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CV Test 5 > Cardiomyopathy > Flashcards

Cardiomyopathy Flashcards

1
Q

What are cardiomyopathies?

A

Disorders that involve the heart muscle itself

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2
Q

What is primary cardiomyopathy?

AKA

A 
Those exclusively (or predominantly) confined to the heart muscle 
Intrinsic
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3
Q

What is secondary cardiomyopathy?

AKA?

A

Demonstrate pathophysiologic involvement of the heart in the context of a multiorgan disorder
Extrinsic

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4
Q

What is dilated cardiomyopathy?

A

Generalized myocardial weakness

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5
Q

What ventricular dysfunction occurs with dilated CM?

A

Biventricular dysfunction

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6
Q

The enlarged heart that occurs with dilated CM causes what 2 cardiac complications?

A 
Valve insufficiency (can’t close)
Dysrhythmias (conduction takes longer due to size)
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7
Q

What can cause dilated CM?

A

Can be primary or secondary

  • diffuse CAD
  • alcohol
  • viral
  • DM
  • etc
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8
Q

What is the treatment for dilated CM similar to?

A

CHF treatment

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9
Q

What is the treatment for dilated CM?

A

Diuretics to keep volume overload off
Vasodilators to improve forward CO
Inotropes to strengthen muscle
Transplant once medical treatment is not enough

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10
Q

What is the most common type of CM?

A

Dilated

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11
Q

What is the most common reason for a heart transplant?

A

Dilated cardiomyopathy

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12
Q

What is the anesthetic management for dilated CM?

A 
Think LV dysfunction:
Avoid further myocardial depression
Careful fluid titration
Optimal filling pressure
Avoid increase in SVR
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13
Q

What is restrictive CM?

A

Heart muscle is infiltrated by abnormal tissue

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14
Q

What usually causes restrictive CM? What is the most common cause

A

Connective tissue disease

Amylidosis

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15
Q

Describe the heart in a restrictive CM patient?

A

Stiff
Noncompliant
Difficult to fill
No cardiomegaly

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16
Q

What 2 things are important about the heart in a restrictive CM patient?

A

SR

Atrial kick

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17
Q

What is restrictive CM clinically similar to?

A

Cardiac tamponade

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18
Q

What is the least common CM?

A

Restrictive CM

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19
Q

What is important to keep in mind about restrictive CM being similar to cardiac tamponade?

A

HR is important!

-it’s the only thing keeping forward flow

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20
Q

Are restrictive CM patients transplant candidates?

A

No

Because it’s a secondary process, the connective tissue disorder will infiltrate the transplanted heart

21
Q

What is hypertrophic CM?

A

Ventricular septal hypertrophy below the aortic valve

22
Q

What happens in the LV with hypertrophic CM?

A

LV becomes elongated and hypercontractile

23
Q

What are the other names for hypertrophic cardiomyopathy?

A

Idiopathic hypertrophic subaortic stenosis
Obstructive hypertrophic cardiomyopathy
Hypertrophic obstructive cardiomyopathy
Asymmetric setup hypertrophy

24
Q

What occurs with hypertrophic CM and LV outflow?

A

Dynamic LV outflow obstruction

  • present with activity
  • absent with rest
25
Q

Why does activity affect hypertrophic CM?

A

The strong the heart contracts the hypertrophied septum is pushed out in the way of flow through the aortic valve
-decreasing SV

27
Q

What is the associated pathology with hypertrophic CM?

A

Myocardial ischemia not from CAD
Decreased LV compliance because of hypertrophied muscle
Increased LV relaxation time

28
Q

Why does hypertrophic CM have myocardial ischemia without CAD?

A

Hypercontractile muscle increases O2 demand

29
Q

What is the most common genetic CV disease?

A

Hypertrophic CM

30
Q

Which cardiomyopathy is seen usually in a young patient and can cause sudden death?

A

Hypertrophic CM

31
Q

What symptoms are seen in elder patients with hypertrophic CM?

A

Angina

Heart failure

32
Q

When should hypertrophic CM be suspected in a patient with angina?

A

When usual treatments of angina make symptoms worse

-NTG, diuretics, digoxin

33
Q

Why do angina treatments make hypertrophic CM worse?

A

Because dynamic outflow obstruction is worsened by increased contractility and decreased preload

34
Q

How is hypertrophic CM treated?

A

BB
CCB
Myocardial depression is beneficial

35
Q

What is the anesthetic management of hypertrophic CM?

A 
Decrease contractility
Increase preload
Maintain SVR
Avoid tachycardia
GA is more manageable than regional
36
Q

What EF is seen in patients who need a heart transplant?

A

EF <20%

37
Q

What is left behind after a heart transplant?

A

Native atria remnants

38
Q

What is seen on EKG of heart transplant patients?

A

Double P waves

-but conduction is normal

39
Q

What is important to remember about nerves and the transplant heart?

A

The heart is denervated

  • no sympathetic
  • no parasympathetic
  • no sensory
40
Q

Why are heart transplant patients at increased infection risk

A

Immunosuppressants

41
Q

What is the vagal influence on a transplant heart?

A

None

  • no response to carotid massage, valsalva
  • high resting HR
42
Q

What is the SNS response in a transplanted heart?

A

Initial response is blunted (quick HR and contractility increase are not seen)
-eventual full response from circulating catecholamines

43
Q

What increased risk do heart transplant patients have because of a rejection reaction in endothelium?

A

Increased risk for CAD

-reaction occurs in the coronary endothelium

44
Q

Why do heart transplant patients have silent ischemia?

A

No sensory innervation

45
Q

What routine testing in performed with heart transplant patients because sensory dennervation?

A

Angiograms

46
Q

The transplant heart is _______ dependent

A

Preload

47
Q

Why is the transplant heart said to be preload dependent?

A

Because it no longer can respond quickly with an increased HR

48
Q

So if a heart transplant patient is hypovolemic how does the heart respond?

A

Hypovolemia does not stimulate a HR increase

49
Q

What pharmacologic considerations should be remembered with heart transplant patients?

A 
The denervated heart will not have the expected HR changes with:
Opioids
Anticholinergics
Anticholinesterases 
Pancuronium
50
Q

What kind of drugs CAN be used to affect the transplanted heart?

A 
Direct acting drugs:
Isoproterenol 
Epinephrine
Dobutamine 
Vasopressin

CV Test 5 (8 decks)

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