Cardiomyopathy Flashcards
1
Q
Originates from an abnormally contracting or relaxing myocardium
A
Cardiomyopathy
2
Q
Cardiomyopathy can be
A
Dilated, hypertrophic, restrictive
3
Q
Dilated cardiomyopathy, low EF
A
Systolic dysfunction
4
Q
Hypertrophic cardiomyopathy, cardiac failure with preserved EF
A
Diastolic dysfunction
5
Q
All forms of cardiomyopathy
A
- SOB, particularly worsened by exertion
- Edema
- Rales
- JVD
6
Q
Best initial test and most accurate test for cardiomyopathy
A
Echocardiography
7
Q
- Should be performed
* Nothing specific on them confirm ds cardiomyopatht
A
EKG & Chest X ray
8
Q
Murmurs NOT increasing with expiration
A
- HOCM
* MVP
9
Q
All cardiomyopathy treated with
A
Diuretics
10
Q
- Alcohol
- Postviral myocarditis
- Radiation
- toxins( doxorubicin)
- Chagas disease( Brazil)
A
Dilated cardiomyopathy
11
Q
GALLOP, dyspnea, edema
A
Dilated cardiomyopathy ( testing same as section of CHF)
12
Q
Meds decrease mortality dilated cardiomyopathy
A
- ACEi / ARB
- BB( metoprolol, carvedilol, bisoprolol)
- Spironolactone ( or eplerenone )
13
Q
Meds control only symptoms. Dilated cardiomyopathy
A
Diuretics& digoxin
14
Q
QRS wide > 120 ms. Dilated cardiomyopathy
A
- Biventricular pacemaker
- Improve both symptoms and survival
- automated implantable cardioverter/ defibrillator has mortality benefit
15
Q
MCC of hypertrophic cardiomyopathy
A
HTN
16
Q
HCM and HOCM different ds
A
- hypertrophic cardiomyopathy
* hypertrophic obstructive cardiomyopathy
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
18
Q
- Genetic disorder
- Abnormal shape of septum
- Asymmetrically hypertrophied septum and valve leaflet blocks blood leaving the heart
A
Hypertrophic obstructive cardiomyopathy
19
Q
S4 gallop
• fewer signs of R heart failure
• less ascites
• less enlargement of liver and spleen
A
Hypertrophic cardiomyopathy
20
Q
HOCM/ presentation
A
- Dyspnea
- Chest pain
- Syncope& lightheadedness
- Sudden death
21
Q
Worsened by increased heart rate( exercise, dehydration, diuretics)
A
HOCM
22
Q
Worsened by decrease in left ventricular chamber size( ACE, ARB, digoxin, hydralazine, Valsalva, standing suddenly)
A
HOCM
23
Q
Best initial test HOCM
A
Echo
• septum 1,5 thickness of posterior wall
24
Q
Systolic anterior motion( SAM) if mitral valve i classic for… It contributes to…
A
HOCM, obstruction
25
Most accurate test for HOCM
Catheterization determine precise gradients of pressure across the chamber
26
EKG HOCM
Nonspecific ST and T wave changed are common. LVH is common. EKG can be normal in a quarter.
27
Septal Q waves in the inferior and lateral leads are common in
HOCM
28
Best initial tx for HOCM & HCM
BB
29
Help HCM but harm HOCM
Diuretics
30
are definitely WRONG in hypertrophic cardiomyopathy
Digoxin and spironolactone
31
HOCM specific tx
Implantable defibrillator:
• HOCM with syncope
Ablation with alcohol of septum:
• Catheter placing absolute alcohol in muscle
• Causes small infarctions
If symptoms persist=> surgical myomectomy
32
HOCM. Tx if all medical and catheter procedures fall
Surgical myomectomy
33
In HOCM, ACEi and diuretics don't help
This is major difference bw HOCM and HCM
34
BB for HCM/ Dilated CM
Yes/yes
35
Diuretics for hcm/ dcm
+/+
36
ACEi/ARB for hcm/dcm
unclear benefit/ yes
37
Spironolactone for hcm/ dcm
No/yes
38
Digoxin for hcm/ dcm
No/yes
39
* Combines worst aspects of dilated and hypertrophic cardiomyopathy
* heart neither contracts nor relaxes
* infiltrated with substances creating immobility
Restrictive cardiomyopathy
40
Restrictive cardiomyopathy
* Sarcoidosis
* Amyloid
* hemochromatosis
* Endomyocardial fibrosis
* Scleroderma
41
Presentation restrictive cardiomyopathy
* Dyspnea: most common
* R heart failure
* Ascites, edema, JVD
* Enlargement of liver &spleen
* pulmonary HTN: common
42
Specific sign for restr cm
Kussmaul sign: incr JVP on inhalation
43
Initial test for restrictive cardiomyopathy
EchoKG
44
EF Restr card/ myop
N or elevated
45
EKG restr card/myop
Low voltage
46
"Speckling of septum on echo or cardiac MRI"
Amyloid( restr card/m)
47
" most accurate test" restr card/m
Rarely done, amyloid Endomyocardial biopsy
48
