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Cardiology > Cardiomyopathy > Flashcards

Cardiomyopathy Flashcards

1
Q

Originates from an abnormally contracting or relaxing myocardium

A

Cardiomyopathy

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2
Q

Cardiomyopathy can be

A

Dilated, hypertrophic, restrictive

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3
Q

Dilated cardiomyopathy, low EF

A

Systolic dysfunction

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4
Q

Hypertrophic cardiomyopathy, cardiac failure with preserved EF

A

Diastolic dysfunction

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5
Q

All forms of cardiomyopathy

A
  • SOB, particularly worsened by exertion
  • Edema
  • Rales
  • JVD
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6
Q

Best initial test and most accurate test for cardiomyopathy

A

Echocardiography

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7
Q
  • Should be performed

* Nothing specific on them confirm ds cardiomyopatht

A

EKG & Chest X ray

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8
Q

Murmurs NOT increasing with expiration

A
  • HOCM

* MVP

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9
Q

All cardiomyopathy treated with

A

Diuretics

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10
Q
  • Alcohol
  • Postviral myocarditis
  • Radiation
  • toxins( doxorubicin)
  • Chagas disease( Brazil)
A

Dilated cardiomyopathy

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11
Q

GALLOP, dyspnea, edema

A

Dilated cardiomyopathy ( testing same as section of CHF)

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12
Q

Meds decrease mortality dilated cardiomyopathy

A
  • ACEi / ARB
  • BB( metoprolol, carvedilol, bisoprolol)
  • Spironolactone ( or eplerenone )
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13
Q

Meds control only symptoms. Dilated cardiomyopathy

A

Diuretics& digoxin

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14
Q

QRS wide > 120 ms. Dilated cardiomyopathy

A
  • Biventricular pacemaker
  • Improve both symptoms and survival
  • automated implantable cardioverter/ defibrillator has mortality benefit
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15
Q

MCC of hypertrophic cardiomyopathy

A

HTN

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16
Q

HCM and HOCM different ds

A
  • hypertrophic cardiomyopathy

* hypertrophic obstructive cardiomyopathy

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17
Q
  • Heart hypertrophies to carry load
  • Develops difficulty “relaxing” in diastole
  • can’t relax= can’t receive blood
A

HCM: reaction to high BP

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18
Q
  • Genetic disorder
  • Abnormal shape of septum
  • Asymmetrically hypertrophied septum and valve leaflet blocks blood leaving the heart
A

Hypertrophic obstructive cardiomyopathy

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19
Q

S4 gallop
• fewer signs of R heart failure
• less ascites
• less enlargement of liver and spleen

A

Hypertrophic cardiomyopathy

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20
Q

HOCM/ presentation

A
  • Dyspnea
  • Chest pain
  • Syncope& lightheadedness
  • Sudden death
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21
Q

Worsened by increased heart rate( exercise, dehydration, diuretics)

A

HOCM

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22
Q

Worsened by decrease in left ventricular chamber size( ACE, ARB, digoxin, hydralazine, Valsalva, standing suddenly)

A

HOCM

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23
Q

Best initial test HOCM

A

Echo

• septum 1,5 thickness of posterior wall

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24
Q

Systolic anterior motion( SAM) if mitral valve i classic for… It contributes to…

A

HOCM, obstruction

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25
Q

Most accurate test for HOCM

A

Catheterization determine precise gradients of pressure across the chamber

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26
Q

EKG HOCM

A

Nonspecific ST and T wave changed are common. LVH is common. EKG can be normal in a quarter.

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27
Q

Septal Q waves in the inferior and lateral leads are common in

A

HOCM

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28
Q

Best initial tx for HOCM & HCM

A

BB

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29
Q

Help HCM but harm HOCM

A

Diuretics

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30
Q

are definitely WRONG in hypertrophic cardiomyopathy

A

Digoxin and spironolactone

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31
Q

HOCM specific tx

A

Implantable defibrillator:
• HOCM with syncope
Ablation with alcohol of septum:
• Catheter placing absolute alcohol in muscle
• Causes small infarctions
If symptoms persist=> surgical myomectomy

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32
Q

HOCM. Tx if all medical and catheter procedures fall

A

Surgical myomectomy

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33
Q

In HOCM, ACEi and diuretics don’t help

A

This is major difference bw HOCM and HCM

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34
Q

BB for HCM/ Dilated CM

A

Yes/yes

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35
Q

Diuretics for hcm/ dcm

A

+/+

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36
Q

ACEi/ARB for hcm/dcm

A

unclear benefit/ yes

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37
Q

Spironolactone for hcm/ dcm

A

No/yes

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38
Q

Digoxin for hcm/ dcm

A

No/yes

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39
Q
  • Combines worst aspects of dilated and hypertrophic cardiomyopathy
  • heart neither contracts nor relaxes
  • infiltrated with substances creating immobility
A

Restrictive cardiomyopathy

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40
Q

Restrictive cardiomyopathy

A
  • Sarcoidosis
  • Amyloid
  • hemochromatosis
  • Endomyocardial fibrosis
  • Scleroderma
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41
Q

Presentation restrictive cardiomyopathy

A
  • Dyspnea: most common
  • R heart failure
  • Ascites, edema, JVD
  • Enlargement of liver &spleen
  • pulmonary HTN: common
42
Q

Specific sign for restr cm

A

Kussmaul sign: incr JVP on inhalation

43
Q

Initial test for restrictive cardiomyopathy

A

EchoKG

44
Q

EF Restr card/ myop

A

N or elevated

45
Q

EKG restr card/myop

A

Low voltage

46
Q

“Speckling of septum on echo or cardiac MRI”

