Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GBA - Y4 > Harrison's 254 - Cardiomyopathy & Myocarditis > Flashcards

Harrison's 254 - Cardiomyopathy & Myocarditis Flashcards

1
Q

What percentage of Heart Failure is represented by Cardiomyopathic Diseases?

A

5-10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 3 major types of Cardiomyopathies?

A
  • Restrictive Cardiomyopathy
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Atrial Size:

  • Restrictive Cardiomyopathy
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
A

Atrial Size

  • Restrictive Cardiomyopathy: Increased, massive
  • Dilated Cardiomyopathy: Increased
  • Hypertrophic Cardiomyopathy: Increased
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the clinical manifestations of CM ?

A

Familial Story of CM
HF symptoms
IHD or Tachyarrhythmias
SCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

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

A

Coxsackievirus
Adenovirus
HIV
HepC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

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

A 
Corynebacterium Diphtheriae - Most common
Borrelia Burgdorferi (Lyme)
Coxiella Burnetii (Q-Fever)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A

Sarcoidosis

Giant cell Myocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

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

A

Eosinophilic Myocarditis
Polymyositis & Dermatomyositis
Collagen vascular disease
Transplant Rejection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Dilated Cardiomyopathy

What Toxicology etiologies does it have?

A 
Ethanol & Steroids
Amphetamines and Cocaine
Chemotherapy & IFN
Antimalarial Drugs
Heavy metals & Occupational exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Dilated Cardiomyopathy

What Vitamin/Micronutrient Deficiencies leads to it?

A

Thiamine
Selenium
Carnitine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Dilated Cardiomyopathy

What Endocrine etiologies does it have?

A

Thyroid - Hypo/Hyper
Pheochromocytoma
DIabetes Mellitus 1/2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Dilated Cardiomyopathy

What Electrolyte etiologies does it have? (Low levels)

A

Hypocalcemia
Hypophosphatemia
Hypomagnesemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Dilated Cardiomyopathy

What Electrolyte etiologies does it have? (high levels)

A

Hemochromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Dilated Cardiomyopathy

What weight changes may trigger it?

A

Obesity

Peripartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the most common cause of Myocarditis?

A

Infective Myocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

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.

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the classic clinical course of viral myocarditis?

A

Young patient, develops dyspnea and fatigue few days-weeks after febrile viral disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the rare clinical course of viral myocarditis?

A

Fulminant course, severe URTI with fever that develops to cardiogenic shock.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Viral Myocarditis

What is the first step of laboratory diagnostic evaluation?

A

ECG, TEE/TTE, Troponin and CPK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Viral Myocarditis

What is the second step of laboratory diagnostic evaluation?

A

MRI - for checking intramyocardial edema with gadolinium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

When suspecting of myocarditis, what will license endomyocardial biopsy?

A

Ventricular Tachyarrhythmias that suggest Sarcoidosis or Giant cell Myocarditis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

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
A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

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
A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the classical symptoms & signs of pericarditis?

A

Pleuritic Chest pain
Widespread concave ST elevation and PR depression
Pericardial rub
Pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the definitive diagnosis of acute myocarditis?

A

Histological or Immunohistochemical evidence for endomyocardial inflammation. No other criteria needed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

RNA Viruses that commonly cause Myocarditis?

A

Picornaviruses - Coxsackie B, Polio, Entero

Orthomyxovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

DNA Viruses that commonly cause Myocarditis?

A

Adenovirus
Parvovirus B19
Herpesviruses -HHV6, VZV, CMV, EBV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

___ infection is associated with a 2% rate of Dilated Cardiomyopathy.

A

HIV infection is associated with a 2% rate of Dilated Cardiomyopathy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Viral Myocarditis treatment:

In the ____ phase of the disease there is a contraindication for anti-inflammatory or immunosuppressive drugs.

A

Viral Myocarditis treatment:

In the acute phase of the disease there is a contraindication for anti-inflammatory or immunosuppressive drugs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the most common cause of Parasitic Myocarditis? What is the mechanism of cardiac damage?

