Harrison's 254 - Cardiomyopathy & Myocarditis Flashcards
What percentage of Heart Failure is represented by Cardiomyopathic Diseases?
5-10%
What are the 3 major types of Cardiomyopathies?
- Restrictive Cardiomyopathy
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
What are the early symptoms Cardiomyopathy (all types)?
What will be on the differential?
Rapid fatigue on Exertion with Dyspnea or Weakness
DD: Aging or Respiratory Illness
What are the long-term Congestive symptoms of Cardiomyopathy (all types)?
Chronic Heart Failure that may be characterized by Orthopnea, Bilateral Pedal Edema, Ascites or Abdominal Discomfort.
What are the long-term prognosis and Auscultative symptoms of Cardiomyopathy (all types)?
Chronic Heart Failure that may be characterized by Tricuspid or Mitral Valve (AV) Regurgitation.
What are the long-term ECG signs of Cardiomyopathy (all types)? What may be a complication?
Supraventricular or Ventricular Arrhythmias.
May result in Embolization.
Different Ejection Fractions (EF):
- Restrictive Cardiomyopathy
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
Ejection Fractions
- Restrictive Cardiomyopathy: EF = 25-50%
- Dilated Cardiomyopathy: EF <30%
- Hypertrophic Cardiomyopathy: EF <60%
Different LV Diastolic Size:
- Restrictive Cardiomyopathy
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
Different LV Diastolic Size
- Restrictive Cardiomyopathy: <60mm
- Dilated Cardiomyopathy: >60mm
- Hypertrophic Cardiomyopathy: <60mm
Different LV wall Thickness:
- Restrictive Cardiomyopathy
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
Different LV wall Thickness
- Restrictive Cardiomyopathy: Normal or Increased
- Dilated Cardiomyopathy: Normal or Decreased
- Hypertrophic Cardiomyopathy: Markedly Increased
Atrial Size:
- Restrictive Cardiomyopathy
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
Atrial Size
- Restrictive Cardiomyopathy: Increased, massive
- Dilated Cardiomyopathy: Increased
- Hypertrophic Cardiomyopathy: Increased
Valvular Regurgitation Origins:
- Restrictive Cardiomyopathy
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
Valvular Regurgitation
- Restrictive Cardiomyopathy: Endocardial Involvement
- Dilated Cardiomyopathy: Annular Dilation
- Hypertrophic Cardiomyopathy: Valve-Septum interaction
Congestion side:
- Restrictive Cardiomyopathy
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
Congestion side
- Restrictive Cardiomyopathy: Right Dominant
- Dilated Cardiomyopathy: Left Dominant
- Hypertrophic Cardiomyopathy: Left Dominant
Type of Arrhythmias:
- Restrictive Cardiomyopathy
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
Type of Arrhythmias
- Restrictive Cardiomyopathy: A.fib, AV block
- Dilated Cardiomyopathy: VT, AV block, A.fib
- Hypertrophic Cardiomyopathy: VT, A.fib
What are the clinical manifestations of CM ?
Familial Story of CM
HF symptoms
IHD or Tachyarrhythmias
SCM
What other systemic genetic diseases could lead to CM?
Duchene & Becker's Muscular Dystrophy Arrhythmogenic right ventricular dysplasia (ARVD) Fabry Disease Amyloidosis (all genetic types) Hemochromatosis
What pathogen may lead to damage similar to the one appearing in Duchenne Muscular Dystrophy?
Coxsackievirus
May cause myocarditis while damaging Dystrophin
Dilated Cardiomyopathy
What Viral etiologies does it have?
(Through myocarditis)
Coxsackievirus
Adenovirus
HIV
HepC
Dilated Cardiomyopathy
What Parasitic etiologies does it have?
(Through myocarditis)
T. Cruzi (Chagas)
African Trypanosomiasis (Sleeping Sickness)
Toxoplasmosis
Dilated Cardiomyopathy
What Bacterial etiologies does it have?
(Through myocarditis)
Corynebacterium Diphtheriae - Most common Borrelia Burgdorferi (Lyme) Coxiella Burnetii (Q-Fever)
Dilated Cardiomyopathy
What Granulomatous Inflammatory etiologies does it have?
(Through myocarditis)
Sarcoidosis
Giant cell Myocarditis
Dilated Cardiomyopathy
What Non-Granulomatous Inflammatory etiologies does it have?
(Through myocarditis)
Eosinophilic Myocarditis
Polymyositis & Dermatomyositis
Collagen vascular disease
Transplant Rejection
Dilated Cardiomyopathy
What Toxicology etiologies does it have?
Ethanol & Steroids Amphetamines and Cocaine Chemotherapy & IFN Antimalarial Drugs Heavy metals & Occupational exposure
Dilated Cardiomyopathy
What Vitamin/Micronutrient Deficiencies leads to it?
Thiamine
Selenium
Carnitine
Dilated Cardiomyopathy
What Endocrine etiologies does it have?
Thyroid - Hypo/Hyper
Pheochromocytoma
DIabetes Mellitus 1/2