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Block 4: Pathophys > Cardiomyopathy and Heart Failure > Flashcards

Cardiomyopathy and Heart Failure Flashcards

1
Q

cardiomyopathy is A heterogeneous group of diseases of the myocardium associated with ________dysfunction that usually exhibit inappropriate ventricular hypertrophy or dilation

A

mechanical and/or electrical

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2
Q

cardiomyopathy May be primary or _______. It May also be genetic or _______, or have elements of both

A

secondary acquired

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3
Q

what are the classifications of cardiomyopathy?

A
  1. Dilated cardiomyopathy (DCM) 2. Hypertrophic cardiomyopathy (HCM) 3. Restrictive cardiomyopathy (RCM) 4. Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) 5. Unclassified cardiomyopathies
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4
Q

Systolic dysfunction is usually associated with what type of cardiomyopathy?

A

dilated cardiomyopathy sometimes hypertrophic

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5
Q

in cardiomyopathy with Systolic dysfunction, _______ is most affected

A

Myocardial contractility

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6
Q

cardiomyopathy with Systolic dysfunction frequently results in reduction of what?

A

left ventricular ejection fraction (EF)

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7
Q

Cardiomyopathy with Diastolic dysfunction has what effect ton ejection fraction?

A

EF may be normal or somewhat reduced

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8
Q

Diastolic dysfunction is usually associated with what type of cardiomyopathy?

A

Usually associated with restrictive cardiomyopathy, sometimes hypertrophic

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9
Q

in cardiomyopathy with Diastolic dysfunction, what happens in regards to the left ventricle and pressures?

A

LV relaxation and filling is abnormal with elevated filling pressures

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10
Q

how is Dilated Cardiomyopathy characterized?

A

Characterized by dilation and impaired contraction of one or both ventricles

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11
Q

dilation and impaired contraction of one or both ventricles is what type of cardiomyopathy?

A

dilated

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12
Q

what are common causes of dilated cardiomyopathy?

A

Common causes include gene mutations, toxicity (chronic alcoholism), myocarditis (virus infection), pregnancy-associated, or idiopathic (no known cause)

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13
Q

Dilated Cardiomyopathy is Usually accompanied by an increase in total _____ (hypertrophy)

A

cardiac mass

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14
Q

Dilated Cardiomyopathy Impairs systolic function with marked reduction in EF and CO, results in_____.

A

heart failure

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15
Q

Are “Ischemic cardiomyopathy” or “valvular cardiomyopathy” considered dilated cardiomyopathies?

A

no “Ischemic cardiomyopathy” or “valvular cardiomyopathy” associated with CAD and valve disease present with ventricular dilation and systolic dysfunction are not true dilated cardiomyopathies per American Heart Association/European Society of Cardiology [AHA/ESC] classification systems

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16
Q

how is Hypertrophic Cardiomyopathy characterized?

A

Characterized by hypertrophy of the left ventricle (sometimes RV)

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17
Q

hypertrophy of the left ventricle (sometimes RV) is what type of cardiomyopathy?

A

Hypertrophic Cardiomyopathy

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18
Q

Hypertrophic Cardiomyopathy Impairs ____ function with preserved or moderately reduced EF and reduced CO, heart failure

A

diastolic

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19
Q

what is Hypertrophic Cardiomyopathy caused by?

A

Caused by genetic mutations, common (1:500 adults) Autosomal dominant trait with incomplete penetrance

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20
Q

Hypertrophic Cardiomyopathy caused by what kind of genetic trait?

A

Autosomal dominant trait with incomplete penetrance

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21
Q

what is the most common cause of LVH?

A

hypertension and aortic stenosis

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22
Q

is LVH caused by HTN or aortic stenosis considered Hypertrophic Cardiomyopathy?

A

NO

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23
Q

how is Restrictive Cardiomyopathy characterized?

A

Characterized by nondilated ventricles with impaired ventricular filling, without myocyte hypertrophy

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24
Q

nondilated ventricles with impaired ventricular filling, without myocyte hypertrophy is considered what type of cardiomyopathy?

