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Cardio > Cardiomyopathy > Flashcards

Cardiomyopathy Flashcards

1
Q

Definition of Cardiomyopathy

A

Structural or functional abnormality of the myocardium, independent of any other valvular, coronary, or myocardial involvement in systemic disease.

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2
Q

Dilated Cardiomyopathy

A

Dilated LV, cardiomegaly, impaired systolic function, increased myocardial mass, increased predisposition of intra-cardiac thrombi.

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3
Q

Etiology of DCM

A

Idiopathic, viral (Coxsackie B, Parvovirus B19), Sarcoidosis, chronic alcohol abuse, hypothyroidism, muscular dystrophy.

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4
Q

Effect of DCM on EDP?

A

Decreases EDP and decreases CO – LV can’t squeeze blood out. Decrease in renal perfusion, increases in RAAS, which increases PVR and causes dilation of all 4 chambers and causes CHF.

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5
Q

Symptoms of DCM?

A

CHF! Dyspnea, orthopnea, PND, peripheral edema, fatigue.

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6
Q

Signs of DCM

A

Gallop rhythm, rales, JVD, edema, tachycardia

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7
Q

Xray of DCM shows

A

Cardiomegaly and signs of HF (boggy lungs)

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8
Q

EKG of DCM shows

A

Nothing specific, can show a number of abnormalities.

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9
Q

Echo of DCM shows

A

Chamber dilatation. Very valuable.

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10
Q

Cardiac cath of DCM

A

Do a biopsy to confirm diagnosis.

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11
Q

Treatment of DCM

A 
Diuretics to reduce preload
ACEI/ARB
Beta Blocker (actually upregulates B receptors)
Aldosterone antagonists 
Last 3 actually reduce mortality

Also need to anticoagulate

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12
Q

Hypertrophic cardiomyopathy

A

Assymetric hypertrophy of the LV septum (not caused by chronic pressure overload)

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13
Q

Etiology of hypertrophic cardiomyopathy?

A

Autosomal dominant inheritance, but much fewer people develop HCM than have the mutation, so clearly some epigenetic factors.

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14
Q

Pathology of HCM and disease states

A

Myofiber disarray -> Ventricular arrythmias –> Sudden death or syncope

LVH –> Impaired relaxation –> Increased filling pressure –> Dyspnea, also increased myocardial oxygen demand, and angina

Dynamic LV outflow obstruction –> increased systolic pressure, mitral regurg, failure to increase CO with exertion. Causes dyspnea

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15
Q

Symptoms of HCM

A

Dyspnea, angina, syncope, sudden cardiac death

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16
Q

Signs of HCM

A

S4 (ventricle is stiff, atria need to contract hard to fill)

17
Q

Effect of Valsalva on HCM systolic murmur

A

Gets louder because venous return reduces, and murmur of obstruction increases

18
Q

Effect of squatting on HCM systolic murmur

A

gets quieter because increased venous return

19
Q

Describe HCM murmur

A

Crescendo-decrescendo at LLSB

20
Q

Best diagnostic test for HCM

A

Echo, will show asymmetrical hypertrophy of the LV septum

21
Q

Treatment of HCM?

A

Beta Blockers- will decrease myocardial oxygen demand, decrease LV outflow gradient, increase diastolic filling, decrease frequency of bad ventricular beats.

Calcium channel blockers
Diuretics for overt CHF
Amiodarone for arrythmias

22
Q

What to avoid with HCM

A

Vasodilators and digoxin.

23
Q

Restrictive cardiomyopathy

A

Less common than the other two. Diastolic dysfunction with preserved systolic function. Causes horrible CHF.

24
Q

Causes of RCM

A

Noninfiltrative – idiopathic

Infiltrative – amyloidosis, sarcoidosis,

Storage- hemochromatosis

Tropical environment

25
Q

Most common etiology of RCm

A

Amyloidosis (AL) – deposition of the Ig light chain fragments secreted by a plasma cell tumor (multiple myeloma). –> primary.

Secondary amyloidosis is from Rheumatoid arthritis.

Deposition is extracellular.

26
Q

Pathophysiology of RCm

A

Increased diastolic ventricular pressure causes venous congestion.

Decreased ventricular filling causes decreased CO, causing weakness and fatigue.

27
Q

Kussmaul sign

A

Increased JVD with inspiration. Shows diastolic dysfunction

RCM has symptoms of both right and left heart failure.

28
Q

Pathology of viral dilated cardiomyopathy?

A

White spots on the outside of heart, congested vasculature.

Histology reveals lymphocytes.

29
Q

Aspergillus infection of the heart

A

Acute angle braching of septate hyphae

30
Q

Chagas disease pathology of the heart?

A

Amastigotes within the cytoplasm. Trypanosoma cruzi transmitted by the Reduviid bug.

31
Q

Giant cell myocarditis

A

Causes granuloma formation with multinucleated giant cells.

32
Q

Sarcoidosis of heart

A

Patchy white discoloration of LV, noncaseating granulomas with multinucleated giant cells.

33
Q

Pathologic feature of hypersensitivity related dilated cardiomyopathy?

A

Eosinophils

34
Q

How does alcohol cause dilated cardiomyopathy?

A

Direct toxic effect of alcohol and formaldehyde

Thiamine deficiency

Cobalt additive

No specific histologic features.

35
Q

Microscopic features of Hypertrophic Cardiomyopathy?

A

Myofibers are completely disarrayed with interstitial fibrosis.

Crissed-crossed myofibrils.

Cardio (23 decks)

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