Cumulative Flashcards
Define Cardiomyopathy
What is the MC type?
Decreased myocardium function w/out ischemic or valvular etiology.
Dilated- systolic dysfunction of myocardium d/t idiopathic etiology.
What genetic defect can cause dilated cardiomyopathy?
What viral etiology can cause this?
What parasitic etiology can cause this?
TTN- controls protein connection w/in sarcomeres.
Coxsackie-B, HIV, Parvo B-19
T. Cruzi- Chaga’s Dz
What two medications can cause dilated cardiomyopathy?
Why/How does B1 (thiamine) deficiency cause dilated cardiomyopathy?
Doxorubicin, Trastuzumab
B1 stims pyruvate dehydrogenase conversion of pyruvate in AcoA. Inc’d pyruvate inc lactic acid - vasodilation - AV shunting
What is the Cardiac Output equation?
Define Pre/Afterload
What is Frank Sterling’s Law?
CO= SV * HR
Pre: blood in heart during diastole
After: resistance LV has to overcome to circulate blood
Inc sarcomere stretch = inc contractility
What 3 factors affect SV?
Define Eccentric/Concentric Hypertrophy
What is LaPlace’s Law?
Pre/Afterload, Contractility
Ecc: inc volume adds sarcomeres longitudinally; thin walls
Con: inc pressure adds sarcomeres parallel/vertically; thick walls
P=2T/R (pressure, tension, radius)
Inc wall pressure= inc tension
What is the Gold Standard for Dx dilated cardiomyopathy?
What hallmark sound is heard on exam?
What are the 6 Ds of etiology for this condition?
Echo- eccentric hypertrophy w/ HFrEF <50% (n= 55-70%)
S3
Drinking
Dunno
Deficient B1
Doxorubicin
Drugs
Dz
What are the Tx goals for dilated cardiomyopathy?
What meds are used for these goals?
Dec pre/afterload, remodel, arrhythmia
Inc contractility
Dec P: Nitro, ACEI, Diuretic, ARB
Dec A: Hydralazine, ACEI/ARB, ISDN
Dec R: Spironolactone, Eplerenone, ACEI/ARB
Dec Arr: BB (M/E-olol)
Inc Con: Digoxin
What is used for anti-coagulation in Pts w/ dilated cardiomyopathy?
When are these Pts candidates for ICDs?
What meds lower mortality vs are used for Sx control?
Native valve: DOAC/Dabigatran
Mechanical: warfarin
LVEF <35%
BB ACEI/ARB Spironolactone Hydralazine Nitrate (ISDN)
Sxs: Loops, Digoxin
Define Restrictive Cardiomyopathy
What are the two MCCs of this condition?
Pts are more likely to present w/ ? type of Sxs?
Fibrotic/infiltrative process causing diastolic dysfunction.
Idiopathic > Amyloidosis
R-sided HF Sxs
How does amyloidosis cause restrictive cardiomyopathy?
How does sarcoidosis cause restrictive cardiomyopathy?
How does hemochromatosis cause restrictive cardiomyopathy?
Mis-folded proteins deposited in endocardium.
Asteroid bodies causing non-caseating granuloma deposition.
Inc hepcidin protein (regulated feroprotein: transports Fe across GI lumen/release from spleen) causing inc Fe uptake/deposition.
Define Loeffler’s Endocarditis
How/why does cardiac ischemia place Pt at higher risk for VT/VF?
What are the 3 phases of diastolic filling?
Inc eosinophil production leading to fibrosis (parasite, drug, allergic, leukemia).
Dec perfusion = inc permeability for inc cation flow;
HCM>restrictive
Early: atrial blood falls down
Mid: blood from vasculature falls down
Late: atrial kick
What will be seen on EKG, Echo and biopsy in restrictive cardiomyopathy?
When are the ventricles most compliant w/ this condition?
What what is the MC presenting Sx and what will be found on PE?
Bi-phasic P-waves
Atrial enlargement
Apple green w/ Congo red stain
Early diastole
Dyspnea; Early: S3 Late: S4
Kussmaul sign: inspiration increases JVD
What finding during cardiac cath suggests restrictive cardiomyopathy?