A

Restrictive Cardiomyopathy

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25
Q

Restrictive Cardiomyopathy May have _____ enlargement with some infiltrative or storage diseases (e.g., amyloidosis)

A

ventricular

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26
Q

Restrictive Cardiomyopathy Impairs diastolic function with preserved or moderately reduced EF and reduced CO, results in _____.

A

heart failure

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27
Q

what causes Restrictive Cardiomyopathy?

A

Causes include genetic noninfiltrative, infiltrative, and storage diseases, and others disorders (e.g., diabetic cardiomyopathy, scleroderma, endomyocardial fibrosis)

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28
Q

how is Arrhythmogenic Right Ventricular Cardiomyopathy characterized?

A

Characterized by ventricular arrhythmias and replacement of ventricular myocardium by fibrous and/or fibro-fatty tissue

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29
Q

if you see ventricular arrhythmias and replacement of ventricular myocardium by fibrous and/or fibro-fatty tissue, what kind of cardiomyopathy is it?

A

Arrhythmogenic Right Ventricular Cardiomyopathy

30
Q

in Arrhythmogenic Right Ventricular Cardiomyopathy, how is ventricular function?

A

Ventricular function is abnormal, with regional akinesis / dyskinesis, or global right ventricular dilation and dysfunction

31
Q

Arrhythmogenic Right Ventricular Cardiomyopathy is genetically determined heart muscle disease, it usually becomes symptomatic in what age group?

A

young adults

32
Q

Arrhythmogenic Right Ventricular Cardiomyopathy is usually associated with a reduced ___ and ____.

A

Usually associated with a reduced EF and reduced CO

33
Q

what is Stroke volume (SV)?

A

volume of blood ejected from the LV with each contraction (mL)

34
Q

how do you determine Cardiac output (CO)?

A

Cardiac output (CO) = heart rate (HR) x SV

35
Q

what is Ejection fraction (EF)?

A

% of LV blood volume ejected per contraction

36
Q

what is a normal Ejection fraction (EF)?

A

Normal: 50-70%;

37
Q

what is a borderline Ejection fraction (EF)?

A

Borderline: 41-49%;

38
Q

what is a reduced Ejection fraction?

A

Reduced: ≤ 40%

39
Q

what is preload?

A

end-diastolic chamber stretch (related to the volume of blood preparing to enter the chamber)

40
Q

what is afterload?

A

contractile force required to eject blood (related to blood pressure in the aorta or pulmonary artery)

41
Q

what is contractility?

A

ability of cardiac muscle fibers to contract with a given preload and afterload, related to cytosolic calcium availability

42
Q

Stroke volume increases in response to an increase in ____.

A

preload

43
Q

increasing ______volume results in more than normal myocyte stretch, resulting in a more forceful contraction (enhances contractility)

A

end-diastolic

44
Q

Suddenly increasing end-diastolic volume results in more than normal myocyte stretch, resulting in a more forceful contraction (enhances contractility). This May be perceived as “_______”, e.g., after a PAC or PVC (since the chamber empties early there will be greater preload with the next contraction, therefore a more forceful contraction)

A

palpitation

45
Q

Past a certain point there is no additional gain in SV, and eventually SV will fall with even more _____.

A

stretch

46
Q

Normally the heart functions midway up the inclining slope allowing adjustment of ____ in both directions

A

SV

47
Q

heart failure results in Reduced cardiac output and reduced tissue perfusion which can result from dysfunction of what two things?

A

Systolic dysfunction Diastolic dysfunction

48
Q

what does Systolic dysfunction cause?

A

insufficient myocardial contractility to provide adequate perfusion (reduced CO and EF)

49
Q

what does diastolic dysfunction cause?

A

insufficient ventricular relaxation / distensability for ventricles to receive available atrial blood during diastole (reduced CO and normal to moderately reduced EF)

50
Q

Heart Failure with Systolic Dysfunction Refers to a decrease in ______

A

myocardial contractility

51
Q

in Heart Failure with Systolic Dysfunction, The slope of the Frank-Starling relationship between LVEDP and SV is reduced and the curve is shifted to the ___ (larger LVEDP needed to maintain SV)

A

right

52
Q

in heart failure ventricular remodeling, there is 3 remodeling patterns, what are they?

A

Concentric hypertrophy Eccentric left ventricular hypertrophy Myocardial remodeling post-infarction

53
Q

Concentric hypertrophy remodeling causes what to wall size and cardiomyocytes? (has what effect on the heart?

