Cardiomyopathy Flashcards
Disease of the heart muscle where the heart is structurally and functionally abnormal
Cardiomyopathy
What are three viruses that can cause viral myocarditis?
Coxsackie group B, Parvo B19, and adenovirus
Immune mediated and leads to myocyte loss and fibrosis
Viral Myocarditis
Viral myocarditis is usually self limited but some progress to
Dilated cardiomyopathy
Toxins such as chronic alcohol ingestion or chemotherapeutic agents can cause
Dilated cardiomyopathy
Causes oxidative stress, cell apoptosis, decreases myocardial protein synthesis
Chronic Alcohol ingestion
Anthracyclines are chemotherapeutic agents that can cause
Dilated Cardiomyopathy
Heart Failure toward the end of pregnancy or in months after delivery wihtout any identifiable cause
Peri-partum CM
Impaired VEGF signaling and altered prolactin processing are causes of
Peripartum CM
Up to 50% of cardiomyopathies are likely
Familial
We want to use diuretics, ACEI/ARB, beta-blockers, and aldosterone antagonists to treat
Dilated cardiomyopathies
with a DCM that has a LVEF less than 35%, treat w/
AICD
If we have a DCM w/ LBBB and a QRS greater than 120 ms, treat w/
CRT
Autosomal dominant condition w/ variable penetrance
-Characterized by myocardial disarray
Hypertrophic Cardiomyopathy (HCM)
Due to mutation in one of several sarcomeric genes such as Beta-myosin heavy chain, cardiac troponins, and myosin binding protein
HCM
Characterized by asymetric LVH and normal to hyperdynamic LVEF
-Most common cause of SCD in athletes
HCM
Clinically presents w/ DOE/SOB and angina
HCM
Which type of murmur is seen in HCM?
S4
If HCM has an LVOT obstruction than we will see a systolic diamond shaped murmur from LPSB and an
Apical holocystoli murmur from MR
EKG will show LVH, LAE, and Q waves (in inferior and lateral leads)
HCM
Increased dynamic obstruction after anextrasystolic beat
Brockenbrough-Braunwald Sign
We can use beta blockers to treat
HCM
Which Ca2+ channel blocker can be used to treat HCM?
Verapamil
What is a class IA anti-arrhythmic that is used to treat HCM?
Disopyramide
Reduces contractility which reduces obstruction in HCM which then decreases O2 demand
Disopyramide
Disopyramide decreaes HR which increases
Diastolic Filling Time
For HCM with a wall thickness of gretaer than 30mm, we want to treat w/
AICD
Characteried by ventricular muscle stiffness leading to diastolic dysfunction
Restrictive Cardiomyopathy
Do not need thick walls for diagnosis (Although most will have increased wall thickness)
-Normal-near normal LVEF except in late stages
Restrictive Cardiomyopathy
Restrictive cardiomyopathy results from
Scarring/fibrosis or infiltration
The most common cause of restrictive cardiomyopathy is
Amyloidosis
Extracellular deposit of amyloid fibrils
-misfolded insoluble protein with a beta-pleated sheet configuration
Amyloidosis
Igg light chain produced by clonal population of plasma cells in bone marrow
AL amyloid
Mutations in gene encoding TTR lead to misfolding and deposition of amyloids
-Autosomal dominant
Familial Systemic Amyloidosis (FAP)
Clincially presents w/ peripheral neuropathy and autonomic dysfunction
FAP
Due to breakdown of normal TTR (non-mutated)
-Almost always limited to the heart
Senile Systemic Amyloidosis (SSA)
Commonly presents w/ Carpal tunnel syndrome
SSA
Caused by a misfolding of ANP
- only seen on autopsy
- Mostly elderly women
Isolated Atrial Amyloidosis
Usually occurs in setting of chronic inflammation
-Breakdown of inflammatory protein serum amyloid A
Secondary Amyloiosis
The major target of secondary amyloidosis is the
Kidney
Fabry’s disease, Myxoedematous cardiomyopthy, an haemochromatosis are conditions that may mimic
Amyloid Heart Disease
In RCM we see increased muscle stiffness which causes
Decreased compliance
We see both right and left sided volume overload w/
RCM
The decrease cavity size seen in RCM causes decreases in
SV and CO
Increased JVD with inspiration
Kussmaul sign
Kussmaul sign is seen w/
RCM
Genetic disorder where the RV free wall is replaced by fibro-fatty tissue
Arrhythmogenic RV cardiomyopathy
Shows RV dysfunction, dilation, and akinesis
Arrhythmogenic RV cardiomyopathy
Arrested development of myocardial compaction during fetal growth
-Autosomal dominant/X-linked recessive
LV non-compliance
Characterized by deep intra-trabecular recesses
LV non-compaction
Also known as Takotsubo CM, broken heart syndrome
Stress-induced cardiomyopathy
