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MHD block 4 > Cardiomyopathy > Flashcards

Cardiomyopathy Flashcards

1
Q

what are the 3 types of cardiomyopathy

A

Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy

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2
Q

Cardiomyopathy

A

Primary abnormality of the myocardium

Cardiac dysfunction not attributable to pressure or volume overload (issue with the muscle itself)

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3
Q

which type of cardiomyopathy is the most common

A

dilated cardiomyopathy

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4
Q

features of dilated cardiomyopathy

A

Contractile (systolic) dysfunction (biventricular failure)
Four chamber dilatation
2-3x normal weight

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5
Q

treatment for dilated cardiomyopathy

A 
medical therapy (meds)
heart transplant
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6
Q

Hypertrophic cardiomyopathy is also called what 2 other names

A

“Idiopathic hypertrophic subaortic stenosis” (IHSS)

“Hypertrophic obstructive cardiomyopathy” (HOCM)

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7
Q

what is the main feature of hypertrophic cardiomyopathy

A

Marked LV myocardial hypertrophy

Septum > free wall hypertrophied = Banana shaped LV cavity

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8
Q

how does hypertrophic cardiomyopathy affect the hearts function

A

Abnormal diastolic filling

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9
Q

describe the gross and histologic findings in hypertrophic cardiomyopathy

A

Asymmetric septal hypertrophy - narrow LV chamber

histological : Hypertrophied myocytes (large cells and nuclei), Haphazard pattern, Interstitial fibrosis (hypertrophy + disorder is unique to hypertrophic cardiomyopathy)

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10
Q

is there a genetic component to Hypertrophic cardiomyopathy

A

yes - nearly 100% familial
Autosomal dominant (Variable expression)
Mutations in genes that encode proteins of sarcomeres

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11
Q

both dilated and hypertrophied cardiomyopathy lead to higher risks of

A

heart failure
sudden death
atrial fibrillation
stroke

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12
Q

signs of Hypertrophic cardiomyopathy

A 
Diastolic heart failure
Exertional dyspnea
Harsh systolic ejection murmur
Anginal pain
Intractable heart failure
Arrhythmias
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13
Q

Hypertrophic cardiomyopathy treatment

A

Medical therapy enhancing ventricular relaxation (beta blockers, and Ca channel blockers)
Surgical excision of muscle (septum)

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14
Q

Restrictive Cardiomyopathy

A

Primary decrease in ventricular compliance

Impeded left ventricular filling during diastole
Systolic function preserved

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15
Q

Restrictive Cardiomyopathy characteristics of the heart anatomy

A

Firm/stiff myocardium
-Ability of LV cavity to expand markedly limited

LV cavity normal size
LA size increased

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16
Q

Amyloid

A

Misfolded protein
Deposits in extracellular space
Causes tissue damage

Multiple proteins can deposit as amyloid

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17
Q

Common features of amyloid deposits, regardless of the protein

A

“β-pleated sheet” configuration

Congo red staining in tissue- looks salmon
“apple-green” under polarized light

18
Q

restrictive cardiomyopathy is caused by

A

amyloid deposits in the heart muscle

19
Q

restrictive cardiomyopathy signs and symptoms are due to

A

reduced myocardial compliance and stroke volume

amyloids make the tissue stiff and less contractile

20
Q

Myocarditis

A

Inflammatory process resulting in myocardial injury

21
Q

myocarditis is most commonly caused by

A

Enteroviruses - Coxsakie A and B

Most common etiology in US

22
Q

myocarditis is caused by what types of organisms

A

viruses
bacteria
parasites

can also be immune mediated

23
Q

common causes of immune mediated myocarditis

A 
hypersenstivity reactions
rheumatic fever (characteristicly has aschoff bodies)
24
Q

what are the histologic differences between etiologies of myocarditis

A

viral - see lots of lymphocytes
hypersensitivity - see eosinophils
parasites- see the organism within the myocytes

25
Q

myocarditis clinical presentations

A

large range may be asymptomatic or have nonspecific symptoms like fatigue or fever or can be critically ill or sudden cardiac death

Acute congestive heart failure
Arrhythmias
Progression to dilated cardiomyopathy (can occur years after the infection)

26
Q

Pericardial Effusion

A

accumulation of fluid within the pericardial sac. Can be clear yellow serous fluid, blood, or pus

27
Q

symptoms of slow accumulating pericardial effusion

A
28
Q

rapidly developing pericardial effusion

A

Compress atria and vena cavae
Compress ventricles
Restrict cardiac filling
Cardiac tamponade*

29
Q

Pericarditis

A

Inflammation of pericardium

Usually secondary to cardiac, thoracic, or systemic process

30
Q

causes of pericarditis

A

Infections
Viruses, Bacteria, TB, Fungi, Parasites

Immune-Mediated Reactions
Rheumatic fever, SLE, Post-cardiotomy, Post-myocardial infarction, drug hypersensitivity

Uremia
Neoplasia
Trauma
Radiation

31
Q

Dressler syndrome

A

is a secondary form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart). It consists of fever, pleuritic pain, pericarditis and/or a pericardial effusion.

32
Q

Fibrinous Pericarditis characteristics

A

Pericardial surface irregular, “shaggy”
Acute viral pericarditis
Uremia
Acute rheumatic fever (bread and butter pericarditis)

Exam:
Pericardial friction rub

33
Q

Suppurative (Fibrinopurulent) Pericarditis

A

Acute bacterial infection (lots of neutrophils)
Extension (primarily of the heart)
Seeding

34
Q

Hemorrhagic Pericarditis

A

Tuberculosis

Malignancy

35
Q

Pericarditis symptoms

A 
Silent
Chest pain (worse laying down, better sitting up)
Systemic complaints
Friction rub
EKG changes  (diffuse ST elevation)
36
Q

Pericarditis symptoms

A 
Silent
Chest pain (worse laying down, better sitting up)
Systemic complaints
Friction rub
EKG changes  (diffuse ST elevation)
37
Q

Pericarditis healing process

A

Focal plaque-like thickening
Mild adhesions
Constrictive pericarditis

Pericardial space obliterated

  • Heart surrounded by dense scar
  • Diastolic expansion limited - Reduced cardiac output (TB, suppurative)

ultimately a fibrotic process - makes the pericardia constrictive

38
Q

Constrictive Pericarditis treatment

A

Pericardiectomy

Surgical removal of constricting pericardium

39
Q

Cardiac Transplantation complications

A

Acute Rejection
Chronic rejection
Infections
Post transplant lymphoma (Epstein-Barr virus)
Late progressive diffuse stenosing intimal proliferation of coronary arteries

70-80% 1 year survival
>60% 5 year survival

40
Q

How are “heart biopsies” obtained?

A

Bioptome inserted transvenously into right side of heart

Septal endomyocardium biopsied

MHD block 4 (9 decks)

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