A

Chagas Disease - Trypanosoma Cruzi

Parasitic lysis of Myocytes with subsequent immune response that damages microvascular and autonomic neurons.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the course of Chagas disease in regards to Myocardial involvement?

A

Acute Phase mainly asymptomatic, 5% myocarditis
10-30 years of silent phase
Myocardial chronic damage with manifestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the manifestations myocardial chronic damage in Chagas Disease?

A

Sick Sinus Syndrome, A.F, A.f, RBBB, VT
Ventricular Aneurysms
Pulmonary and Systemic Emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the diagnostic laboratory tests used in chagas disease?

A

2 Positive Serological IgG findings for Trypanosoma Cruzi: ELISA/IF/Hemagglutination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the antiparasitic drugs for chagas disease?

A

Benznidazole & Nifurtimox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what is the five year survival rate after HF diagnosis in chagas disease?

A

30% FYS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

__________ ________ has cardiac involvement in half of patients, it is most common cause of death of that infection.

A

Corynebacterium Diphtheriae has cardiac involvement in half of patients, it is most common cause of death of that infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

__________ ________ releases a toxin that disturbs the protein synthesis in the cardiac conduction system therefore antitoxin is the most immediate treatment for prevention of arrhythmias.

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

GAS is associated with Rheumatic Fever and valvular involvement, a complication of ________ infiltration into the myocardium is possible.

A

GAS is associated with Rheumatic Fever and valvular involvement, a complication of mononuclear infiltration into the myocardium is possible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

__________ ________ rarely penetrates the cardiac tissue and infect myocardium, when it does there is a high mortality rate.

A

Mycobacterium Tuberculosis rarely penetrates the cardiac tissue and infect myocardium, when it does there is a high mortality rate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Borrelia Burgdorferi causes Lyme disease that among other symptoms causes AV block. What is the first line treatment?

A

1-2 weeks of Doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Non-Infective myocarditis has the highest prevalence in people who have pulmonary involvement of -

A

Granulomatous diseases: Sarcoidosis or Giant cell arteritis

55
Q

Ventricular Tachycardia, Low-grade fever, Heart Blocks and Heart Failure (without IHD, Valvular Disease, HTN etc) is suggestive of-

A

Non-Infective Myocarditis

56
Q

In Non-Infective Myocarditis ventricles can be Dilated or Constricted, with mostly _____ ventricle dominance.

A

In Non-Infective Myocarditis ventricles can be Dilated or Constricted, with mostly Right ventricle dominance.

57
Q

In Non-Infective Myocarditis the later stages are characterized by ______ that leads to Reentry Arrhythmias.

A

In Non-Infective Myocarditis the later stages are characterized by Fibrosis that leads to Reentry Arrhythmias.

58
Q

In Non-Infective Myocarditis, the final diagnosis is mostly made by-

A

Mediastinal lymph node biopsy.

59
Q

Giant cell myocarditis is ____ common to involve the cardiac than Sarcoidosis.

A

Giant cell myocarditis is Less common to involve the cardiac than Sarcoidosis.

60
Q

What other diseases does Giant cell myocarditis associate with?

A

Thymomas
Thyroiditis
Pernicious Anemia

61
Q

Giant cell myocarditis - Treatment and Prognosis

A

Steroids are less effective than in Sarcoid, must involve other immunosuppressant.
Usually with Fulminant course that requires transplant

62
Q

Hypereosinophilic syndrome leads to Restrictive Cardiomyopathy and Myocarditis, it may result from a previous infection but can develop from systemic syndromes like-

A

Churg-Strauss or Malignancies

63
Q

Penicillins, Thiazides, AEDs, Indomethacin, Methyldopa and Pox vaccine are all linked to - ?
What is the treatment?

A

Hypersensitivity Myocarditis

Cessation of Drug and high dose steroids is needed

64
Q

_________ Cardiomyopathy is defined as cardiac dilation and failure circa the last trimester or 6 months following delivery.

A

Peripartum Cardiomyopathy is defined as cardiac dilation and failure circa the last trimester or 6 months following delivery.

