Cardiomyopathy Flashcards
What cardiomyopathy- ventricles muscle layer is dilated
Dilated
Dilated is systolic or diastolic
Systolic- blood continues to fill but can not contract as efficiently
What cardiomyopathy- muscle of heart become thick and scared. Ventricles are smaller
Restrictive
Restrictive is systolic or diastolic
Diastolic- ventricles are smaller they can not expand or relax. they are unable to bring as much volume into the ventricle and output is decreased
What cardiomyopathy- abnormal protein myocytes that can not contract –> thickening of cells asymmetrically –> septum is hypertrophic
Hyertrophic - HOCM
Hyertrophic is systolic or diastolic
Diastolic- septum is hypertrophic and blocks blood from the left ventricle to the aorta and decreased CO
What cardiomyopathy has this patho- dysfunciton in contractile ability of myoctes leading to decrease outflow compensatory dilation of ventricles increase volume filling atria dilate decrease outflow and back up
Dilated cariomyopathy
What cardiomyopathy has this patho- bad myoctes proteins that cause decrease contractiosn of the myocetes compensatory hypertophy smaller ventricles decreased filling decreased outflow
Hyertrophic - HOCM
Why is Hyertrophic - HOCM so dangerous- what is happening in the heart to make it dangerous?
two main problems
- walls are thick and cause a filling problem that leads to intermittent outflow obstruction
- this will lead to and increased HR that is dangerous
What are causes of Dilated Cardiomyopathy
- genetics
- myocarditis- viral cox B virus * Most common
- Alcohol
- Prgnancy
- Idiopathic
Hypertrophic- HOCM is caused by what?
- Genetics
Restrictive is caused by what?
- Radiation
- idiopathic
- Infiltrated
- Open heart surgery
- Diabetes
symptoms of this cardiomyopathy- Congestive heart failure, chest pain, syncope, ascites
Dilated
symptoms of this cardiomyopathy- asymptomatic mainly, dyspnea, syncope, chest pain
Hypertrophic- HOCM
symptoms of this cardiomyopathy- Right sided heart failure> left. edema, ascites, increased JVP
Dyspnea and fatigue
Restrictive
what is the most common presenting symptom Hypertrophic- HOCM
Sudden death
What cardiomyopathy physical exam- increased JVP
S3, cardiomegaly, rales in lungs*
Dilated
What cardiomyopathy physical exam- increased JVP
S4, kussmaul sign?
Restrictive
What cardiomyopathy physical exam- S4, systolic ejection murmur increased standing up
sustained PMI
pulse is bisferiens (double peak) in the carotid
Hypertrophic- HOCM
CXR- cariomegaly and pulmonary congestion
Dilated
CXR- pulmonary congestion
*normal heart size
Restrictive
CXR- normal
Hypertrophic- HOCM
Echocardiogram- ventricular thickness
Biatrial enlargement
EF >55%
Restrictive
Caused by- inflirations of myocytes amylodiosis scarcoidosis hemachromatosis radiation
Restrictive
Echocardiogram- Increased septum ratio >1.3 : 1
left ventricular wall thickness
EF > 55%
Hypertrophic- HOCM
Treatment for Dilated Cardiomyopathy
Low sodium diet diuretics - fluid overload ACE-I BBlocker or CCB Digoxin Pacemaker Transplant
Treatment for Restrictive
Low sodium diet diuretics ACE-I BBlocker or CCB pacemaker Transplant
What other imagaing/tests besides ECHO is good to obtain with Dilated Cardiomyopathy
- Angiogram to rule out ischemia
2. Bx of heart muscle
What other imagaing/tests besides ECHO is good to obtain with Restrictive Cardiomyopathy
- Angiogram - can look like pericarditis
- BX = fibrosis and finlitration
- MRI- Gadoliniumhypernhancement
- cardica cath- high diastolic pressure mildly reduced left ventricle function
Treatment for Hypertrophic Cardiomyopathy
Low sodium diet Diuretics ACE-I BBlockers or CCB Pacemaker Transplant
What other imagaing/tests besides ECHO is good to obtain with HOCM
- Cardic cath- small, hypercontrictile left ventricle dynamic outflow gradient and diastolic dysfunciton
What other imaging/tests besides ECHO is good to obtain with HOCM
- Cardic cath- small, hypercontrictile left ventricle dynamic outflow gradient and diastolic dysfunciton
What cardiomyopathy is caused by a infection process leading to inflammation of the myocardium
Myocarditits
Caused by virus * most common Cardiotoxins- alcohol or toxin hypersenitivity perdispoition
Myocarditits
What cardiomyopathy - left ventricle apical ballooning from high catecholamine rush
Tasko-Tsubo
Caused by Post-meopausal women surgery hypoglycemia earthquake emotional stress
Tasko-Tsubo
What cardiomyopathy - occurs in the last month of pregnancy or the first 5 months post-partum
Peripartum cardiomyopathy - PPCM
Caused by
etiology unknown but likely multifactorial
altered prolactin processing
Peripartum cardiomyopathy - PPCM
What cardiomyopathy - caused by fibrofatty replacement of the right ventricle myocardium can cause sudden cardiac death in young athletes
Arrhythmogenic Right Ventricular Cardiomyopathy
ARVC
Symptoms of this cardiomyopathy- Orthopena, paroxymal noctural dyspnea, cough, pedal edema, fatigue, signs of heart failure
Peripartum cariomyopathy - PPCM
Symptoms of this cardiomyopathy- Mimics acute MI
angina, dyspnea, EKG changes, Elevated cardic enzymes
Tasko-Tsubo
Caused by fibrous fat replacing myocardium leading to wall motion abnormalities
Right ventricle will dilated and thin causing an arrhythmia
Arrhythmogenic Right Ventricular Cardiomyopathy
ARVC
Symptoms of this cardiomyopathy-
most common asymptomatic
palpitations, chest pain, *arrhythmia with frequent PVC’s dyspnea, syncope or sudden death
Arrhythmogenic Right Ventricular Cardiomyopathy
ARVC
Symptoms of this cardiomyopathy-Heart failure, S3, tachycardia arrhythmia followed by days-weeks of a viral infection
Myocarditits
What is the gold standard test for Myocarditits
Biopsy *
viral titers
What cardiomyopathy- left ventral apical dyskinesia
cardiac cath- left ventricular ballooning
Task-Tsubo
Treatment for Myocarditits
Treat like HF
- BBlocker
- ACE-I
- ARB
- Limit acitivty for 6 months
what medication do you need to avoid in Myocarditits
it will increase mortality !
NSAIDS - thats why you need to be sure its not pericarditis your treating
Treatment for Task-Tsubo
Rule out MI
- Asprin
- BBlockers
- ACE-I
Treatment for Peripartum Cardiomyopathy- PPCM
Treat like HF
- BBlocker
- ACE- I
- diurectis
Treatment for Arrhythmogenic Right Ventricular Cardiomyopathy
ARVC
Treat like HF
- antiarrhythmic drugs
- ICD implatation
- Activity restriction