Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CSI- Winter > Cardiomyopathy > Flashcards

Cardiomyopathy Flashcards

1
Q

Case presentation

A

19 y/o Male, presents to your office with complaints of palpitations and occasional chest pain especially when he has been practicing for his football team

Fam Hx: Uncle passed away at age 25, Cousin has heart problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Definition of cardiomyopathy

A

a heterogeneous group of diseases of the myocardium associated with mechanical &/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and are due to a variety of causes that frequently are genetic. Cardiomyopathies either are confined to the heart or are a part of generalized systemic disorders, often leading to cardiovascular death or progressive heart failure-related disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dilated cardiomyopathy

A

Dilatation and impaired contraction of the left or both ventricles (chamber enlargement)

  • Ventricular dilation, hypokinetic left ventricle, and systolic dysfunction
  • can be inherited
  • congestive presentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hypertrophic cardiomyopathy

A

Left and/or right ventricular hypertrophy, often asymmetrical, which usually involves the interventricular septum.

-Inappropriate myocardial hypertrophy, with or without left ventricular obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Restrictive cardiomyopathy

A

Restricted filling and reduced diastolic size of either or both ventricles with normal or near-normal systolic function.

-Abnormal ventricular filling with diastolic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Arrhythmogenic right ventricular cardiomyopathy

A

Progressive fibro-fatty replacement of the right ventricle

-Fibroadipose replacement of right ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Common causes of Dilated Cardiomyopathy

A
  1. Idiopathic
  2. Toxin induced (alcohol, anthracycline, cobalt, catecholamines)
  3. Radiation
  4. Infection (viral, HIV, parasite)
  5. Metabolic (starvation, thiamine deficiency like beriberi, thyrotoxicosis)
  6. Sarcoidosis
  7. Hemochromatosis
  8. Peripartum/postpartum
  9. Genetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Dilated cardiomyopathy incidence

A
  • most common of all
  • myocyte injury and fibrosis
  • Third most common cause of heart failure
  • Middle age, men > women
  • Annual mortality: 12% !
  • Most frequent cause of heart transplantation
  • complete recovery is rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

S/S of Dilated cardiomyopathy

A
  1. Pulmonary congestion-left heart failure: dyspnea (rest, excertional, nocturnal), orthopnea
  2. Systemic congestion- right heart failure: edema, nausea, abdominal pain, nocturia
  3. Hypotension (low CO), tachycardia, tachypnea, fatigue and weakness
  4. Arrhythmia
    Atrial fibrillation, conduction delays, complex PVC’s, sudden death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

During dilated cardiomyopathy cardiac exam shows

A

S3, S4 and murmur of TR and/or MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CXR

A

shows enlarged heart, CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment for dilated cardiomyopathy

A
  • Limit activity based on functional status
  • Salt restriction
  • Fluid restriction
  • Diuretics
  • Beta Blockers, ACE/ARB (improve mortality)
  • Hydralazine/nitrate combination if cannot tolerate ACE/ARB
  • Spironolactone if EF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dilated cardiomyopathy is the most common indication for ________

A

cardiac transplantation
Survival after transplant is
80% one year
70% 5 years

-or can do left vent reshaping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

People with Hypertrophic Cardiomyopathy (HCM) also have:

A
  • Small LV cavity
  • septal hypertrophy (huge)
  • systolic anterior motion of the mitral valve leaflet +/- obstruction of left ventricular outflow
  • low stroke volume
  • elevated EF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Usually patients with Hypertrophic Cardiomyopathy (HCM) are

A

very young

may lead to MI, mitral regurgitation or arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What type of dysfunction is Hypertrophic Cardiomyopathy and what does it lead to?

A

Diastolic dysfunction (impaired filling, increased filling pressure)

Leads to pulmonary congestion (have LV outflow obstruction and hyper dynamic systolic function bc of so much muscle, especially septum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

“Classic” feature of hypertrophic cardiomyopathy is

A

Dynamic left ventricular outflow tract obstruction

absent in about half of people and obstruction varies greatly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The severity of LV outflow obstruction increases with

hypertrophic obstructive= HOCM

A

**exercise
-positive inotropic agents
volume depletion

Anything that decreases filling:

  • *sudden assumption of upright posture
  • tachycardia
  • *Valsalva maneuver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

S/S of hypertrophic cardiomyopathy

A
  • Asymptomatic (Echo finding only)
  • Dyspnea in 90%
  • Angina pectoris in 75% (ISCHEMIC CHEST PAIN)
  • Fatigue, pre-syncope, SYNCOPE (incr. risk of SCD)
  • Palpitation, PND, CHF, dizziness
  • Atrial fibrillation, thromboembolism
  • SUDDEN CARDIAC DEATH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In HCM, ejection murmur is heard at

A

left sternal border

-does NOT radiate to the carotid arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

