Harrison's 254 - Cardiomyopathy & Myocarditis Flashcards

1
Q

What percentage of Heart Failure is represented by Cardiomyopathic Diseases?

A

5-10%

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2
Q

What are the 3 major types of Cardiomyopathies?

A
  • Restrictive Cardiomyopathy
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
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3
Q

What are the early symptoms Cardiomyopathy (all types)?

What will be on the differential?

A

Rapid fatigue on Exertion with Dyspnea or Weakness

DD: Aging or Respiratory Illness

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4
Q

What are the long-term Congestive symptoms of Cardiomyopathy (all types)?

A

Chronic Heart Failure that may be characterized by Orthopnea, Bilateral Pedal Edema, Ascites or Abdominal Discomfort.

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5
Q

What are the long-term prognosis and Auscultative symptoms of Cardiomyopathy (all types)?

A

Chronic Heart Failure that may be characterized by Tricuspid or Mitral Valve (AV) Regurgitation.

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6
Q

What are the long-term ECG signs of Cardiomyopathy (all types)? What may be a complication?

A

Supraventricular or Ventricular Arrhythmias.

May result in Embolization.

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7
Q

Different Ejection Fractions (EF):

  • Restrictive Cardiomyopathy
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
A

Ejection Fractions

  • Restrictive Cardiomyopathy: EF = 25-50%
  • Dilated Cardiomyopathy: EF <30%
  • Hypertrophic Cardiomyopathy: EF <60%
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8
Q

Different LV Diastolic Size:

  • Restrictive Cardiomyopathy
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
A

Different LV Diastolic Size

  • Restrictive Cardiomyopathy: <60mm
  • Dilated Cardiomyopathy: >60mm
  • Hypertrophic Cardiomyopathy: <60mm
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9
Q

Different LV wall Thickness:

  • Restrictive Cardiomyopathy
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
A

Different LV wall Thickness

  • Restrictive Cardiomyopathy: Normal or Increased
  • Dilated Cardiomyopathy: Normal or Decreased
  • Hypertrophic Cardiomyopathy: Markedly Increased
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10
Q

Atrial Size:

  • Restrictive Cardiomyopathy
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
A

Atrial Size

  • Restrictive Cardiomyopathy: Increased, massive
  • Dilated Cardiomyopathy: Increased
  • Hypertrophic Cardiomyopathy: Increased
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11
Q

Valvular Regurgitation Origins:

  • Restrictive Cardiomyopathy
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
A

Valvular Regurgitation

  • Restrictive Cardiomyopathy: Endocardial Involvement
  • Dilated Cardiomyopathy: Annular Dilation
  • Hypertrophic Cardiomyopathy: Valve-Septum interaction
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12
Q

Congestion side:

  • Restrictive Cardiomyopathy
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
A

Congestion side

  • Restrictive Cardiomyopathy: Right Dominant
  • Dilated Cardiomyopathy: Left Dominant
  • Hypertrophic Cardiomyopathy: Left Dominant
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13
Q

Type of Arrhythmias:

  • Restrictive Cardiomyopathy
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
A

Type of Arrhythmias

  • Restrictive Cardiomyopathy: A.fib, AV block
  • Dilated Cardiomyopathy: VT, AV block, A.fib
  • Hypertrophic Cardiomyopathy: VT, A.fib
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14
Q

What are the clinical manifestations of CM ?

A

Familial Story of CM
HF symptoms
IHD or Tachyarrhythmias
SCM

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15
Q

What other systemic genetic diseases could lead to CM?

A
Duchene & Becker's Muscular Dystrophy
Arrhythmogenic right ventricular dysplasia (ARVD)
Fabry Disease
Amyloidosis (all genetic types)
Hemochromatosis
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16
Q

What pathogen may lead to damage similar to the one appearing in Duchenne Muscular Dystrophy?

