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USMLE STEP 2 and 3 > Cardiomyopathy > Flashcards

Cardiomyopathy Flashcards

1
Q

What is Dilated Cardiomyopathy (DCM)?

A

A condition characterized by dilation and impaired systolic function of one or both ventricles, often resulting in heart failure. The ejection fraction is less than 40% due to dilation of the left ventricle. Either the left or the right ventricle can be dilated.

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2
Q

What are the etiologies of Dilated Cardiomyopathy (DCM)?

A

Ischemia, genetic mutations, alcohol, cocaine, viral myocarditis, peripartum (usually the end of pregnancy), chemotherapy (e.g., doxorubicin), and tachycardia-induced cardiomyopathy.

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3
Q

How is dilated cardiomyopathy diagnosed?

A

TTE

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4
Q

At what stages of pregnancy are patients most at risk for developing dilated cardiomyopathy?

A

Third trimester. Sometimes after childbirth.

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5
Q

What is the advice to patients of childbearing who have a history of dilated cardiomyopathy?

A

Avoid pregnancy with contraceptives until 6 months and the ejection fraction is above 50%.

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6
Q

What breast cancer medication is known to cause cardiomyopathy?

A

Trastuzumab is a monoclonal antibody used in the treatment of HER2-positive breast cancer. This is reversible.

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7
Q

Is cardiomyopathy secondary to doxorubicin reversible or irreversible?

A

irreversible

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8
Q

What medication serves to prevent or mitigate cardiomyopathy secondary to doxorubicin?

A

Dexrazoxane (iron chelator) prevents anthracycline-induced cardiotoxicity

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9
Q

What arrhythmia is associated with the development of dilated cardiomyopathy?

A

Chronic atrial fibrillation can lead to tachycardia mediated cardiomyopathy.

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10
Q

Other than viral, what infections can lead to dilated cardiomyopathy?

A

Lyme disease and Chagas.

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11
Q

What are the clinical features of Dilated Cardiomyopathy (DCM)?

A

Symptoms of heart failure (dyspnea, fatigue, orthopnea), arrhythmias, and thromboembolic events.

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12
Q

What are the characteristic ECG findings in Dilated Cardiomyopathy (DCM)?

A

Non-specific ST-T wave changes, left bundle branch block (LBBB), or atrial fibrillation.

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13
Q

What imaging findings are seen in Dilated Cardiomyopathy (DCM)?

A

Echocardiogram: Dilated ventricles with reduced ejection fraction.
MRI: Late gadolinium enhancement in non-ischemic patterns.

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14
Q

What is the management of Dilated Cardiomyopathy (DCM)?

A

HFrEF management with ACE inhibitors, beta-blockers, diuretics, aldosterone antagonists, anticoagulation if atrial fibrillation or thrombi present. Consider ICD for severe cases.

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15
Q

What is Hypertrophic Cardiomyopathy (HCM)?

A

A genetic condition characterized by asymmetric left ventricular hypertrophy, often involving the interventricular septum, leading to diastolic dysfunction.

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16
Q

What are the etiologies of Hypertrophic Cardiomyopathy (HCM)?

A

Autosomal dominant mutations in sarcomere proteins (e.g., MYH7, MYBPC3); associated with sudden cardiac death in young athletes.

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17
Q

What are the clinical features of Hypertrophic Cardiomyopathy (HCM)?

A

Dyspnea, chest pain, syncope, palpitations; increased risk of sudden cardiac death during exertion.

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18
Q

What are the characteristic ECG findings in Hypertrophic Cardiomyopathy (HCM)?

A

Left ventricular hypertrophy (LVH), deep narrow Q waves in lateral leads, or T-wave inversions.

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19
Q

What imaging findings are seen in Hypertrophic Cardiomyopathy (HCM)?

A

Echocardiogram: Asymmetric septal hypertrophy. MRI: Myocardial fibrosis (late gadolinium enhancement).

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20
Q

What is the management of Hypertrophic Cardiomyopathy (HCM)?

A

Beta-blockers, calcium channel blockers (e.g., verapamil) for symptom relief. Avoid dehydration. ICD for high-risk patients.

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21
Q

What is Restrictive Cardiomyopathy (RCM)?

A

A group of disorders characterized by impaired ventricular filling due to reduced myocardial compliance, often resulting in diastolic heart failure (HFpEF).

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22
Q

What are the etiologies of Restrictive Cardiomyopathy (RCM)?

A

Infiltrative diseases (e.g., amyloidosis, sarcoidosis), storage diseases (e.g., hemochromatosis), or Fabry disease.

23
Q
A
24
Q

What are the clinical features seen with all Restrictive Cardiomyopathies (RCM)?

A

Fatigue, dyspnea, right-sided heart failure symptoms (e.g., ascites, peripheral edema); preserved systolic function.

25
Q

What symptoms are most prominent in patients with restrictive cardiomyopathy?

A

right sided heart failure symptoms.

26
Q

How is restrictive cardiomyopathy diagnosed?

A

TTE

27
Q

What is unique about the cardiomyopathy associated with hemochromatosis?

A

This can lead to both restrictive and dilated cardiomyopathy.

28
Q

What is the most common form of restrictive cardiomyopathy?

A

The most common form of restrictive cardiomyopathy (RCM) is amyloidosis.

29
Q

What is Restrictive Cardiomyopathy due to Amyloidosis?