A

Increased relative wall thickness compared to cavity size Cardiomyocyte hypertrophy

54
Q

Concentric hypertrophy remodeling is caused by what?

A

pressure overload (e.g., HTN, obstruction)

55
Q

Eccentric left ventricular hypertrophy remodeling is caused by what?

A

volume overload

56
Q

Eccentric left ventricular hypertrophy remodeling has what effect on the heart?

A

Increased cardiac mass and chamber volume (relative wall thickness may be normal, increased, or decreased) Cardiomyocyte hypertrophy with chamber enlargement

57
Q

Myocardial remodeling post-infarction has what effect on the heart?

A

Infarcted tissue stretches, increasing left ventricular volume leading to combined volume and pressure load on noninfarcted zones and mixed concentric/eccentric hypertrophy

58
Q

what medications can slow or reverse cardiac remodeling?

A

Angiotensin converting enzyme (ACE) inhibitors and some beta blockers can slow or reverse certain parameters of cardiac remodeling

59
Q

Heart Failure with Systolic Dysfunction results in Increased _____ (e.g., fluid overload) which results in dilation of atria and ventricles with increased diameter (stretch)

A

preload

60
Q

in Heart Failure with Systolic Dysfunction, Increasing stretch results in output of what two peptides (ventricles) to increase loss of water and sodium, and to increase vasodilation (reduce preload)?

A

ANP (atria) and BNP

61
Q

in Heart Failure with Systolic Dysfunction, Increased mechanical load (e.g., HTN) or end diastolic volume (e.g., volume overload) causes myocyte and ventricular ______ (results in increased cardiac muscle oxygen requirements)

A

hypertrophy

62
Q

in Heart Failure with Systolic Dysfunction, there is stretch, ANP and BNP output to try and reduce preload (vasodilation), and increased mechanical load/ end diastolic volume which causes myocyte hypertrophy and ventricular hypertrophy. All of these factors eventually result in what?

A

Together these factors eventually result in decreased CO

63
Q

in Heart Failure with Systolic Dysfunction, reduced CO leads to increased ____ activity, restoring CO by increasing contractility and HR

A

SNS

64
Q

in Heart Failure with Systolic Dysfunction, a negative cycle is established. what is this cycle?

A

Negative cycle established: decreased CO results in reduced renal perfusion → increased renin-angiotensin, aldosterone → increased BP with Na+ and water retention, increases ventricular remodeling → further increased preload → further reduction in CO

65
Q

Heart Failure with ________Dysfunction Results from inability of the ventricle to fully dilate to accept preload, contractility is not affected therefore EF frequently preserved

A

Diastolic Dysfunction

66
Q

what two things cause Diastolic Dysfunction in heart failure?

A
  1. Mocardial hypertrophy reducing ventricular relaxation and EDV 2. Fibrosis or related changes to cardiac tissue, reducing dispensability / stretch, thereby reducing EDV
67
Q

Left-Sided Heart Failure is Commonly caused by? (4 things)

A
  1. Ischemic heart disease (e.g., post-MI) 2. Hypertension (increased afterload) 3. Aortic (increased afterload) or mitral valve disease (decreased SV due to regurgitant flow during systole) 4. Other non-ischemic myocardial disease (infectious, alcohol, medications, postpartum, chronic tachycardia, ESRD, sarcoidosis, autoimmunity)
68
Q

Left-Sided Heart Failure Results from increased LV _______?

A

afterload or increased preload

69
Q

in Left-Sided Heart Failure, “Backup” of blood in pulmonary circulation results in what?

A

increased lung circulation pressure, pulmonary edema, shortness of breath, eventual right heart failure

70
Q

Right-Sided Heart Failure Results from increased RV _____?

A

increased RV afterload

71
Q

Right-Sided Heart Failure is Commonly caused by what two things?

A
  1. Pulmonary hypertension (results in “cor pulmonale”)–>Only right ventricle involvement 2. Left-sided failure (MCC)
72
Q

in Right-Sided Heart Failure, “Backup” of blood results in what?

A

increased systemic and portal venous pressure, peripheral edema

Block 4: Pathophys (5 decks)

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