A

Coxsackievirus

May cause myocarditis while damaging Dystrophin

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17
Q

Dilated Cardiomyopathy
What Viral etiologies does it have?
(Through myocarditis)

A

Coxsackievirus
Adenovirus
HIV
HepC

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18
Q

Dilated Cardiomyopathy
What Parasitic etiologies does it have?
(Through myocarditis)

A

T. Cruzi (Chagas)
African Trypanosomiasis (Sleeping Sickness)
Toxoplasmosis

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19
Q

Dilated Cardiomyopathy
What Bacterial etiologies does it have?
(Through myocarditis)

A
Corynebacterium Diphtheriae - Most common
Borrelia Burgdorferi (Lyme)
Coxiella Burnetii (Q-Fever)
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20
Q

Dilated Cardiomyopathy
What Granulomatous Inflammatory etiologies does it have?
(Through myocarditis)

A

Sarcoidosis

Giant cell Myocarditis

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21
Q

Dilated Cardiomyopathy
What Non-Granulomatous Inflammatory etiologies does it have?
(Through myocarditis)

A

Eosinophilic Myocarditis
Polymyositis & Dermatomyositis
Collagen vascular disease
Transplant Rejection

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22
Q

Dilated Cardiomyopathy

What Toxicology etiologies does it have?

A
Ethanol & Steroids
Amphetamines and Cocaine
Chemotherapy & IFN
Antimalarial Drugs
Heavy metals & Occupational exposure
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23
Q

Dilated Cardiomyopathy

What Vitamin/Micronutrient Deficiencies leads to it?

A

Thiamine
Selenium
Carnitine

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24
Q

Dilated Cardiomyopathy

What Endocrine etiologies does it have?

