Cardiomyopathy and Myocarditis Flashcards
Dilated sx, ECG, other
CHF (left)
DOE/PND
PE risk
Dedema
SInus tachy, AV arrhythmias
Conduction defects
ST changes
Impaired systolic fxn
Restirctive sx, ECG, other
Right sided
Peripheral edema
Low voltage
Cnduction defects
Impaired diastolic
Hypertrophic sx, ECG, other
Faituge etc
Systolic murmur
LVH, A/V arrhythmias, ST changes, Q waves
Vigorous systolic pump activity
EF in each type
Dliated - dec
Hypertrophic - inc
Restrictive - same
DCM
1/3 inherited (present 20-50)
Other 2/3 - HTN, alcohol, postpartum, coxsackie, chagas, adriamycin, herceptin
DCM prgoression
Large heart with 4 chamber dilation
Thrombi often present
Comps of pulm and systemic emboli
Eval for HT
Idiopathic DC M
Suspect gene defect
Sarcolemmal protein (like dystrophin)
Cytoskeletal protein
Nuclear envelope protein
COR pulmonale
Must be excluded
Right heart hypertrophy and failure secondary to chonric lung or vascular dz leading to pulm HTNT
Chem oinduced CM
Dilated
Breast cancer pts
Anthracyclinees - check for low LVEF (doxorubicin and daunorubicin)
Herceptin - Her 2 receptor block….also on breast cancer cells
Mech of trastuzamab
Herceptin
Reversible
Her2 antagonist…worse if cotx with adriamycin
Restrictive major causes
Sarcodiosis
Amyloidosis
Post radiation fibrosis
Familial/genetic
Could also be hemochromatosis
Diastolic ONLY and can low voltage ECG
Endomyocardial biopsy
Used to eval in CM and study of HT
Amyloidosis
Restrive CM
Insoluble extracellular fibrillar deposits of protein fragments secreted by B cells
Congo red stain
Deposit around cardiomyocytes, vessel walls, or endocardium
Contrast cardiac MRI is sensitive
Transthyetin gene mutation in AAs
Sarcoidosis
Noncaseating granulomatous myocarditis
Acute HS myocarditis
Antibiotics, diuretics, anti-HTN meds
Elderly taking multiple meds with allergies
Eosinophilia
Rarely - Virmani
Heart biospy shows eosinophils
If necrosis present - necortizing eosinophilic myocarditis
Recover normal fn…remove offneeing agent
IHSS
Idiopathic hypertrophic cardiomyopathy
Young men
Contractile protein defect in beta myosin heavy chain gene
Cardiomegaly
Dynamic LV outflow obstruction…muscle push against ant mitral leaflet
Disarray of cardiomycotes
DOE - arrhytnmia and sudden death
Txs of IHSS
DOE and progressive MI
Palliative resection of muscle
Cardiac pacing may be required
ASH may be detected by echo of 1st deg relatives
Stillborn hypertrophic cardiomyopathy
Fetus exposed to elevated glucose…islet beta cell hyperplasia…hyperinsulinism
Reversible if survives
ARVC
Cardiomyopathy of RV
RV develops small bulges
AICD placement due to electricla instability
10-20% of SCD under 65…20% in athletes
Genetic - cell jxn proteins of cardiomyocuytes
Desmosomopathy
May be with cardiocutaenous syndrome
LVNCC
Left ventricular non-compaction CM
Trabeculations in LV lead to thrombi formaiton
Recent cong CM with spongy myocardium
LV apex
Arrest of normal embryonic development
LV systolic fxn and CHF with mural thrombi
Long term aspirin
Isolated genetics
Rasopathies
At risk for hypertrophic
Noonan, CFC syndrome, costello syndrome
Due to intracellular Ras MapKinase singlaing defects…same path as herceptin
Chronic severe CHF
Exclusions
Rare causes
Viral
May need transplant
Systemic HTN, valve dz, CAD< cor pulmonale, constrictive pericarditis
Sarcoid, amyloid, iron prob
Acute HF recovery…chornic - —-DCM
Alcohol and drugs
Isolated HCM
Syndromes with HCM
Reveresible
Genetic and some others genetic
Noonan, costello, CFC