HCM, the EKG will show

A

*LVH (Strain pattern) and *abnormal Q waves

may see giant T wave inversions or LA enlargement, bbb or arrhythmias

22
Q

In HCM, the valsava will

A

decrease LV volume and INCREASE THE MURMUR

-standing will do this too

23
Q

In HCM, squatting will

A

increase LV volume and DECREASE THE MURMUR

24
Q

Echo findings in HCM

A
  • Echocardiogram is best test
  • Left ventricular hypertrophy > 1.3 cm
  • Septal to posterior wall ratio > 1.3:1
  • Mitral regurgitation
  • Systolic anterior motion of the mitral valve (SAM)
  • Premature midsystolic closure of the aortic valve
  • Asymmetric septal hypertrophy (ASH)
  • Diastolic dysfunction
  • Left ventricular outflow tract obstruction (LVOT)
25
Q

Recommendation when there is a family history of HCM

A

Serial ECHOs are recommended up to the age of 20 yr where there is a family history of HCM

-LVH usually develops between 5-15 y/o

26
Q

Accounts for 36% of deaths in

A

athletes

27
Q

Management of HCM

A
  • careful family history focused on sudden cardiac death
  • counseling regarding avoidance of strenuous exercise, avoidance of dehydration
  • all first-degree family members should be periodically screened with an echo
28
Q

HCM treatment

A
  1. FIRST- Beta blockers
    - CCB
    - Anti-arrhythmics – Amiodarone, disopyramide
    - Pacemakers (ICD) / Defibrillators (AICD)
    * **Myomectomy (resection of septum)
    * **Alcohol septal ablation (controlled MI through septal perforator perfusing basal septum), leads to wall thinning which decreases LV outflow obstruction
29
Q

Beta blockers help HMC by

A

*NEGATIVE inotropic effect decreases outflow gradient
-decreased myocardial demand results in reduced
ischemia
-prolonged diastolic filling time results in improved LV
filling as well as improved coronary perfusion
-may have an antiarrhythmic effect

30
Q

IN HCM, usually, signs and symptoms _____ with
age
Leading cause of death: _____________

A

increase

sudden death in asymptomatic patients

31
Q

Restrictive Cardiomyopathy (RCM) background

A
  • rare in western world
  • can affect both ventricles
  • systolic fx usually normal (especially early on)
  • SMALL ventricular cavity size
32
Q

RCM is a ________ dysfunction and involves __________

A
  • DIASTOLIC DYSFUNCTION

- elevated vent filling pressures (small ventricular cavity size)

33
Q

RCM has a ________ with impaired ventricular filling

A

rigid ventricular wall

34
Q

RCM bears some functional resemblance to _________

A

constrictive pericarditis

-Importance lies in its differentiation from operable constrictive pericarditis

35
Q

RCM is much less common then DCM or HCM outside the tropics, but frequent cause of death in ________ primarily because of the high incidence of endomyocardial fibrosis in those regions

A

Africa, India, South and Central America and Asia

36
Q

Non-infiltrative causes of RCM

A

*Idiopathic
*Scleroderma
Familial
Hypertrophic

37
Q

Infiltrative causes of RCM

A

Amyloid (most common)
*Sarcoid
Gaucher’s

38
Q

Storage disease causes of RCM

A

Hemochromatosis
Glycogen storage disease
Fabry’s

39
Q

Endomyocardial causes of RCM

A

*Endomyocardial fibrosis
*Hypereosinophilic syndrom
*Radiation
*Chemotherapy toxicity
Carcinoid
Metastatic malignancy

40
Q

Rigid myocardium –> ______ diastolic vent pressure —> venous congestion –> ________

A

increased

-Jugular venous distention, Hepatomegaly, Ascites

41
Q

Rigid myocardium–> _____ ventricular filling –>

_____ CO –> ________

A

decreased
decreased
fatigue and weakness

42
Q

in RCM, Echo shows

A
  • *thick walls, reduced systolic fxn**
  • Abnormal mitral inflow pattern
  • Prominent E wave (rapid diastolic filling)
  • Reduced deceleration time (increased LA pressure)
43
Q

procedure that is commonly necessary in RCM

A

Right heart cath

-can help with endomyocardial biopsy

44
Q

Consider RCM in any patient with

A

R sided heart failure without evidence of either cardiomegaly or systolic dysfunction

45
Q

RCM diagnosis

A

possibly biopsy

46
Q

RCM treatment

A

CHF THERAPY

  • No Clear medical therapy
  • Treat reversible causes
  • Transplant maybe only option
47
Q

GOOD TABLE COMPARING 3 ON SLIDE 56

A

slide 56

48
Q

Arrhythmogenic RV Cardiomyopathy is characterized by

A

fibroadipose replacement of segments of the free wall of the right ventricle

49
Q

Arrhythmogenic RV Cardiomyopathy is predominately found in ____

A

young adults; cause of young adult sudden death

50
Q

Arrhythmogenic RV Cardiomyopathy- all patients who are symptomatic with arrhythmias get

A

ICD implantation

CSI- Winter (44 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions