DCM / HCM / Restrictive CM Flashcards
Define DCM?
Primary myocardial disease which leads to dilation and impaired systolic function which is not due to ischemia.
What are the common causes of DCM?
1) idiopathic (50%)
2) viral myocarditis (9%)
3) ischemic cardiomyopathy (not really DCM)
4) Takotsubo
5) Peripartum
6) HTN
7) connective tissue diseases
8) daunorubricin
9) HIV
What is the difference in terms of survival between ICM and NICM?
ICM has worse survival
What is the cause of HCM?
Autosomal dominant genetic disease in sarcomeres. Non inherited are likely de novo mutations
What are the risks of HCM?
Arrthythmias, syncope, SCD, dyspnea
What are the main forms of HCM?
Obstructive: LVOT or midcavitary
Nonobstructive: Asymmetric or apical
What are the features of apical HCM?
Apical hypertrophy (“spades sign”). Also giant neg t-waves on EKG. Prevalent on asians.
What are the major causes of restrictive cardiomyopathy?
Amyloid, Idiopathic, sarcoid heart, carcinoid heart, hemachromotosis, chemotherapy.
What are the pathyphysiologic problems with restrictive cardiomyopathy?
Diastolic dysfunction with right heart failure due to increased LVEDP. Thus, often see pericardial and pleural effusions, hepatomegaly and peripheral edema.
What are the TTE features of restrictive cardiomyopathy?
1) LVH in absence of HTN
2) normal LV function and volumes.
3) Biatrial enlargement with enlarged pulmonary veins
4) RHF: IVC dilation, TR
Differentiate primary vs. secondary amyloidosis
1) AL: due to immune system disease with deposition (MM, light chain)
2) AA amyloid secondary to chronic inflammatory diseass (RA, IBD, chronic infections etc.
How to differentiate restrictive vs. constrictive CM on echo?
Difficult as they share overlapping features. Restrictive CM will have attenuated E’ on tissue doppler whereas E’ will be preserved or accentuated in constrictive CM.
