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Block 4 - Cardio > Cardiomyopathy and Pericardial Diseases > Flashcards

Cardiomyopathy and Pericardial Diseases Flashcards

0
Q

What is the difference between primary and secondary cardiomyopathies?

A

Secondary is due to a specific disease

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1
Q

What is the definition of cardiomyopathy?

A

Myocardial disorder in which heart muscle is structurally or functionally abnormal, in absence of CAD, HT, valvular disease, and congenital heart disease sufficient to cause observed myocardial abnormality

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2
Q

What is the definition of dilated cardiomyopathy?

A

Left ventricular dilatation and reduced systolic function in absence of abnormal loading conditions or CAD sufficient to cause it

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3
Q

What are the causes of dilated cardiomyopathy?

A

Idiopathic - most common
Toxins - alcohol, anthracycline agents
Inflammatory - post partum
Infectious - post viral (most have prodromal URI 2-4 weeks before onset of symptoms), HIV, chagas, t Cruzi
Familial - 20% have first degree relatives

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4
Q

What can a patient with dilated cardiomyopathy present with?

A

Left heart failure symptoms
Right heart failure symptoms
Low output state symptoms
Any combo of the above

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5
Q

What does physical exam of dilated cardiomyopathy show?

A 
JVD
lateral PMI
s3, s4 universal 
RHF absent in 50%
Mitral/tricuspid regurg 
Resting tach, narrow pulse pressure
Generalized cardiomegaly
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6
Q

What are bad and good indicators of prognosis in dilated cardiomyopathy and other systolic dysfunctions?

A

LVEF - bad
Good - symptom class and functional abilities
Best - maximal oxygen consumption

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7
Q

What are the 3 big consequences of untreated dilated cardiomyopathy?

A

Lethal arrhythmias and SCD
Progressive heart failure
Thromboembolic events

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8
Q

What does the EKG of dilated cardiomyopathy show?

A 
Sinus tach
A fib
LVH with strain
Conduction defects 
Possible atrial enlargement 
Atrial and ventricular ectopy
Nonspecific ST-T wave abnormalities 
Pseudo infarction - q waves in ant or inf leads in absence of MI
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9
Q

What is the definition of hypertrophic cardiomyopathy?

A

Inappropriate LV hypertrophy resulting in impaired diastolic function in absence of apparent etiology
Usually asymmetric involving septum, apex, or lateral wall
Might be obstructive - LV outflow tract

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10
Q

What 3 findings characterize obstructive HCM?

A

Thickened and asymmetric septum (>1.3x wall)
Abnormal movement of anterior mitral valve leaflet during systole
Cavity obliteration during systole

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11
Q

What kinds of mutations are responsible for familial HCM?

A

Mutations in sarcomeric proteins
Beta Myosin heavy chain gene mutation
Troponin I mutations
Tropomyosin mutations

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12
Q

What is the pathophysiology of HCM?

A

Abnormal diastolic relaxation –> increased LV end diastolic pressure –> increased LA pressure –> pulm congestion and dyspnea

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13
Q

What is HCM responsible for?

A

Leading cause of death in young athletes

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14
Q

What kinds of symptoms will a patient with HCM present with?

A

Primarily left sided heart failure symptoms

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15
Q

What is found on the physical exam of a patient with HCM?

A 
Bisferiens pulse 
Forceful and lateral PMI 
Prominent s4
Apical systolic thrill 
Systolic murmur - do maneuvers to differentiate from aortic stenosis
16
Q

What kinds of maneuvers will affect the murmur in HCM?

A

Increases when standing or Valsalva maneuver - reduces LV size and increases contractility
Decreases when squatting or hand grip - increases LV size and decreases contractility

17
Q

What are three things that can cause worsening symptoms in HCM?

A

Increased hypertrophy
Development of a fib
Worsening mitral regurg

18
Q

What does the EKG of HCM show?

A

LVH
Prominent q waves due to septal hypertrophy in inf and lateral leads
Giant inverted t waves in precordial leads

19
Q

What is restrictive cardiomyopathy?

A

Infiltration, scarring, and fibrosis of myocardium and results in diastolic dysfunction initially
Systolic dysfunction appears late in disease

20
Q

What is restrictive cardiomyopathy?

A

Diastolic dysfunction with normal systolic ventricular function and normal wall thickness
Excessive rigidity of right and left ventricle

21
Q

What are the three most common causes of restrictive cardiomyopathy?

A

Amyloidosis - pink amorphous material in endocardium biopsy of RV
Hemochromatosis
Sarcoidosis - granulomas in myocardium

22
Q

What are the signs and exam findings of restrictive cardiomyopathy?

A

Diminished co and primarily right sided symptoms - fatigue, exercise intolerance
A fib or heart block - respond poorly to medical therapy, common thromboembolic events
Signs of right heart failure
Kussmauls sign
S1 and S2 normal

23
Q

What does a ground glass appearance of myocardium on echo suggest?

A

Cardiac amyloid

24
Q

What findings on imaging procedures can be found in restrictive cardiomyopathy?

A

Atrial pressures elevated and equal with prominent y descent
Ventricular tracings show square root sign
Biopsy can reveal underlying etiology

25
Q

What are the three most common causes of constrictive pericarditis?

A

Idiopathic
Previous cardiac surgery
Tuberculosis

26
Q

How does a patient with constrictive pericarditis present?

A

Similar to restrictive cardiomyopathy

27
Q

What is a physical exam finding present in constrictive pericarditis but not restrictive cardiomyopathy?

A

Pericardial knock

28
Q

How can you tell the difference between restrictive cardiomyopathy and constrictive pericarditis?

A

Look at the pericardium - is it thickened?

Biopsy the endocardium - is there an etiology of RC present?

29
Q

What is the treatment of constrictive pericarditis?

A

Mild symptoms can be treated with diuretics

Patients who have failed medical therapy should undergo pericardiectomy

30
Q

What is acute pericarditis?

A

Inflammation of pericardium with or without resultant pericardial effusion

31
Q

What are the four most common causes of acute pericarditis?

A

Acute MI
viral infection
Uremia
Cardiac surgery

32
Q

What is the presentation of acute pericarditis?

A

Retro sternal chest pain worsened with deep inspiration and lying supine, improved by sitting upright
Symptoms from compression of bronchi, recurrent laryngeal, and esophagus by pericardial effusion
Pericardial friction rub - other sounds normal

33
Q

What are the four tests routinely ordered for acute pericarditis?

A

EKG
Chest radiograph
Serum creatinine
Cardiac enzymes

34
Q

What are signs of pericardial tamponade?

A 
Decreased BP
Increased HR
increased RR
increased JVP
Pulsus paradoxus
Faint heart sounds
Clear lungs
35
Q

What findings can confirm the diagnosis of pericardial tamponade?

A

RV diastolic collapse on echo
Equalization of diastolic pressures in right sided heart chambers
Electrical alternans on EKG - QRSs have different heights because the heart is swinging

Block 4 - Cardio (15 decks)

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