How to Tx/manage this condition?
Square root/Dip and plateau sign- end diastolic pressure rapidly increases.
Dec Pre: Na/Water restriction, diuretics
Dec Aft: ACEI/ARB, Hydralazine, ISDN
Arr: BB/CCBs
Coag: DOAC/Warfarin
What genetic mutation causes HOCM?
What triad d/o can occur w/ this condition?
Why is there an increase in septal wall growth?
Autosomal dominant mutation of heavy chain of myosin causing decreased sarcomere function.
Trinucleotide repeat of GAA= Frederick Ataxia: DM, HCM, Ataxia: loss of body function.
Dec sarcomere function stims release of GF causing concentric myocyte growth.
Why is the anterior leaflet of the MV pulled anteriorly during systole in HOCM?
What will be seen/heard on PE?
Venturri effect: volume under pressure passing through small area pulls on leaflet.
MR
JVP A-wave: RA contracting against resistance
Apical lift
Biphasic radial pulse
S4
What causes murmur of HOCM to increase?
What causes murmur of HOCM to decrease?
Inc preload: squat/leg raise
Inc afterload: hand grips
Dec preload: stand/valsalva
Dec afterload: vasodilators (amylnitrate, hydralazine)
How to manage HOCM?
What needs to be avoided?
Increase preload: hydrate
Maintain HR/contractility: BB, Non-DHP CCB
Dec afterload: dilation decreases blood return to heart= inc SV/dec ESV increasing obstruction
Inc contractility: worsens obstruction while increasing O2 demand
What are the two definitive Txs for HOCM?
What are the Echo Dx criteria?
Myomectomy
Alcohol septal ablation
15mm septal thickness
13mm w/ +FamHx
What are the cardiac causes of Afib?
What are the non-cardiac causes?
HTN/Hypertrophy
Ischemia/inflammation
MR/S
Stretch (CHF/DCM)
Post-surgical catecholamine response
E+ abnormality (hypoK/Mg)
Hypoxia
Thyrotoxicosis: inc T3/4 inc B-adrenergic receptors=inc SNS
Sepsis- fight/flight response to HOTN
Pheo ETOH Drugs: meth/coke
What is the MC location for the ectopic foci causing Afib?
What is the equation for MAP
Pulmonary veins
2(DBP)+SDP/3
Goal: 70-100 to perfuse kidney/brain
What are the four classifications of Afib?
What determines if they’re hemodynamically unstable?
Mitral valve
Onset/Duration
Hemodynamics
Ventricular rate: >100bpm= Afib w/ RVR; <60bpm= Afib w/ SVR
Chest pain HOTN AMS Pulm edema
What are the four groups of timing classifications?
How is unstable Afib Tx?
New: <72hrs
Paroxysmal: <7days
Persistent: >7days
Long standing: >12mon
Permanent: >7days w/out attempt to convert to NSR
+CHAP= cardio convert
How is stable Afib Tx?
When is conversion considered in stable Afib?
What is procedure/confirmation imaging is preferred before converting?
Rate control (Amiodarone, BB, CCB, Digoxin)
Anti-coagulate (DOAC/LMWH)
Afib <48hrs w/ low CHADSVASC score w/ anti-coag x 4wks
TEE
What is the risk of using Amiodarone for rate control in Afib?
BBs are c/i for use if ? exists?
CCBs are c/i for use if ? exists?
When is Digoxin preferred?
Pulmonary fibrosis
Asthma/COPD
Decompensated HF
HOTN/HF due to vagus nerve stimulation to inc acetylcholine
What are the four methods of rhythm control for Afib?
What is the scoring system for anticoagulating these Pts?
Maze procedure, Ablation Chemical (Ia, Ic, 3) Electrical
CHA2DS2VASC:
CHF HTN Age>75 DM Stoke/TIA Vascular dz Age 65-74y/o Sex M=0, F=1)
0= low risk, no anti-coag
1= possible
2 or more= anti-coag
Criteria for unstable Aflutter
How are these Pts Tx?