65
Q

What are the risk factors for Peripartum Cardiomyopathy?

A 
Older maternal age
Twins & Gravidity (Peripartum)
Malnutrition
Tocolytics
Preeclampsia
66
Q

Heart Failure appearing in the first trimester is called

A

Pregnancy Associated Cardiomyopathy

67
Q

Similarly to DCM 15% of PPCM has a ___ mutation, that specifically results in refractory decreased systolic function even after pregnancy.

A

Similarly to DCM 15% of PPCM has a TTN mutation, that specifically results in refractory decreased systolic function even after pregnancy.

68
Q

What is the most common toxic etiology for Dilated Cardiomyopathy? What is the genetic predisposition

A

Chronic Alcohol abuse (10%) - 5-6 years.

depends on ACE and ADH genes.

69
Q

What is another toxic alcoholic heart disease that is not characterized by tissue alteration like CM?

A

Holiday Heart Syndrome

Reccurent arrhythmias after alcohol loads

70
Q

What kind of Chemotherapy Family usually causes DCM? Examples and Mechanism

A

Anthracyclines - Doxorubicin, Daunorubicin.

ROS leads to myocardial necrosis and fibrosis leading to Acute Heart Failure.

71
Q

Doxorubicin can lead to DCM. what are the precipitating risk factors? what is the Preventive drug?

A

High doses of Doxorubicin, Previous heart disease, previous chest Irradiation.
Preventive - Dexrazoxane

72
Q

In chronic Doxorubicin intake what is an important factor that determines the clinical manifestation of the DCM ? + different outcomes?

A

Pre-teen : Cardiac maldevelopment and HF until 20 yo

Post-teen : Cardiac symptoms worsen due to secondary event such as Flu or AF

73
Q

What is the EF in a Doxorubicin related DCM? why?

A

usually no severe dilation of ventricles - 30-40% EF

74
Q

What other chemotherapy treatment becomes highly cardiotoxic with Anthracyclines?

A

Herceptin

75
Q

Hypothyroidism and Hyperthyroidism will not cause HF on their own but will worsen it due to ___.

A

Hypothyroidism and Hyperthyroidism will not cause HF on their own but will worsen it due to DCM.

76
Q

a Patient with AF progresses to VF/VT, what will be the lab value that taken regarding the Thyroid?

A

TSH

77
Q

In a state of Hypothyroidism with DCM, the administrator of Levothyroxine must titer the load _____ to avoid tachyarrhythmias exacerbations.

A

In a state of Hypothyroidism, the administrator of Levothyroxine must titer the load slowly to avoid tachyarrhythmias exacerbations.

78
Q

What is the deadly process that may happen in treatment of DCM with Hyperthyroidism? what is the medical response?

A

Decompensation - Close monitoring is required

79
Q

Apart from thyroid dysfunction, what other endocrine pathologies lead to DCM?

A

Elevated Renin from renal artery stenosis

Pheochromocytoma

80
Q

What disease is characterised by low levels of thiamine, high EF with vasodilatory state that progresses to DCM with low EF?

A

Beri-Beri Disease

81
Q

Beri-Beri Disease - Etiologies?

A

Processed food based consumption
Malnutrition
Alcoholics

82
Q

Diseases involving altered Creatinine metabolism in children results in - DCM or RCM?

A

BOTH

83
Q

Keshan’s Disease

A

Selenium deficiency resulting in Cardiomyopathy

84
Q

What is unique in the cardiac manifestation of Hemochromatosis?

A

Restrictive Cardiomyopathy that may have DCM signs

85
Q

What is the diagnosis & treatment of Hemochromatosis related RCM?

A

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
Q

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?

A

Takotsubo/Stress-Induced Cardiomyopathy

Vase-like ballooning of the ventricles

87
Q

Takotsubo/Stress-Induced Cardiomyopathy

Prognosis? Treatment?

A

disease passes after a days-weeks (10% return)

supportive treatment for comorbidities - Nitrates, Intra-aortic balloon, Beta/alpha blockers and Magnesium.