A

A specific type of restrictive cardiomyopathy caused by amyloid protein deposition in the myocardium, leading to stiffness and reduced compliance.

30
Q

What type of underlying heart failure is associated with restrictive cardiomyopathy secondary to amyloidosis?

A

Amyloidosis is associated with heart failure with preserved ejection fraction (HFpEF).

31
Q

What characteristic finding is seen on ECHO with amyloidosis leading to restrictive cardiomyopathy?

A

Speckled

32
Q

What is observed on EKG and ECHO with amyloidosis induced restrictive cardiomyopathy?

A

Low voltage ECG, and ventricular wall thickening on echocardiogram.

33
Q

What are the characteristic ECG findings in Restrictive Cardiomyopathy (RCM)?

A

atrial fibrillation, or nonspecific ST-T wave changes.

34
Q

Which two restrictive cardiomyopathies are associated with Low voltage QRS complexes?

A

1) Amyloidosis: The deposition of amyloid fibrils within the myocardial tissue leads to electrical dissociation, meaning the thickened myocardium does not generate high voltage signals, resulting in a paradoxically low QRS voltage despite ventricular wall thickening seen on echocardiography.

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2) Sarcoidosis (sometimes): If extensive fibrosis infiltrates the myocardium, it can cause conduction abnormalities and occasionally low voltage.

35
Q

What atrial structural changes are seen with restrictive cardiomyopathy?

A

Bilateral atrial enlargement.

36
Q

What imaging findings are seen in Restrictive Cardiomyopathy (RCM)?

A

Echocardiogram: Biatrial enlargement, normal or reduced ventricular size, restrictive filling pattern.

37
Q

What is the management of Restrictive Cardiomyopathy (RCM)?

A

Treat underlying cause (e.g., amyloidosis, hemochromatosis), diuretics for volume overload, or heart transplantation in severe cases.

38
Q

What are the etiologies of Restrictive Cardiomyopathy due to Amyloidosis?

A

Caused by systemic amyloidosis (e.g., AL amyloidosis, transthyretin [ATTR] amyloidosis).

39
Q

What are the clinical features of Restrictive Cardiomyopathy due to Amyloidosis?

A

Symptoms of heart failure with preserved ejection fraction, low voltage QRS on ECG, and pseudoinfarction patterns.

40
Q

What are the characteristic ECG findings in Restrictive Cardiomyopathy due to Amyloidosis?

A

Low voltage QRS, pseudoinfarction patterns (Q waves), and conduction abnormalities (e.g., AV block).

41
Q

What imaging findings are seen in Restrictive Cardiomyopathy due to Amyloidosis?

A

Echocardiogram: Thickened myocardium with a ‘speckled’ appearance. MRI: Diffuse late gadolinium enhancement.

42
Q

What is the management of Restrictive Cardiomyopathy due to Amyloidosis?

A

Treat underlying amyloidosis (e.g., chemotherapy for AL amyloidosis or tafamidis for ATTR amyloidosis).

43
Q

What is Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?

A

A genetic cardiomyopathy affecting the right ventricle, characterized by fibrofatty replacement of the myocardium and risk of arrhythmias.

44
Q

What are the etiologies of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?

A

Mutations in desmosomal proteins (e.g., plakoglobin, desmoplakin), typically inherited in an autosomal dominant pattern.

45
Q

What are the clinical features of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?

A

Palpitations, syncope, ventricular tachycardia, and risk of sudden cardiac death; right-sided heart failure in advanced cases.

46
Q

What are the characteristic ECG findings in Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?

A

T-wave inversions in right precordial leads (V1-V3), epsilon waves, or ventricular arrhythmias.

47
Q

What imaging findings are seen in Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?

A

Echocardiogram: RV dilation, reduced function, and regional wall motion abnormalities. MRI: Fibrofatty infiltration.

48
Q

What is the management of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?

A

Implantable cardioverter-defibrillator (ICD) for arrhythmia prevention, beta-blockers, and antiarrhythmic drugs (e.g., sotalol).

49
Q

What is Stress-Induced (Takotsubo) Cardiomyopathy?

A

A transient form of cardiomyopathy triggered by acute stress, often presenting with apical ballooning on imaging and reversible left ventricular dysfunction.

50
Q

What are the risk factors for Stress-Induced (Takotsubo) Cardiomyopathy?

A

Emotional or physical stress, hypoglycemia, catecholamine surge, or postmenopausal status.

51
Q

What are the clinical features of Stress-Induced (Takotsubo) Cardiomyopathy?

A

Acute chest pain, dyspnea, ST-elevation on ECG mimicking myocardial infarction; no obstructive coronary disease.

52
Q

What are the characteristic ECG findings in Stress-Induced (Takotsubo) Cardiomyopathy?

A

ST-elevation in anterior leads, prolonged QT interval; resolves as function improves.

53
Q

What imaging findings are seen in Stress-Induced (Takotsubo) Cardiomyopathy?

A

Echocardiogram: Apical ballooning and ventricular dyskinesia, with normal coronary arteries.
MRI: No late gadolinium enhancement.

54
Q

What is the management of Stress-Induced (Takotsubo) Cardiomyopathy?

A

Supportive care with beta-blockers, ACE inhibitors, and resolution of stressors. Typically resolves within weeks.

USMLE STEP 2 and 3 (156 decks)

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