treatment
Tx underlying cause Manage Heart Failure Prevent Sudden cardiac arrest Heart transplant
47
Restrictive CM is characterized by what?
NON-dilated ventricle with impaired filling
48
What is wrong with the ventricular walls with Restrictive CM?
Fibrotic or infiltrated by something
49
What kind of dysfunction occurs in Restrictive CM? Systolic or Diastolic?
Diastolic Dysfunction
50
T/F: Restrictive CM is common in United States
False
51
What are possible etiologies for Restrictive CM?
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
How does Restrictive CM present?
Right Heart Failure -JVD -Edema -Ascites -Hepatic enlargement -Kussmaul's sign
53
How to diagnose with Restrictive CM?
Echo or Cardiac MRI (Biopsy can be considered)
54
How to treat Restrictive CM?
Tx underlying cause Diuretics to Reduce Pulm & systemic congestion
55
Hypertrophic CM is caused by what?
Sarcomere gene mutations
56
Hypertrophic CM is characterized by what?
LVH NOT caused by pathologic loading disease (like HTN or Aortic stenosis)
57
Hypertrophic CM is commonly seen in who?
Young athletes having cardiac arrest during practice
58
What part of the heart is most involved in Hypertrophic CM?
Interventricular septum is huge which causes LV outflow obstruction= impaired filling =decreased systemic blood flow
59
How does Hypertrophic CM present?
SAD! Syncope, Angina, Dyspnea
60
What murmur may be heard with Hypertrophic CM?
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
How to diagnose Hypertrophic CM?
#1) Echo= LV wall>1.5cm thick EKG= LVH pattern
62
How to treat Hypertrophic CM?
Avoid volume depletion Restrict Activity Beta Blocker or Verapamil (relaxes contractility) Surgery- septal myectomy or alcohol septal ablation Also screen 1st degree relatives
63
What medications should we avoid with Hypertrophic CM?
Diuretics Vasodilators
64
MCC of Heart Failure in United States
Ischemic Cardiomyopathy
65
What causes Ischemic CM?
Reduced Oxygen causing damage/death of myocardium
66
MCC of Ischemic CM
CAD (Can also be caused by cocaine, vasospasm or thrombus)
67
Ischemic CM is characterized by what dysfunction?
Systolic dysfunction- usually LV
68
How does Ischemic CM present?
CHF- edema, dyspnea, JVD
69
How to diagnose Ischemic CM?
First-Line: Coronary angiography Echo- low LVEF, regional wall motion abnormality
70
What could possibly be on EKG with Ischemic CM?
Q waves
71
What may present on CXR for Ischemic CM?
Pulm edema
72
How to treat Ischemic CM
Revascularize with PCI or CABG Heart Failure tx if needed Prevent Sudden Cardiac Attack -External defibrillator -Implanted defibrillator
73
What could we do if we want to know what is causing myocardial dysfunction in Ischemic CM?
Nuclear viability study Will tell us if it is due to scarring or hibernating myocardium
74
What characterizes Arrhythmogenic RV CM?
Inherited Dominant trait causing Ventricular arrhythmia
75
What happens to the RV in Arrhythmogenic RV CM?
RV free wall myocardium replaced by fibrous or fatty tissue with causes RV dilation and myocardial thinning
76
Average age of presentation of Arrhythmogenic RV CM
30yo
77
Presentation of Arrhythmogenic RV CM
Palpitations, syncope, CP, Dyspnea, Suddent Cardiac Arrest (Can be asymptomatic)
78
MC arrhythmia with Arrhythmogenic RV CM
Ventricular Tachycardia with LBBB pattern
79
How do diagnose Arrhythmogenic RV CM?
Echo and cardiac MRI
80
How to treat arrhythmogenic RV CM
Antiarrhythmics, ablation or Implanted defibrillator Manage heart failure sx Transplant if severe
81
Left Ventricular Noncompaction cause
Congenital issue causing altered myocardial wall
82
T/F: Left ventricular noncompaction is common
False! Very rare
83
How does LV Noncompaction present?
CHF, Thromboembolism, Ventricular arrhythmia
84
How to diagnose LV Noncompaction
Echo to check Confirm with Cardiac MRI
85
How to treat LV Noncompaction
Consider heart transplant
86
Stressed Induced CM aka
Broken Heart Syndrome :( Takotsubo CM
87
What causes Stressed Induced CM?
Surge of catecholamine because of psychological or physical stress
88
Who typically experiences Stressed Induced CM?
Post menopausal women
89
How to diagnose Stress Induced CM?
Echo or LV angiography which show LV apical ballooning
90
Treatment for Stressed Induced CM
Beta blockers for 1 year Usually will recover in a few weeks

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