A

Thyroid - Hypo/Hyper
Pheochromocytoma
DIabetes Mellitus 1/2

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25
Dilated Cardiomyopathy | What Electrolyte etiologies does it have? (Low levels)
Hypocalcemia Hypophosphatemia Hypomagnesemia
26
Dilated Cardiomyopathy | What Electrolyte etiologies does it have? (high levels)
Hemochromatosis
27
Dilated Cardiomyopathy | What weight changes may trigger it?
Obesity | Peripartum
28
What is the most common cause of Myocarditis?
Infective Myocarditis
29
Any systemic infection may lead to high levels of ______ that suppress cardiac systolic function, therefore not every acute infection of that kind is definitively myocarditis.
Any systemic infection may lead to high levels of cytokines that suppress cardiac systolic function, therefore not every acute infection of that kind is definitively myocarditis.
30
What is the classic clinical course of viral myocarditis?
Young patient, develops dyspnea and fatigue few days-weeks after febrile viral disease.
31
what is the rare clinical course of viral myocarditis?
Fulminant course, severe URTI with fever that develops to cardiogenic shock.
32
Viral Myocarditis | What is the first step of laboratory diagnostic evaluation?
ECG, TEE/TTE, Troponin and CPK
33
Viral Myocarditis | What is the second step of laboratory diagnostic evaluation?
MRI - for checking intramyocardial edema with gadolinium
34
When suspecting of myocarditis, what will license endomyocardial biopsy?
Ventricular Tachyarrhythmias that suggest Sarcoidosis or Giant cell Myocarditis.
35
Myocarditis Diagnosis - Probable/Optional? A patient with viral symptoms with one or more: - CK-MB - ECG: diffuse T wave inversions; saddle-shaped ST-segment elevations - LVEF decreased on TEE/TTE - Chest X-ray alterations
Myocarditis Optional Diagnosis A patient with viral symptoms with one or more: - CK-MB - ECG: diffuse T wave inversions; saddle-shaped ST-segment elevations - LVEF decreased on TEE/TTE - Chest X-ray alterations
36
Myocarditis Diagnosis - Probable/Optional? A patient with dyspnea/chest pain/pericarditis together with one or more: - CK-MB - ECG: diffuse T wave inversions; saddle-shaped ST-segment elevations - LVEF decreased on TEE/TTE - Chest X-ray alterations
Myocarditis Probable Diagnosis A patient with dyspnea/chest pain/pericarditis together with one or more: - CK-MB - ECG: diffuse T wave inversions; saddle-shaped ST-segment elevations - LVEF decreased on TEE/TTE - Chest X-ray alterations
37
What are the classical symptoms & signs of pericarditis?
Pleuritic Chest pain Widespread concave ST elevation and PR depression Pericardial rub Pericardial effusion
38
What is the definitive diagnosis of acute myocarditis?
Histological or Immunohistochemical evidence for endomyocardial inflammation. No other criteria needed.
39
RNA Viruses that commonly cause Myocarditis?
Picornaviruses - Coxsackie B, Polio, Entero | Orthomyxovirus
40
DNA Viruses that commonly cause Myocarditis?
Adenovirus Parvovirus B19 Herpesviruses -HHV6, VZV, CMV, EBV
41
___ infection is associated with a 2% rate of Dilated Cardiomyopathy.
HIV infection is associated with a 2% rate of Dilated Cardiomyopathy.
42
Viral Myocarditis treatment: | In the ____ phase of the disease there is a contraindication for anti-inflammatory or immunosuppressive drugs.
Viral Myocarditis treatment: | In the acute phase of the disease there is a contraindication for anti-inflammatory or immunosuppressive drugs.
43
What is the most common cause of Parasitic Myocarditis? What is the mechanism of cardiac damage?
Chagas Disease - Trypanosoma Cruzi | Parasitic lysis of Myocytes with subsequent immune response that damages microvascular and autonomic neurons.
44
What is the course of Chagas disease in regards to Myocardial involvement?
Acute Phase mainly asymptomatic, 5% myocarditis 10-30 years of silent phase Myocardial chronic damage with manifestations
45
What are the manifestations myocardial chronic damage in Chagas Disease?
Sick Sinus Syndrome, A.F, A.f, RBBB, VT Ventricular Aneurysms Pulmonary and Systemic Emboli
46
What are the diagnostic laboratory tests used in chagas disease?
2 Positive Serological IgG findings for Trypanosoma Cruzi: ELISA/IF/Hemagglutination
47
What are the antiparasitic drugs for chagas disease?
Benznidazole & Nifurtimox
48
what is the five year survival rate after HF diagnosis in chagas disease?
30% FYS
49
__________ ________ has cardiac involvement in half of patients, it is most common cause of death of that infection.
Corynebacterium Diphtheriae has cardiac involvement in half of patients, it is most common cause of death of that infection.
50
