Cardiomyopathy Flashcards

Question

How can chemotherapy affect the heart?

Answer 1

Irreversible cardiomyopathy (e.g. anthracycline derivatives for breast cancer, sarcomas, lymphomas; cyclophosphamide for lymphomas, leukemias; pacitaxel for breast cancer); in some cases - Reversible (monoclonal antibodies such as trastuzumab for Her2 (+) breast cancer; small molecule tyrosine kinase inhibitors)

Answer 2

1.Acute, within days: EKG changes, LV dysfunction is usually transient and reversible. 2.Late-onset: ventricular dysfunction and arrhythmias; irradiation increases risk. 3.Dilated cardiomyopathy: cumulative, dose dependent, irreversible, progressive. Overall incidence of severe CHF is 2-3%. Causes cytoplasmic vacuoles

Answer 3

1 in 500 people (most common genetic cardiovascular disease) –Incidence is about 0.2% to 0.5% of general population. •An estimated 600,000 to 1.5 million Americans have HCM. •HCM can present at anytime in any age of life •Most people are not aware they have HCM because symptoms can go unnoticed and most people with the disease live healthy, normal lives

Answer 4

Systole –dynamic outflow tract gradient; Diastole –impaired diastolic filling, increased filling pressure; Myocardial ischemia – increased muscle mass, filling pressure, O2 demand; decreased vasodilator reserve, capillary density; abnormal intramural coronary arteries; systolic compression of arteries; Mitral Regurgitation; Arrhythmias

Answer 5

* Chest pain * Fainting, especially during exercise * Light-headedness or dizziness, especially after activity or exercise * Palpitations * Shortness of breath * Fatigue, reduced activity tolerance * Shortness of breath * Heart failure

Answer 6

Asymptomatic, echocardiographic finding; Symptomatic: dyspnea in 90%, angina pectoris in 75%, fatigue, pre-syncope, syncope, increased risk of SCD in children and adolescents; palpitation, PND, CHF, dizziness less frequent

Answer 7

- Apex localized, sustained •Palpable S4 •Tripple ripple •Prominent “a” wave •Rapid upstroke carotid pulse, “jerky” bifid (spike-and-dome pulse) •Harsh systolic ejection murmur across entire precordium to the apex & heart base •MR: separate murmur: severity of MR related to degree of outflow obstruction

Answer 8

•First discovered in the 1950s •Autosomal dominant trait –Mutations in genes that encode one of the sarcomere proteins including - More than 400 mutations in these genes. –Frequency: 45% of mutations occur in beta myosin heavy chain gene, 35% involve cardiac myosin binding protein C gene. Males and females equally affected Onset of clinical symptoms is delayed until adolescence or early adulthood Certain mutations (and certain clinical features) are highly predictive of sudden death

Answer 9

HCM can be asymmetric, Athlete is concentric and regresses; HCM wall thickness 15+ mm, Athlete less than 15; LA in HCM 40+; LVEDD in HCM less than 45; diastolic function in HCM is always abnormal vs normal in athletic heart

Answer 10

Annual mortality 3% in referral centers, probably closer to 1% for all patients; Risk of SCD higher in children may be as high as 6% per year – Majority have progressive hypertrophy; Adults - 2-3% SCD per year, Adolescents - 4-6% SCD per year, Infants (less than 1 yr old), mortality = 50%; Clinical deterioration usually is slow; Progression to DCM occurs in 10-15%

Answer 11

* Massive LVH (e.g > 30 mm) * Family history of sudden death * Unexplained/recurrent syncope * Nonsustained VT (Holter Monitoring) * Drop in blood pressure during exercise

Answer 12

Follow closely, implantable cardioverter-defibrillator if high risk of sudden death, meds if a fib or progressive heart failure symptoms