88
Q

What disease represents 2/3 of DCM? what are the diagnostic steps?

A

Idiopathic Dilated Cardiomyopathy

Diagnosis of Exclusion, still investigated for Genes

89
Q

Cardiomyopathies with Overlapping Symptoms:

Sarcoidosis and Hemochromatosis can manifest as _______ or ______ Cardiomyopathy

A

Cardiomyopathies with Overlapping Symptoms:

Sarcoidosis and Hemochromatosis can manifest as Restrictive or Dilated Cardiomyopathy

90
Q

Cardiomyopathies with Overlapping Symptoms:

Amyloidosis is a RCM that has earlier symptoms of ___.

A

Cardiomyopathies with Overlapping Symptoms:

Amyloidosis is a RCM that has earlier symptoms of HCM.

91
Q

Cardiomyopathies with Overlapping Symptoms:

Genetic disease with Beta-Glucosidase deficiency?

A

Gaucher Disease

92
Q

Cardiomyopathies with Overlapping Symptoms:

Genetic disease with Alpha-Galactosidase A deficiency?

A

Fabry Disease

93
Q

What kind of heart sounds are typical for DCM?

A

S3

Systolic Regurgitant Murmur

94
Q

DCM involves _______ hypertrophy of cardiac muscle where sarcomeres are added in ____ which results in ____ dysfunction.

A

DCM involves eccentric hypertrophy of cardiac muscle where sarcomeres are added in series which results in Systolic dysfunction.

95
Q

HCM involves _______ hypertrophy of cardiac muscle where sarcomeres are added in ____ which results in ____ dysfunction.

A

HCM involves concentric hypertrophy of cardiac muscle where sarcomeres are added in parallel which results in Diastolic dysfunction.

96
Q

RCM involves _______ of ventricular muscle wall which results in ____ dysfunction.

A

RCM involves hardening of ventricular muscle wall which results in Diastolic dysfunction.

97
Q

What are the infiltrative causes of RCM?

A

Primary Amyloidosis
Familial Transthyretin
Senile Transthyretin

98
Q

What are the Fibrotic causes of RCM?

A

Radiation

Scleroderma

99
Q

What are the Endomyocardial causes of RCM?

A 
Carcinoid syndrome / Serotonin or Ergotamine
Hypereosinophilic Syndrome (Loeffler's)
Tropical endomyocardial Fibrosis
100
Q

What is the pathophysiological changes in RCM?

A

Dilated Atria
End-Diastolic Pressures are elevated
CO is preserved until progressive disease
Thrombogenic ventricular filling

101
Q

What is the first clinical changes in RCM?

A

Fatigue upon exertion & Dyspnea

102
Q

What is the late clinical changes in RCM?

A

Ascites, Hepatomegaly and Edema

103
Q

What is the ECG and Auscultatory changes in RCM?

A

Distant Heart sounds, S4 & S3, AF.

104
Q

What sign is positive in RCM?

A

Kussmaul sign

JVP with Y descents that may worsen with inspiration

105
Q

How would you differentiate Constrictive Pericarditis from RCM on physical examination?

A

Constrictive Pericarditis- PMI is easily detected & higher prevalence of MR

106
Q

What is the usual first finding of Cardiac Amyloidosis?

A

Low Voltage ECG with Enlarged Ventricular Wall in Xray

107
Q

Cardiac Amyloidosis - 4 major clinical signs?

A

Systolic Dysfunction
Diastolic Dysfunction
Arrhythmias and Blocks
Orthostatic Hypotension

108
Q

What are the diagnostic steps in suspicion for Cardiac Amyloidosis?

A

TTE/TEE / CMRI
Biopsy from Mucosal Linings
Biopsy from Cardiac tissue

109
Q

How does Scleroderma causes RCM?

A

Vasospasms and Ischemic processes and Fibrosis leads to a smaller more rigid heart with ventricles remaining stiff.

110
Q

In which patient (parameters) it is probable we will see loeffler’s endocarditis becoming a RCM?

A

Men, with 1500 eos/microL for at least half a year.

