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CVS > Cardiomyopathy > Flashcards

Cardiomyopathy Flashcards

1
Q

What is cardiomyopathy classified into

A

Hypertrophic
Dilated
Restrictive
A lot of overlap so new way to classify

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2
Q

What are new classification

A

Genetic
Secondary cause
Acquired
Mixed

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3
Q

What are genetic causes

A

Autosomal dominant

Mutation in B-myosin / protein C

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4
Q

What do genetic mutation cause

A

HCM

Arrythmogenic R ventricular cardiomyopathy - replaced fatty tissue

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5
Q

What does HCM cause

A

Leading cause of cardiac death in the young

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6
Q

How do you Dx

A

Genetic test
ECG - arrythmia
ECHO - MR / hypertrophy
Cardiac MRI

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7
Q

What is the treatment

A

Defibrillator

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8
Q

What are secondary causes

A

Drugs

  • Alcohol / thiamine deficiency
  • Doxorubin (chemo)

Endocrine

  • DM
  • Thyrotoxicosis
  • Acromegaly

Infection
- Coxsackie

Infiltrative

  • Amyloidosis
  • Haemochromatosis
  • Sarcoidosis
  • SLE

Other

  • Myotonic dystrophy
  • Post RT
  • Endocarditis
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9
Q

What are acquired causes

A

Post partum

Tokotsubo

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10
Q

Who is at greater risk of post partum

A

Older women
Greater parity
Multiple

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11
Q

What is tokotsubo

A

Stress induced transient ballooning of myocardium

Follows severe stress such as family death / break up

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12
Q

How does tokotsubo present

A 
ACS 
Chest pain
HF features
ST elevation
Normal angiogram
Rx = supportive
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13
Q

What is HCM

A

Inappropriate ventricular hypertrophy
Causes impaired relaxation
Systolic usually preserved
Eventually reduced LVOT and reduced CO

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14
Q

What is associated with HCM

A

WPW

Freidreich’s ataxia

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15
Q

What are the symptoms of HCM

A 
Asymptomatic
Sudden cardiac death
Chest pain
Angina
SOB
Palpitations
Syncope
Fatigue
Cardiac failure
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16
Q

What causes syncope

A

Arrhythmia or LVOT / AS

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17
Q

What are signs of HCM

A 
Jerky pulse
AF
Double impulse over apex
Ejection systolic murmur increases valsalva 
Thrill 
Raised JVP
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18
Q

What are RF for HCM

A

FH sudden cardiac death

Maternal DM

19
Q

How do you Dx HCM

A 
ECG
ECHO
MRI
Angiogram
Genetic test
20
Q

What are ECHO findings

A

MR SAM ASH
Mitral regurgitation as mitral valve doesn’t close properly
Systolic anterior motion of MV
Asymmetric hypertrophy

21
Q

What are ECG findings

A 
LVH
ST and T wave abnormality
Q waves
AF
WPW
VT
Ectopics

VT = cause of death

22
Q

How do you treat HCM

A

Avoid heavy exercise
Anti-coagulation if AF
Surgical resection / ablation
ABCDE

23
Q

What is ABCDE in HCM

A 
Anti-arrhythmia - amiadarone + anti-coagulant if AF
BB / verapamil for Sx
Cardiac defibrillator - ICD
Dual chamber pacemaker
Endocarditis - watch
24
Q

What should you avoid

A

Digoxin
INotrope
Nitrates
As increase contractility of heart

25
Q

What are complications of HCM

A 
Sudden death
LVOT
Arrhythmia
HF
AF
MR
26
Q

What is most common cardiomyopathy

A

Dilated

27
Q

What is dilated

A

Enlarged heart
Often all chambers - LV>RV
Ventricular function impaired, systolic dysfunction resulting in reduced CO and increased EDV
Leads to HF

28
Q

What causes dilated

A 
Mixed
Genetics
Idiopathic 
Infection - Coxsackie / HIV / viral 
Toxins - alcohol / Doxcirubin (chemo) / cocaine
High BP 
Inflammation - SLE
Infiltration - amyloid / sarcoid / hamochromatosis
Post partum
Endocrine - Hyperthyroid
29
Q

What gene

A

DCN SCN5A

DMD

30
Q

How does dilated cardiomyopathy present

A 
Classic HF signs 
Progressive SOB
Fatigue
Pulmonary oedema
Cough
Palpitations
Arrhythmia - AF / VT
RVF
Emboli  
Mitral and tricuspid regurgitation - pan systolic
31
Q

What are the signs of dilated cardiomyopathy

A 
Systolic murmur 
Tachycardia
Hypotension
Poor perfusion
Thread pulse
Elevated JVP
Displaced apex
S3+S4
Pleural effusion
Ascites
Hepatomegaly as RHF develops
32
Q

What is important in the history

A 
Travel
Systemic illness
High BP / vascular
Thyroid
Neuromuscular
33
Q

What investigations do you do

A 
Bloods 
ECG
CXR
ECHO
Angiogram
BNP
Biopsy
34
Q

What does ECG show

A

LBBB

Tachy

35
Q

What does ECHO show

A

Low ejection

Global dilatation

36
Q

What does CXR show

A

Cardiomegaly

Oedema

37
Q

How do you treat

A 
Treat cause if known
Remove exacerbating drugs e.g. NSAIDs
Reduce fluid and salt intake
ACEI, diuretic, BB, spironolactone
Anti-coagulate if indicated 
Treat HF + arrhythia
VTE prophylaxis
SCD assessment
38
Q

What are the complications of dilated

A

VTE
Heart failure
Renal failure
Sudden cardiac death

39
Q

What is restrictive cardiomyopathy

A

Relaxation affected
Unable to fill ventricle
Systolic may or not be impaired

40
Q

What causes restrictive

A 
Form of HCM
Haemochrmatosis
Amyloid - biopsy
Sarcoid - ACE
Scleroderma - Ab
Fibrosis
Radiation
Drugs
Malignancy 
DM
Storage disease - low plasma galactodise
41
Q

What are the symptoms of restrictive

A 
Present like constrictive pericarditis
Back pressure leads to
RVF
Oedema
Increased JVP with X and Y descent
Hepatomegaly
Ascites
42
Q

How do you treat restrictive

A 
Treat cause
BB
Anti-coagulant
Transplant 
Specific treatment for iron / storage
SCD assessment
43
Q

What has limited use in restrictive

A

ACEI/ diuretic

Low filling pressure so worsen

CVS (30 decks)

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