A

Amyloid( restr card/m)

47
Q

” most accurate test” restr card/m

A

Rarely done, amyloid Endomyocardial biopsy

48
Q

Tx restrictivd card/myop

A
  • treat underlying cause

* diuretics relieve some pulmonary HTN and signs of RHF

49
Q

MS AS squatting/leg raising

A

Increases murmur

50
Q

MS AS standing/Valsalva

A

Decreases

51
Q

MR AR squatting/ leg raising

A

Increases

52
Q

MR AR standing/Valsalva

A

Decreases

53
Q

Mitral valve prolapse HOCM squatting/leg raising

A

Decrease

54
Q

Mitral valve prolapse HOCM standing/ Valsalva

A

Increase

55
Q

More blood increases all murmurs except

A

MVP HOCM

56
Q

Less blood decreases all murmurs except

A

MVP HOCM

57
Q
  • Opens vessels of legs

* Decreases venous return to heart

A

Standing from a squatting position

58
Q
  • Exhalation against a closed glottis
  • Increases intrathoracic pressure
  • decreases venous return to heart
A

Valsalva

59
Q

If lesions get better from diuretic use( MR AR AS MS)

A

They will get better from standing valsalva( less)

60
Q

Stenotic& regurgitant murmurs all treated with

A

Diuretics, salt restriction

61
Q

Worsen with diuretics ( diuretics decrease LV size), standing and Valsalva worsens them( increase murmur)

A

MVP HOCM

62
Q
  • increases afterload
  • contraction of arm muscles compresses arteries
  • decreases emptying of heart
  • opposite of ACE inhibitor
A

Handgrip

63
Q

Worsens AR and MR

A

Handgrip

64
Q
  • Direct arteriolar vasodilator
  • Decreases afterload
  • Simulates ACEi or ARBs on heart
  • Valv d treated with ACEi/ ARB will improve with ..
  • improve AR MR
A

Amyl nitrate

65
Q

Fuller left ventricle

A

Handgrip

66
Q

ACEi= emptier LV

A

Amyl nitrate

67
Q

AS handgrip

A

Decreases

68
Q

AS amyl nitrate

A

Increases

69
Q

MS. Handgrip

A

No effect

70
Q

MS amyl nitrate

A

No effect

71
Q

AR handgrip

A

Increases

72
Q

AR amyl nitrate

A

Decreases

73
Q

MR handgrip

A

Increases

74
Q

MR amyl nitrate

A

Decreases

75
Q

MVProlapse handgrip

A

Decreases

76
Q

MVP amyl nitrate

A

Increases

77
Q

HOCM handgrip

A

Decreases

78
Q

HOCM amyl nitrate

A

Increases

79
Q

Handgrip and amyl nitrate have no meaningful effect on … , in the same way ACEi has no effect on …

A

MS

80
Q
  • sharp chest pain
  • changes with respiration
  • changes with position of body
  • worsened by lying flat
  • improved by sitting up
A

Pericarditis

81
Q

EKG shows ST segment elevation in all leads,

•!PR segment depression

A

Pericarditis

82
Q 
Pericarditis Tx
• treat cause
• majority idiopathic
• treated with NSAIDs( ibuprofen, naproxen)
• colchisine decreases recurrences
A

Idiopathic presumed viral, coxsackie B virus

83
Q

50 ml acutely cause

A

Tamponade

84
Q

Over weeks to months, pericardium stretches for

A

2 L of fluid

85
Q
  • Hypotension
  • Tachycardia
  • distended neck vein
  • CLEAR LUNGS
A

Pericardial tamponade

86
Q
  • Pulsus paradoxus

* Decrease of more than 10 mmHg in systolic BP on inhalation

A

Pericardial tamponade

87
Q 
EKG
Electrical alternans ( different heights of QRS complexes between beats)
A

Pericardial tamponade

88
Q

Chest X ray: Enlarged cardiac shadow expanding in both directions( “ globular heart”)

A

Pericardial tamponade

89
Q

Echocardiogram : RA and V diastolic collaps

A

Pericardial tamponade

90
Q

Right heart catheterization: equalization of pressures in diastole

A

Pericardial tamponade

91
Q

Most appropriate test to confirm pericardial tamponade

A

EchoCG

92
Q

Pericardial Tamponade TX

A
  • pericardiocentesis
  • IV fluids
  • a hole or “ window” recurrent cases
93
Q

What tx will kill pericardial tamponade pt

A

Diuretics

94
Q

Will decrease intracardiac filling pressure and may markedly worsen collapse of right side of heart

A

Diuretics

95
Q
  • Edema
  • ” heart cant fill”
  • Ascites
  • enlargement of liver and spleen
  • JVD
  • calcification on chest Xray
A

Constrictive pericarditis

96
Q

Kussmaul sign
• increase in JVD on inhalation
• Normally neck veins go down on inhalation

A

Constrictive pericarfitis

97
Q

” Knock”
•Extra heart sound in diastole
• from ventricular filling
• heart fills to its maximum, it hits the stiff, rigid pericardium with a “knock”

A

Constrictive pericarditis

98
Q

” best initial test” constrictive pericarditis

A

Chest X ray: calcification& fibrosis

99
Q

More accurate tests, but not 1st

A

CT scan or MRI

100
Q

Constr. Per. Excludes RV hypertrophy or cardiomyopathy as cause. Myocardium moves normally with constr. myocard

A

Echocardiogram

101
Q

Constr. Pericarditis Tx

A
  • diuretics( decompress filling of heart, relieves edema and organomegaly)
  • surgical removal of pericardium

Cardiology (10 decks)

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