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M1 CPR > Cardiomyopathy management > Flashcards

Cardiomyopathy management Flashcards

1
Q

What are the overlapping pathologies encompassed by congestive heart failure (CHF) and cardiomyopathy (CM)?

A

Problems with several different aspects of cardiac anatomy and physiology.

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2
Q

What are the two commonly used classification systems for heart failure?

A

New York Heart Association (NYHA) classification and American College of Cardiology/American Heart Association (ACC/AHA) classification.

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3
Q

What defines heart failure with preserved ejection fraction (HFpEF)?

A

Normal ejection fraction (>50%) with evidence of diastolic dysfunction.

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4
Q

What is the ejection fraction threshold for heart failure with reduced ejection fraction (HFrEF)?

A

EF <50%.

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5
Q

What are the goals of treating patients with heart failure?

A
  • Improve symptoms
  • Reduce morbidity
  • Reduce mortality
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6
Q

What is a common cause of HFpEF related to ventricular filling?

A

Concentric hypertrophy due to hypertension.

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7
Q

Which class of medications has evidence for improving cardiovascular mortality in HFpEF?

A

SGLT-2 inhibitors.

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8
Q

What is the role of loop diuretics in the management of HFpEF?

A

Useful for managing symptoms related to fluid overload/hypervolemia.

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9
Q

True or False: Beta blockers have convincing evidence of benefit in HFpEF.

A

False.

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10
Q

What are the pharmacologic classes that have definitive benefits for morbidity and mortality in HFrEF?

A
  • RAA antagonists
  • Beta blockers
  • MRAs
  • SGLT-2 inhibitors
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11
Q

What is the first-line agent for HFrEF treatment according to current evidence?

A

Sacubitril-valsartan (neprilysin inhibitor with ARB).

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12
Q

What is the indication for mineralocorticoid receptor antagonists in HFrEF?

A

Improve morbidity and mortality in symptomatic HFrEF.

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13
Q

What is the effect of digoxin in heart failure management?

A

Lowers hospitalization rates but has no effect on mortality.

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14
Q

What are common precipitating factors of acute decompensated heart failure (ADHF)?

A
  • Non-compliance with medications
  • Excessive salt intake
  • New medications
  • Other medical conditions
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15
Q

What is the primary management focus in patients with ADHF?

A

Improving hemodynamic parameters.

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16
Q

What is the role of vasodilators in managing ADHF?

A

Useful for heart failure due to increases in afterload.

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17
Q

What is the purpose of mechanical support in ADHF?

A

Provide cardiovascular and/or pulmonary support.

18
Q

What is the indication for an implantable cardioverter-defibrillator (ICD) in heart failure patients?

A

Patients with EF <35% who are symptomatic on maximal medical therapy.

19
Q

What are the effects of SGLT-2 inhibitors in HFrEF?

A

Improve morbidity and mortality, even in patients without diabetes.

20
Q

What is the relationship between right ventricular failure and left heart failure?

A

Right ventricular failure is commonly caused by left heart failure.

21
Q

What does ADHF stand for?

A

Acute Decompensated Heart Failure

ADHF is a condition where the heart cannot pump enough blood to meet the body’s needs, leading to fluid buildup and symptoms like shortness of breath.

22
Q

What is the role of positive pressure ventilation (PPV) in ADHF?

A

PPV can improve cardiac output (CO) in ADHF

PPV is used in patients with respiratory distress to assist with breathing and can also support cardiac function.

23
Q

What is an Intraaortic Balloon Pump (IABP)?

A

An inflatable balloon inserted percutaneously to improve cardiac function

The IABP works by inflating and deflating in sync with the cardiac cycle, enhancing coronary perfusion.

24
Q

What is a Left Ventricular Assist Device (LVAD)?

A

A battery-powered device implanted to pump blood forward

LVADs are often used as a bridge to heart transplantation.

25
Q

What monitoring is recommended for patients with ADHF?

A

Telemetry, continuous pulse oximetry, central venous access, arterial line placement, and foley catheter

These monitoring methods help in tracking heart rhythm, oxygen levels, volume status, and urine output.

26
Q

What are the two common types of cardiomyopathy?

A

Hypertrophic cardiomyopathy and dilated cardiomyopathy

Hypertrophic cardiomyopathy is characterized by LV hypertrophy, while dilated cardiomyopathy involves enlarged ventricular chambers.

27
Q

What is the prevalence of hypertrophic cardiomyopathy?

A

1:500

Hypertrophic cardiomyopathy is the most common idiopathic cardiomyopathy.

28
Q

What treatment is often used for symptoms of hypertrophic cardiomyopathy?

A

Beta blockers

Beta blockers help increase filling time and relieve outflow obstruction.

29
Q

True or False: Dilated cardiomyopathy leads to heart failure with reduced ejection fraction (HFrEF).

A

True

Dilated cardiomyopathy is a leading indication for cardiac transplantation and generally results in HFrEF.

30
Q

What genetic mutation is associated with familial dilated cardiomyopathy?

A

Mutation in the TTN gene

The TTN gene codes for the protein titin, which is important for cardiac function.

31
Q

Fill in the blank: _______ is characterized by left ventricular hypertrophy without dilation.

A

Hypertrophic cardiomyopathy (obstructive cardiomyopathy)

This condition can lead to significant health risks, including sudden cardiac death.

32
Q

What is the older name for hypertrophic obstructive cardiomyopathy?

A

Hypertrophic cardiomyopathy (HOCM)

The term reflects the condition’s association with left ventricular outflow obstruction.

33
Q

What are some underlying causes that should be treated in patients with cardiomyopathy?

A
  • Autoimmune diseases
  • Endocrine disorders
  • Infections
  • Nutritional deficiencies

Addressing these underlying causes is crucial for effective management of cardiomyopathy.

34
Q

What may be necessary for patients with severe symptoms of outflow obstruction in hypertrophic cardiomyopathy?

A

Debulking procedures such as surgical myomectomy or alcohol septal ablation

These procedures may help alleviate symptoms when medication is insufficient.

35
Q

First-line Tx for HFrEF

A

Sacubitril-valsartan

36
Q

Which type of metroprolol is not indicated in HFrEF?

A

Shorter-acting version of metoprolol

37
Q
A

Loop diuretic

HCOM Pt’s are preload-dependent

38
Q

a) Sacubitril-valsartan
b) Diltiazem
c) Hydralazine alone
d) Isosorbide alone
e) Hydralazine and isosorbide dinitrate together

A

e) Hydralazine and isosorbide dinitrate together

39
Q
A

Placement of an implantable cardioverter-defibrillator (EF<35%)

40
Q

Indication of hydralazine and isosorbide dinitrate Tx

A

Intolerance of RAAS medications

M1 CPR (22 decks)

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