HOTN Angina AMS
Stable: vagal, BB/CCB and anti-coagulate
unstable: synch’d conversion
Definitive: ablation
Acronym for normal conduction pathway in the heart?
For AV blocks, what EKG measurement is used to determine presence?
Send A Big Bounding Pulse
SA AV BOH Bundles Purkinje
PR: time from atrial depolarization to ventricular depolarization
Norm: .12-.20ms (.20=one large box)
Define 1* AV Block
What are the etiologies for this condition by age?
Abnormally slow conduction through AV node >.2ms
Young: athlete/inc vagal tone
Old: fibrosis
What are the four AV blocking meds?
How are unstable 1* blocks Tx?
Define 2-1* AV Block
ABCDs: Adenosine BBs CCBs Digoxin
Atropine (first) then Epi
Impaired AV conduction leading to conduction delays until non-conducted impulse is sent
Mnemonics for AV block etiologies
How are unstable 2-1* AB Blocks Tx
BLOCKS:
BBs
Lyme dz
Ordinary variant
CCBs
K, hyper
Stemi
HOTN AMS Angina= Atropine to Pacing to Pacemaker
Define 2*-2 AV Block
Difference in location of block between 2-1 and 2-2
Dz of conduction system leading to dropped beat w/ fixed/normal PR interval
2-1: at AV node
2-2: below AV node/at BOH
How are 2*-2 Tx?
Why is the use of atropine use avoided in the Tx of 2*-2?
Stable: transcutaneous pacing
Unstable: B-agonist (dopamine, epi) to pacemaker
Atropine decreases refractory time/inc speed through AV node
Define 3* AV block
How are unstable 3* AV blocks Tx
Defected conduction system where all atrial impulses fail to reach ventricles= complete dissociation between atria/ventricles
Atropine
B-agonists: Dopamine/Epi
Pacing to pacemaker
Define PSVT
What are the two types
Tachyarrhythmia originating above ventricles w/ HR of 150-250bpm
AVNRT (MC)- accessory pathway in AV node
AVRT- accessory pathway outside of AV node
How will the two types of PSVT appear on EKG
How are they Tx
Orthodromic (MC)- narrow and tachy
Antidromic- wide and tachy
Stable, narrow: vagal, adenosine, BB, CCB, Digoxin
Stable, wide: amiodarone/procainamide
Unstable: synch’d conversion
Definitive: ablation
MOA and dosage of Adenosine
MOA of Amiodarone
Slows AV conduction
6mg w/ 10ml flush then
12mg w/ 10ml flush
Class 3 K blocker to prolong action potential for atrial and ventricular arrhythmias; s/e: pulmonary fibrosis
Define Sick Sinus Syndrome
What is the MCC
How are unstable Pts Tx?
Dysfunctional node causing periods of arrest followed by brady/tachy arrhythmias
Fibrosis
Atropine (FL) then Epi/Dopamine then Pacing
Pacemaker/IDC
Define VFib
How are these Pts Tx
Ineffective ventricular contractions MC d/t ischemia
Unsynch’d defib w/ CPR
What is the MC type of cardiomyopathy?
What are the etiologies of this MC?
Dilated- systolic dysfunction of myocardium w/out valvular or ischemic pathology.
A Bunch Can Cause Cardiac Dilation:
Acohol Beriberi Coxsackie Coke Chagas Doxorubicin
6 Ds:
Dunno Drugs Drinking Deficiency B1 Doxorubicin Dz, viral
Define Preload
Define Afterload
Blood in heart during diastole
Pressure LV must overcome to circulate blood.
What are the two types of remodeling that can occur within the heart?
What is the GS for Dx dilated cardiomyopathy?
Volume= eccentric, thin wall
Pressure= concentric, thick wall
Echo: ventricular enlargement w/ eccentric remodeling and HFrEF <50%
How is dilated cardiomyopathy Tx to reduce mortality?
How is it symptomatically Tx?
BB
ACEI/ARB
Spironolactone/Eplenerone
Hydralazine/ISBDN
Diuretic, Digoxin