__________ ________ releases a toxin that disturbs the protein synthesis in the cardiac conduction system therefore antitoxin is the most immediate treatment for prevention of arrhythmias.
Corynebacterium Diphtheriae releases a toxin that disturbs the protein synthesis in the cardiac conduction system therefore antitoxin is the most immediate treatment for prevention of arrhythmias.
51
GAS is associated with Rheumatic Fever and valvular involvement, a complication of ________ infiltration into the myocardium is possible.
GAS is associated with Rheumatic Fever and valvular involvement, a complication of mononuclear infiltration into the myocardium is possible.
52
__________ ________ rarely penetrates the cardiac tissue and infect myocardium, when it does there is a high mortality rate.
Mycobacterium Tuberculosis rarely penetrates the cardiac tissue and infect myocardium, when it does there is a high mortality rate.
53
Borrelia Burgdorferi causes Lyme disease that among other symptoms causes AV block. What is the first line treatment?
1-2 weeks of Doxycycline
54
Non-Infective myocarditis has the highest prevalence in people who have pulmonary involvement of -
Granulomatous diseases: Sarcoidosis or Giant cell arteritis
55
Ventricular Tachycardia, Low-grade fever, Heart Blocks and Heart Failure (without IHD, Valvular Disease, HTN etc) is suggestive of-
Non-Infective Myocarditis
56
In Non-Infective Myocarditis ventricles can be Dilated or Constricted, with mostly _____ ventricle dominance.
In Non-Infective Myocarditis ventricles can be Dilated or Constricted, with mostly Right ventricle dominance.
57
In Non-Infective Myocarditis the later stages are characterized by ______ that leads to Reentry Arrhythmias.
In Non-Infective Myocarditis the later stages are characterized by Fibrosis that leads to Reentry Arrhythmias.
58
In Non-Infective Myocarditis, the final diagnosis is mostly made by-
Mediastinal lymph node biopsy.
59
Giant cell myocarditis is ____ common to involve the cardiac than Sarcoidosis.
Giant cell myocarditis is Less common to involve the cardiac than Sarcoidosis.
60
What other diseases does Giant cell myocarditis associate with?
Thymomas Thyroiditis Pernicious Anemia
61
Giant cell myocarditis - Treatment and Prognosis
Steroids are less effective than in Sarcoid, must involve other immunosuppressant. Usually with Fulminant course that requires transplant
62
Hypereosinophilic syndrome leads to Restrictive Cardiomyopathy and Myocarditis, it may result from a previous infection but can develop from systemic syndromes like-
Churg-Strauss or Malignancies
63
Penicillins, Thiazides, AEDs, Indomethacin, Methyldopa and Pox vaccine are all linked to - ? What is the treatment?
Hypersensitivity Myocarditis | Cessation of Drug and high dose steroids is needed
64
_________ Cardiomyopathy is defined as cardiac dilation and failure circa the last trimester or 6 months following delivery.
Peripartum Cardiomyopathy is defined as cardiac dilation and failure circa the last trimester or 6 months following delivery.
65
What are the risk factors for Peripartum Cardiomyopathy?
``` Older maternal age Twins & Gravidity (Peripartum) Malnutrition Tocolytics Preeclampsia ```
66
Heart Failure appearing in the first trimester is called
Pregnancy Associated Cardiomyopathy
67
Similarly to DCM 15% of PPCM has a ___ mutation, that specifically results in refractory decreased systolic function even after pregnancy.
Similarly to DCM 15% of PPCM has a TTN mutation, that specifically results in refractory decreased systolic function even after pregnancy.
68
What is the most common toxic etiology for Dilated Cardiomyopathy? What is the genetic predisposition
Chronic Alcohol abuse (10%) - 5-6 years. | depends on ACE and ADH genes.
69
What is another toxic alcoholic heart disease that is not characterized by tissue alteration like CM?
Holiday Heart Syndrome | Reccurent arrhythmias after alcohol loads
70
What kind of Chemotherapy Family usually causes DCM? Examples and Mechanism
Anthracyclines - Doxorubicin, Daunorubicin. | ROS leads to myocardial necrosis and fibrosis leading to Acute Heart Failure.
71
Doxorubicin can lead to DCM. what are the precipitating risk factors? what is the Preventive drug?
High doses of Doxorubicin, Previous heart disease, previous chest Irradiation. Preventive - Dexrazoxane
72
In chronic Doxorubicin intake what is an important factor that determines the clinical manifestation of the DCM ? + different outcomes?
Pre-teen : Cardiac maldevelopment and HF until 20 yo | Post-teen : Cardiac symptoms worsen due to secondary event such as Flu or AF
73
What is the EF in a Doxorubicin related DCM? why?
usually no severe dilation of ventricles - 30-40% EF
74
What other chemotherapy treatment becomes highly cardiotoxic with Anthracyclines?