111
Q

What are the possible treatments of Tropical endomyocardial Fibrosis?

A

Steroids & Hydroxyurea - lower eosinophils
Diuretics and Anticoagulation
sometimes Surgical removal of fibrotic tissue

112
Q

What is the pathomechanism of Carcinoid related RCM?

A

Serotonin yields fibrotic plaques in endocardium and right heart valves leading to stenosis/regurgitation of Tricuspid or Pulmonary Valves.

113
Q

What is the definition of HCM?

A

LV concentric hypertrophy that is not related to HTN/AS/Infiltrative disease.

114
Q

What are the macroscopic pathological findings of HCM?

A

Asymmetric (Septal usually) LV hypertrophy
Provoked/Unprovoked LV outflow obstruction
Diastolic Dysfunction with LVEDP

115
Q

Etiology of HCM?

A

AD genetic cause in 60%

Manifestation in puberty

116
Q

What is the most common cause of SCD (mostly in teens during exertion)?

A

HCM

117
Q

Common symptoms of HCM?

A

Exertional Dyspnea
Syncope
Angina
AF

118
Q

What are the physical examination signs of HCM?

A

Double & Triple apical precordial impulse
S4
in LVOT - Crescendo-Decrescendo Murmur

119
Q

HCM in LVOT has a Crescendo-Decrescendo Murmur

What will worsen the murmur?

A

Preload Decreasing states:
Valsalva Maneuver
Sudden Standing up
Nitroglycerin

120
Q

HCM in LVOT has a Crescendo-Decrescendo Murmur

What will alleviate the murmur?

A

Preload/Afterload Increasing states:
Passive leg raising
Pregnancy
Squatting/Hand Gripping

121
Q

What are possible ECG findings in HCM?

A

LVH
Q wave that are widespread (septal hypertrophy)
Negative T waves (Apical Hypertrophy)
SVT/VT

122
Q

Echocardiogram is the diagnostic step!

What are common TEE/TTE findings in HCM?

A

Systolic Anterior Motion
Septum x 1.3 > Lateral Wall
Concentric ventricular size
Septal Hyperkinesia and Apical Hypokinesia

123
Q

Hypertrophic Cardiomyopathy Treatment Algorithm

In all points of treatment algorithm if there is a risk of SCD, we have to consider an -

A

ICD

124
Q

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
A 
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
Q

Hypertrophic Cardiomyopathy Treatment

If symptomatic, with fluid retention evidence -

A

Use Diuretics and avoid hypotension

126
Q

Hypertrophic Cardiomyopathy Treatment Algorithm

If symptomatic, titrate _ ______ or ___ to possible dosage.

A

Hypertrophic Cardiomyopathy Treatment Algorithm

If symptomatic, titrate β Blockers or CCBs to possible dosage.

127
Q

Hypertrophic Cardiomyopathy Treatment Algorithm:

If symptomatic, without improvement on β Blockers or CCBs + Outflow gradient is present try -

A

Disopyramide

128
Q

Hypertrophic Cardiomyopathy Treatment Algorithm :
If symptomatic, without improvement on β Blockers or CCBs without Outflow gradient but with severe progressive LV dysfunction consider -

A

Cardiac Transplantation

129
Q

Hypertrophic Cardiomyopathy Treatment Algorithm :
If symptomatic with Outflow gradient, without improvement on β Blockers or CCBs or Disopyramide and has severe refractory symptoms consider -

A

Mitral valve Surgery or Septal Ablation Surgery

130
Q

1 in 20 HCM patients will -

A

develop systolic dysfunction with low EF

131
Q

1 in 100 HCM patients will -

A

have SCD per year

132
Q

Why Adenovirus and Coxsackievirus are associated with increased susceptibility to cause myocarditis in some familial DCM cases?

A

Adeno-Coxsackievirus Receptor abnormality

133
Q

Most common mutations that cause DCM & HCM are involving the ________. TTN, MYBPC3, MYL2 etc..

A

Most common mutations that cause DCM are involving the Sarcomere. TTN, MYBPC3, MYL2 etc..

GBA - Y4 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions