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clinical medicine II > cardiomyopathy > Flashcards

cardiomyopathy Flashcards

1
Q

what is cardiomyopathy

A

an abnormality of heart function secondary to changes in the structure of the heart muscle

  • can result in no symptoms, mild, moderate, or severe symptoms of heart failure
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2
Q

what are the three types of cardiomyopathy

A
  1. dilated
  2. hypertrophic
  3. restrictive
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3
Q

what is the leading cause of “congestive heart failure”

A

dilated cardiomyopathy

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4
Q

does ventricular dysfunction caused by coronary disease (ischemic cardiomyopathy) fall under cardiomyopathy

A

No, may look the same, but has a different cause

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5
Q

name some causes of dilated cardiomyopathy

A
  • ideiopathic
  • infectious - cocksackie, adenovirus
  • alcoholism
  • uncontrolled tachycardia
  • chemotherapy
  • cocaine
  • peripartum/post-partum (3rd trimester-6 months post)
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6
Q

what are the diagnostic criteria for idiopathic dilated cardiomyopathy

A
  • EF < 45% or FS (fractional shortening) <25%
  • LVEDD (end diastolic dimension) > 117% of predicted

make sure idiopathic: always ask about alcohol and cocaine use

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7
Q

define idiopathic cardiomyopathy

A
  • disease of unknown etiology that principally affects myocardium
  • LV dilated and systolic dysfunction
    • increased heart size and weight
    • ventricular dilation, usually normal wall thickness
  • can be post-viral or unknown genetic
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8
Q

what patient population is most affected by idiopathic cardiomyopathy

A
  • blacks: whites 2:1
  • men:women 3:1
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9
Q

alcoholic cardiomyopathy accounts for what percentage of clinical DCM

A

1/3

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10
Q

what is the risk for SVT in patients who drink > 6 drinks/day

A

2.6x

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11
Q

peripartum cardiomyopathy affects what patient population the most

A
  • twin pregnancies
  • multiparas: women who has given birth 2 or more times
  • > 30 y.o
  • african american

*subsequent pregnancies discouraged

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12
Q

what are the non-pharmalogical treatment recommendations for dilated cardiomyopathy

A
  • limit activity based on functional status
  • salt restriction of 2 g (Na+) or 5g NaCl
  • fluid restriction for significantly low Na+ levels
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13
Q

what is the primary pharmacological treatment option for dilated cardiomyopathy

A
  • ACE inhibitors
    • reduce afterload by vasodilation, BP reduction
    • underdosing is common error
    • most start with Captopril (50 mg/d in 3 divided doses)
  • Diuretics
    • watch K+ levels
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14
Q

what are some other pharmalogical treatment options you can give a patient with dilated cardiomyopathy

A
  • Digoxin: inotropic agent
  • B-blockers: if symptoms persist
  • anticoagulation for EF < 30%, h/o clots
  • antiarrhythmics
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15
Q

Putting it all together, what medication treatment should a patient with dilated cardiomyopathy put on when they are discharged home? (compensated DCM)

A
  • ACE -I afterload reduction
  • diuretics
  • B-blockers: reduce contractility
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16
Q

What is the purpose of putting someone with dilated cardiomyopathy on a beta blocker?

A
  • in heart failure, there is massive catecholamine release and constant stimulation of heart -> causes B-receptor desentisization
  • B-receptor blockers enable B-receptors to recover and let them become more efficient
    • may help prevent cardiac remodeling
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17
Q

What are the only two B-blockers approved for treatment of chronic compensated heart failure

A

Metroprolol and Carvedilol

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18
Q

what is the treatment for uncompensated dilated cardiomyopathy

A
  • inotropes
  • diuretics
  • ACE-I
  • mechanical support
  • transplantation
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19
Q

Patients with dilated cardiomyopathy are are increased risk for ventricular arrhythmias and sudden cardiac death. Patients who have a LVEF < 30% can be considered for what medical treatment

A
  • cardiac defibrillator

*regardless of symptom status

20
Q

patients with LVEF < 35%, BBB (QRS >0.12 s) and persistant heart failure sypmtoms may benefit from

A

cardiac resynchronization therapy via a biventricular pacemaker

21
Q

what is hypertrophic cardiomyopathy

A

disease of cardiac muscle characterized by severe myocardial hypertrophy, in absence of a cause for secondary hypertrophy

  • LV is hypercontractile and during systole ejects all of its blood, with high wall stress
  • small LV cavity
22
Q

hypertrophic cardiomyopathy is familial, and inherited in 60% of cases, what is the genetic trait

A
  • autosomal dominant
23
Q

symptoms of hypertrophic cardiomyopathy are similar to what other cardiac condition

A
  • vavlular Aortic stenosis
    • symptoms: dyspnea, syncope, angina, palpitations
24
Q

how is murmur in hypertrophic cardiomyopathy differ from vavular AS?