Herceptin
75
Hypothyroidism and Hyperthyroidism will not cause HF on their own but will worsen it due to ___.
Hypothyroidism and Hyperthyroidism will not cause HF on their own but will worsen it due to DCM.
76
a Patient with AF progresses to VF/VT, what will be the lab value that taken regarding the Thyroid?
TSH
77
In a state of Hypothyroidism with DCM, the administrator of Levothyroxine must titer the load _____ to avoid tachyarrhythmias exacerbations.
In a state of Hypothyroidism, the administrator of Levothyroxine must titer the load slowly to avoid tachyarrhythmias exacerbations.
78
What is the deadly process that may happen in treatment of DCM with Hyperthyroidism? what is the medical response?
Decompensation - Close monitoring is required
79
Apart from thyroid dysfunction, what other endocrine pathologies lead to DCM?
Elevated Renin from renal artery stenosis | Pheochromocytoma
80
What disease is characterised by low levels of thiamine, high EF with vasodilatory state that progresses to DCM with low EF?
Beri-Beri Disease
81
Beri-Beri Disease - Etiologies?
Processed food based consumption Malnutrition Alcoholics
82
Diseases involving altered Creatinine metabolism in children results in - DCM or RCM?
BOTH
83
Keshan's Disease
Selenium deficiency resulting in Cardiomyopathy
84
What is unique in the cardiac manifestation of Hemochromatosis?
Restrictive Cardiomyopathy that may have DCM signs
85
What is the diagnosis & treatment of Hemochromatosis related RCM?
Serum Iron (over 30 μmol/L) and Transferrin above 60% (men) 50% (women) with following MRI and biopsy. tx - phlebotomy, with severe cases- chelators.
86
a 88 year old lady who unfortunately just became a widow lately comes to the clinic for a routine check up. she had just went through a PCI following a "false-alarm" MI after Ischemic changes appeared on her ECG. She has pulmonary edema, Hypotension and chest pain right now with no ST elevations or Troponin .What will her TTE/X-ray reveal? What is the most probable diagnosis?
Takotsubo/Stress-Induced Cardiomyopathy | Vase-like ballooning of the ventricles
87
Takotsubo/Stress-Induced Cardiomyopathy | Prognosis? Treatment?
disease passes after a days-weeks (10% return) | supportive treatment for comorbidities - Nitrates, Intra-aortic balloon, Beta/alpha blockers and Magnesium.
88
What disease represents 2/3 of DCM? what are the diagnostic steps?
Idiopathic Dilated Cardiomyopathy | Diagnosis of Exclusion, still investigated for Genes
89
Cardiomyopathies with Overlapping Symptoms: | Sarcoidosis and Hemochromatosis can manifest as _______ or ______ Cardiomyopathy
Cardiomyopathies with Overlapping Symptoms: | Sarcoidosis and Hemochromatosis can manifest as Restrictive or Dilated Cardiomyopathy
90
Cardiomyopathies with Overlapping Symptoms: | Amyloidosis is a RCM that has earlier symptoms of ___.
Cardiomyopathies with Overlapping Symptoms: | Amyloidosis is a RCM that has earlier symptoms of HCM.
91
Cardiomyopathies with Overlapping Symptoms: | Genetic disease with Beta-Glucosidase deficiency?
Gaucher Disease
92
Cardiomyopathies with Overlapping Symptoms: | Genetic disease with Alpha-Galactosidase A deficiency?
Fabry Disease
93
What kind of heart sounds are typical for DCM?
S3 | Systolic Regurgitant Murmur
94
DCM involves _______ hypertrophy of cardiac muscle where sarcomeres are added in ____ which results in ____ dysfunction.
DCM involves eccentric hypertrophy of cardiac muscle where sarcomeres are added in series which results in Systolic dysfunction.
95
HCM involves _______ hypertrophy of cardiac muscle where sarcomeres are added in ____ which results in ____ dysfunction.
HCM involves concentric hypertrophy of cardiac muscle where sarcomeres are added in parallel which results in Diastolic dysfunction.
96
RCM involves _______ of ventricular muscle wall which results in ____ dysfunction.
RCM involves hardening of ventricular muscle wall which results in Diastolic dysfunction.
97
What are the infiltrative causes of RCM?
Primary Amyloidosis Familial Transthyretin Senile Transthyretin
98
What are the Fibrotic causes of RCM?
Radiation | Scleroderma
99
What are the Endomyocardial causes of RCM?
``` Carcinoid syndrome / Serotonin or Ergotamine Hypereosinophilic Syndrome (Loeffler's) Tropical endomyocardial Fibrosis ```
100
What is the pathophysiological changes in RCM?
Dilated Atria End-Diastolic Pressures are elevated CO is preserved until progressive disease Thrombogenic ventricular filling
101
What is the first clinical changes in RCM?
Fatigue upon exertion & Dyspnea
102
What is the late clinical changes in RCM?
Ascites, Hepatomegaly and Edema
103
What is the ECG and Auscultatory changes in RCM?
