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Cardiology Secrets > DILATED CARDIOMYOPATHY > Flashcards

DILATED CARDIOMYOPATHY Flashcards

1
Q

What is the definition of heart failure (HF)?

A

HF is a clinical syndrome resulting from progressive myocardial dysfunction that compromises ventricular filling and cardiac output.

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2
Q

What are the categories of heart failure based on left ventricular ejection fraction (LVEF)?

A
  • HF with preserved ejection fraction (HFpEF): LVEF > 50%-55%
  • HF with reduced ejection fraction (HFrEF): LVEF < 40%
  • HF with mid-range ejection fraction (HFmEF): LVEF 41%-49%
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3
Q

What is the lifetime risk of developing heart failure?

A

Approximately 20%.

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4
Q

What is the prognosis for heart failure patients within 5 years of diagnosis?

A

Absolute mortality remains high at 50%.

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5
Q

What is the major pathophysiology of HFrEF?

A

A primary insult to the myocardium leads to depression in LV systolic function and decreased systemic blood flow, activating neurohormonal responses that cause adverse cardiac remodeling.

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6
Q

What is dilated cardiomyopathy (DCM)?

A

DCM is a term describing myocardial dysfunction with progressive LV wall thinning and dilation and reduced LVEF in the absence of abnormal loading conditions.

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7
Q

What are common causes of dilated cardiomyopathy?

A
  • Genetic causes
  • Toxins
  • Infection
  • Inflammatory disorders
  • Nutritional disorders
  • Pregnancy
  • Endocrine disorders
  • Tachycardia-induced cardiomyopathy
  • Stress-induced cardiomyopathy
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8
Q

What are typical presenting symptoms of DCM?

A
  • Exertional dyspnea
  • Fatigue
  • Reduced exercise tolerance
  • Weakness
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Weight gain
  • Early satiety
  • Nausea
  • Bendopnea
  • Lower extremity edema
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9
Q

What key physical examination findings are associated with DCM?

A
  • Elevated jugular vein pressure (JVP)
  • Extra heart sounds (S3, S4)
  • Pulmonary congestion
  • Lower extremity edema
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10
Q

What diagnostic tests are part of the initial evaluation for DCM?

A
  • Complete blood count
  • Comprehensive metabolic panel
  • Fasting lipid profile
  • Urinalysis
  • Thyroid-stimulating hormone (TSH)
  • Natriuretic peptide levels
  • Cardiac enzymes
  • Chest radiograph
  • Electrocardiogram (ECG)
  • Echocardiography
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11
Q

What is the role of transthoracic echocardiography (TTE) in diagnosing LV dysfunction?

A

TTE quantifies LVEF and provides prognostic information on LV dilation, chamber geometry, wall motion abnormalities, and right ventricular assessment.

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12
Q

What advanced imaging technique is considered the gold standard for assessing biventricular EF?

A

Cardiac magnetic resonance imaging (CMRI).

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13
Q

Do all patients with new LV dysfunction or DCM require an ischemic evaluation?

A

True, especially if experiencing angina symptoms or having CAD risk factors.

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14
Q

What are the advantages of using cardiac MRI?

A
  • Superior assessment of myocardial viability
  • Diagnostic value for infiltrative cardiomyopathies
  • Noninvasive with no radiation exposure
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15
Q

What are the disadvantages of using cardiac MRI?

A
  • Gadolinium contraindicated in certain kidney conditions
  • Limited availability
  • Expensive and time-consuming
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16
Q

Fill in the blank: Heart failure patients are categorized based on their _______.

A

[left ventricular ejection fraction (LVEF)]

17
Q

What is the role of endomyocardial biopsy (EMB) in the diagnosis of LV dysfunction?

A

EMB is not commonly indicated for newly diagnosed HF and should only be performed in specific clinical circumstances. Class 1 recommendations include:
* Unexplained acute HF with hemodynamic compromise
* New HF with dilated LV and new ventricular arrhythmias/high-degree AV block, or failure to respond to standard care.