Tx restrictivd card/myop
* treat underlying cause
| * diuretics relieve some pulmonary HTN and signs of RHF
49
MS AS squatting/leg raising
Increases murmur
50
MS AS standing/Valsalva
Decreases
51
MR AR squatting/ leg raising
Increases
52
MR AR standing/Valsalva
Decreases
53
Mitral valve prolapse HOCM squatting/leg raising
Decrease
54
Mitral valve prolapse HOCM standing/ Valsalva
Increase
55
More blood increases all murmurs except
MVP HOCM
56
Less blood decreases all murmurs except
MVP HOCM
57
* Opens vessels of legs
| * Decreases venous return to heart
Standing from a squatting position
58
* Exhalation against a closed glottis
* Increases intrathoracic pressure
* decreases venous return to heart
Valsalva
59
If lesions get better from diuretic use( MR AR AS MS)
They will get better from standing valsalva( less)
60
Stenotic& regurgitant murmurs all treated with
Diuretics, salt restriction
61
Worsen with diuretics ( diuretics decrease LV size), standing and Valsalva worsens them( increase murmur)
MVP HOCM
62
* increases afterload
* contraction of arm muscles compresses arteries
* decreases emptying of heart
* opposite of ACE inhibitor
Handgrip
63
Worsens AR and MR
Handgrip
64
* Direct arteriolar vasodilator
* Decreases afterload
* Simulates ACEi or ARBs on heart
* Valv d treated with ACEi/ ARB will improve with ..
* improve AR MR
Amyl nitrate
65
Fuller left ventricle
Handgrip
66
ACEi= emptier LV
Amyl nitrate
67
AS handgrip
Decreases
68
AS amyl nitrate
Increases
69
MS. Handgrip
No effect
70
MS amyl nitrate
No effect
71
AR handgrip
Increases
72
AR amyl nitrate
Decreases
73
MR handgrip
Increases
74
MR amyl nitrate
Decreases
75
MVProlapse handgrip
Decreases
76
MVP amyl nitrate
Increases
77
HOCM handgrip
Decreases
78
HOCM amyl nitrate
Increases
79
Handgrip and amyl nitrate have no meaningful effect on ... , in the same way ACEi has no effect on ...
MS
80
* sharp chest pain
* changes with respiration
* changes with position of body
* worsened by lying flat
* improved by sitting up
Pericarditis
81
EKG shows ST segment elevation in all leads,
| •!PR segment depression
Pericarditis
82
```
Pericarditis Tx
• treat cause
• majority idiopathic
• treated with NSAIDs( ibuprofen, naproxen)
• colchisine decreases recurrences
```
Idiopathic presumed viral, coxsackie B virus
83
50 ml acutely cause
Tamponade
84
Over weeks to months, pericardium stretches for
2 L of fluid
85
* Hypotension
* Tachycardia
* distended neck vein
* CLEAR LUNGS
Pericardial tamponade
86
* Pulsus paradoxus
| * Decrease of more than 10 mmHg in systolic BP on inhalation
Pericardial tamponade
87
```
EKG
Electrical alternans ( different heights of QRS complexes between beats)
```
Pericardial tamponade
88
Chest X ray: Enlarged cardiac shadow expanding in both directions( " globular heart")
Pericardial tamponade
89
Echocardiogram : RA and V diastolic collaps
Pericardial tamponade
90
Right heart catheterization: equalization of pressures in diastole
Pericardial tamponade
91
Most appropriate test to confirm pericardial tamponade
EchoCG
92
Pericardial Tamponade TX
* pericardiocentesis
* IV fluids
* a hole or " window" recurrent cases
93
What tx will kill pericardial tamponade pt
Diuretics
94
Will decrease intracardiac filling pressure and may markedly worsen collapse of right side of heart
Diuretics
95
* Edema
* " heart cant fill"
* Ascites
* enlargement of liver and spleen
* JVD
* calcification on chest Xray
Constrictive pericarditis
96
Kussmaul sign
• increase in JVD on inhalation
• Normally neck veins go down on inhalation
Constrictive pericarfitis
97
" Knock"
•Extra heart sound in diastole
• from ventricular filling
• heart fills to its maximum, it hits the stiff, rigid pericardium with a "knock"
Constrictive pericarditis
98
" best initial test" constrictive pericarditis
Chest X ray: calcification& fibrosis
99
More accurate tests, but not 1st
CT scan or MRI
100
Constr. Per. Excludes RV hypertrophy or cardiomyopathy as cause. Myocardium moves normally with constr. myocard
Echocardiogram
101
Constr. Pericarditis Tx
* diuretics( decompress filling of heart, relieves edema and organomegaly)
* surgical removal of pericardium