A
  • murmur is similar but LOUDER if patient STANDS or VALSALVAS
25
Q

treatment for hypertrophic cardiomyopathy

A
  • calcium channel blockers
  • beta-blockers
26
Q

how does hypertrophic cardiomyopathy lead to myocardial ischemia

A
  • increased muscle mass and filling pressure increases O2 demand
  • decrease in vasodilatory reserve
  • systolic compression of arteries
27
Q

what are the two most common symptoms in patients with hypertrophic cardiomyopathy

A
  • dyspnea (90%)
  • angina pectoris (75%)
  • fatigue, syncope
  • **increased risk of Sudden cardiac death in children and adolescents
28
Q

how do the following impact HCM murmur?

  • postextrasystolic beat
  • squatting
  • isometric handgrip exercises
A
  • postextrasystolic beat: increase contractility and increase preload: murmur is louder
  • squatting: softer
  • isometric handgrip exercises: increase afterload; murmur is softer
29
Q

what are the principe pathways of disease progression in hypertrophic cardiomyopathy

A
  • progression of symptoms
  • AFIB
  • sudden death
  • end stage with systolic dysfunction
30
Q

when is surgery for hypertrophic cardiomyopathy considered

A
  • gradient > 50 mmHg at rest
  • class III or IV heart failure

treatment options

** non-surgical alcohol septal ablation or surgical myomectomy

31
Q

what is the hallmark of restrictive cardiomyopathy

A

abnormal diastolic function

32
Q

what is restrictive cardiomyopathy

A
  • rigid ventricular wall with impaired diastolic ventricular filling
  • **can’t correct with surgery
  • least common form of cardiomyopathy
33
Q

what are the classifiations for restrictive cardiomyopathy

A
  1. idiopathic
  2. myocardial
    1. noninfiltrative
    2. infiltrative
      • amyloid
      • sarcoid
    3. storage disease
      • hemochromatosis
  3. endomyocardial
34
Q

symptoms of restrictive cardiomyopathy are consistent with

A

right and left heart failure

  • * jugular venous pulse prominent
35
Q

diagnosis of restrictive cardiomyopathy is confirmed by

A

endomyocardial biopsy

36
Q

how can you differentiate between restrictive and constrictive pericarditis

A
  • **History
    • constrictive
      • h/o TB, trauma
    • restrictive
      • amyloidosis, hemochromatosis
    • mixed
      • mediastinal radiation, cardiac surgery
37
Q

what is the most common cause of restrictive cardiomyopathy in the USA

A

amyloidosis

  • amyloid of myocardial biopsy could be due to primary amyloidosis or secondary to multiple myeloma and hypergammaglobulinemia
38
Q

hemochromatosis is characterized by

A

iron overload

39
Q

clinical presentation

  • cirrhosis, DM, hyperpigmentation, cardiac dysfunction
  • CHF-leading cause of death
A

hemochromatosis

40
Q

treatment for hemochromatosis

A
  • phlebotomy
  • chelation therapy
  • **cardiac function may normalize
41
Q

treatment of restrictive cardiomyopathy

A
  • NO satisfactory medical therapy
    • drug therapy use with caution
      • diuretics for extremely high filling pressures
    • Inotropic agents are NOT indicated
42
Q

what two conditions account for the highest percentrage of transplants

A
  • CAD
  • cardiomyopathy (majority DCM)
43
Q

what EKG changes are commonly seen in dilated cardiomyopathy

A
  • sinus tachycardia
  • L BBB
44
Q

what EKG changes are commonly seen in hypertrophic cardiomyopathy

A
  • LVH
  • septal Q waves
45
Q

what conditon causes sudden cardiac death in young athletes

A

hypertrophic cardiomyopathy

clinical medicine II (8 decks)

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