Distant Heart sounds, S4 & S3, AF.
104
What sign is positive in RCM?
Kussmaul sign | JVP with Y descents that may worsen with inspiration
105
How would you differentiate Constrictive Pericarditis from RCM on physical examination?
Constrictive Pericarditis- PMI is easily detected & higher prevalence of MR
106
What is the usual first finding of Cardiac Amyloidosis?
Low Voltage ECG with Enlarged Ventricular Wall in Xray
107
Cardiac Amyloidosis - 4 major clinical signs?
Systolic Dysfunction Diastolic Dysfunction Arrhythmias and Blocks Orthostatic Hypotension
108
What are the diagnostic steps in suspicion for Cardiac Amyloidosis?
TTE/TEE / CMRI Biopsy from Mucosal Linings Biopsy from Cardiac tissue
109
How does Scleroderma causes RCM?
Vasospasms and Ischemic processes and Fibrosis leads to a smaller more rigid heart with ventricles remaining stiff.
110
In which patient (parameters) it is probable we will see loeffler's endocarditis becoming a RCM?
Men, with 1500 eos/microL for at least half a year.
111
What are the possible treatments of Tropical endomyocardial Fibrosis?
Steroids & Hydroxyurea - lower eosinophils Diuretics and Anticoagulation sometimes Surgical removal of fibrotic tissue
112
What is the pathomechanism of Carcinoid related RCM?
Serotonin yields fibrotic plaques in endocardium and right heart valves leading to stenosis/regurgitation of Tricuspid or Pulmonary Valves.
113
What is the definition of HCM?
LV concentric hypertrophy that is not related to HTN/AS/Infiltrative disease.
114
What are the macroscopic pathological findings of HCM?
Asymmetric (Septal usually) LV hypertrophy Provoked/Unprovoked LV outflow obstruction Diastolic Dysfunction with LVEDP
115
Etiology of HCM?
AD genetic cause in 60% | Manifestation in puberty
116
What is the most common cause of SCD (mostly in teens during exertion)?
HCM
117
Common symptoms of HCM?
Exertional Dyspnea Syncope Angina AF
118
What are the physical examination signs of HCM?
Double & Triple apical precordial impulse S4 in LVOT - Crescendo-Decrescendo Murmur
119
HCM in LVOT has a Crescendo-Decrescendo Murmur | What will worsen the murmur?
Preload Decreasing states: Valsalva Maneuver Sudden Standing up Nitroglycerin
120
HCM in LVOT has a Crescendo-Decrescendo Murmur | What will alleviate the murmur?
Preload/Afterload Increasing states: Passive leg raising Pregnancy Squatting/Hand Gripping
121
What are possible ECG findings in HCM?
LVH Q wave that are widespread (septal hypertrophy) Negative T waves (Apical Hypertrophy) SVT/VT
122
Echocardiogram is the diagnostic step! | What are common TEE/TTE findings in HCM?
Systolic Anterior Motion Septum x 1.3 > Lateral Wall Concentric ventricular size Septal Hyperkinesia and Apical Hypokinesia
123
Hypertrophic Cardiomyopathy Treatment Algorithm | In all points of treatment algorithm if there is a risk of SCD, we have to consider an -
ICD
124
2 OR MORE OF THE FOLLOWING would indicate: ``` Cardiac Arrest History Sustained VT History or Spontaneous VT on Exertion Syncope SCD in family LV>30 cm in TEE Abnormal BP in Exertion ```
``` ICD - 2 OR MORE OF THE FOLLOWING Cardiac Arrest History Sustained VT History or Spontaneous VT on Exertion Syncope SCD in family LV>30 cm in TEE Abnormal BP in Exertion ```
125
Hypertrophic Cardiomyopathy Treatment | If symptomatic, with fluid retention evidence -
Use Diuretics and avoid hypotension
126
Hypertrophic Cardiomyopathy Treatment Algorithm | If symptomatic, titrate _ ______ or ___ to possible dosage.
Hypertrophic Cardiomyopathy Treatment Algorithm | If symptomatic, titrate β Blockers or CCBs to possible dosage.
127
Hypertrophic Cardiomyopathy Treatment Algorithm: | If symptomatic, without improvement on β Blockers or CCBs + Outflow gradient is present try -
Disopyramide
128
Hypertrophic Cardiomyopathy Treatment Algorithm : If symptomatic, without improvement on β Blockers or CCBs without Outflow gradient but with severe progressive LV dysfunction consider -
Cardiac Transplantation
129
Hypertrophic Cardiomyopathy Treatment Algorithm : If symptomatic with Outflow gradient, without improvement on β Blockers or CCBs or Disopyramide and has severe refractory symptoms consider -
Mitral valve Surgery or Septal Ablation Surgery
130
1 in 20 HCM patients will -
develop systolic dysfunction with low EF
131
1 in 100 HCM patients will -
have SCD per year
132
Why Adenovirus and Coxsackievirus are associated with increased susceptibility to cause myocarditis in some familial DCM cases?
Adeno-Coxsackievirus Receptor abnormality
133
Most common mutations that cause DCM & HCM are involving the ________. TTN, MYBPC3, MYL2 etc..
Most common mutations that cause DCM are involving the Sarcomere. TTN, MYBPC3, MYL2 etc..