EMB results may often be nonspecific or unrevealing in DCM.

18
Q

What is the significance of right heart catheterization (RHC) in patients with newly diagnosed and chronic DCM?

A

RHC may provide critical hemodynamic information in acute decompensated HF, especially with:
* Progressive dyspnea
* Poor perfusion
* Worsening end-organ function
* Poor response to medical therapy.

RHC also assesses pulmonary hypertension severity.

19
Q

What are the most commonly studied biomarkers in heart failure (HF)?

A

BNP and NT-proBNP are the most studied biomarkers in HF.

Elevated BNP indicates worse clinical outcomes, while a decrease with therapy suggests improved outcomes.

20
Q

What is the relationship between genetic factors and dilated cardiomyopathy (DCM)?

A

25% to 30% of DCM cases are familial. Common genetic mutations include:
* Sarcomere proteins
* Cytoskeletal proteins
* Calcium handling proteins
* Nuclear membrane proteins.

The most common genetic abnormality involves mutations encoding the sarcomere protein titin (TTN).

21
Q

What characterizes stress-induced or Takotsubo’s cardiomyopathy?

A

Takotsubo’s is characterized by:
* Acute LV dysfunction
* Emotional or physical stress
* Chest pain, shortness of breath
* ECG changes (T-wave inversions, ST elevation)
* Apical akinesis with basal hyperkinesis.

Recovery of LVEF usually occurs within 1 to 2 weeks.

22
Q

What are the features of toxin-mediated cardiomyopathy?

A

Alcohol is a direct cardiomyocyte toxin leading to DCM with chronic use. Other toxic substances include:
* Cocaine
* Amphetamines
* Clozapine
* Hydroxychloroquine
* Cobalt
* Lead.

Alcohol abstinence can partially or completely reverse DCM.

23
Q

What defines chemotherapy-induced cardiomyopathy?

A

Defined as LVEF reduction of at least 5% (symptomatic HF) or 10% (asymptomatic HF) to LVEF <50%. Most prominent agents include:
* Anthracyclines
* Trastuzumab.

Anthracyclines can cause cardiotoxicity early or 10 to 20 years post-therapy.

24
Q

What are the features of peripartum cardiomyopathy (PPCM)?

A

PPCM occurs in the last trimester or within 6 months postpartum. Risk factors include:
* African American race
* Preeclampsia
* Hypertension
* Multigestational pregnancy
* Older maternal age.

Treatment includes beta-blockers and anticoagulation due to higher thromboembolism incidence.

25
Q

What is tachycardia-mediated cardiomyopathy?

A

Occurs due to persistent tachyarrhythmias with elevated ventricular rates. Common arrhythmias include:
* Atrial fibrillation
* Atrial flutter.

Recovery of LV function usually occurs after eliminating the tachyarrhythmia.

26
Q

What is included in guideline-directed medical therapy (GDMT) for LV dysfunction?

A

GDMT includes:
* Beta-blockers
* ACE inhibitors
* Aldosterone antagonists
* Hydralazine/isosorbide dinitrate
* ARNI
* SGLT2 inhibitors.

Diuretics provide symptom relief but do not improve mortality.

27
Q

What is the current HF staging and classification system?

A

Patients are classified according to:
* ACC/AHA Stage (A to D)
* NYHA Functional Class (I to IV) based on symptom severity.

Stages have direct therapeutic and prognostic implications.

28
Q

When is device therapy (ICD or CRT) recommended for patients with DCM?

A

ICD is recommended for patients with:
* Prior sustained ventricular arrhythmia
* LVEF ≤35% with NYHA Class II or III symptoms on chronic GDMT for at least 90 days.

CRT is indicated for patients with LVEF <35% and left bundle branch block.

Cardiology Secrets (26 decks)

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