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Cardiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What genetic abnormalities are implicated in HCM?

A

In 60-70%
Mutations in sarcomeric contractile protein genes
Most commonly b-myosin heavy chain + cardiac myosin binding protein C gene

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2
Q

What is the most specific imaging modality to diagnose HCM?

A

CMRI

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3
Q

What treatments have been shown to have mortality benefit in heart failure and what are the approx benefits (RR)?

A 
ACE-I = 15%
B-blocker = 33%
Spironolactone = 25%
CRT = 29%
ICD = 26%

Every article quotes different values, this is from a meta analysis

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4
Q

What 3 types of immunosuppressive drugs are used post cardiac transplant?

A

Calcineurin inhibitor (Cyclosporin, Tacrolimus)
Inhibitor of T-cell proliferation (Mycophenolate, azathioprine)
Steroids

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5
Q

What is the mean survival post cardiac transplant?

A

Mean 14 years

> 1/3 survive greater then 20 years

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6
Q

What are indications for heart transplant?

A

Severe symptomatic heart failure (Class IV) despite maximal medical therapy
Cardiogenic shock
Requiring mechanical cardiac support
Frequent repeated discharges from ICD
Intractable angina despite optimal medical/surg and intervention

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7
Q

What are the 2 classifications of heart failure?

A

HF with reduced election fraction (HFrEF)

HF with preserved ejection fraction (HFpEF)

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8
Q

What are the NYHA classes of heart failure?

A

Class 1-no limitation
Class 2 - limited slightly on physical exertion
Class 3 - markedly limited in physical exertion
Class 4 - symptoms at rest

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9
Q

What is the main late complication of cardiac transplant, not related to immunosuppression?

A

Cardiac allograft vasculopathy

  • transplant coronary artery disease
  • usually diffuse, distal, concentric, non calcified and hard to treat
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10
Q

What other things are important to consider in heart failure aside from medications + devices?

A

Vaccinations
Cardiac rehab and MDT
Advanced care planning

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11
Q

What drugs are used in heart failure that provide symptomatic benefit only?

A

Diuretics
Digoxin (note withdrawal of digoxin CHF can worsen symptoms, only really indicated starting digoxin in those with CHF and AF)

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12
Q

What is the requirements to qualify for CRT?

A

Sinus rhythm, LBBB
QRS >120ms (definite for > 150)
LVEF less then or equal to 35%
Ongoing symptoms (NYHA II, III + IV) despite optimal medical therapy

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13
Q

What two drugs slow the remodelling process?

A

B-blockers - reduce sympathetic input + neurohormonal activation
ACE-I -block RAA system

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14
Q

What are two new drugs in heart failure (not available in NZ)?

A

Ivabradine - direct sinus node inhibitor, doesn’t cause hypotension. When used in patients with SR and HR > 70bpm, reduced mortality by 5%

Angiotensin-Neprilysin inhibition - neprilysin breaks down naturetic peptides (anp/bnp) which work to reduce blood volume by decreasing SVR and increasing naturesis, by blocking their degradation the affect is enhanced

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15
Q

What are the major risk factors for sudden cardiac death in HCM?

A 
Aborted cardiac death
Spontaneous sustained VT
FH of premature sudden death
Unexplained syncope
LV thickness > 30mm
Abnormal exercise blood pressure response
Non-sustained VT on holter

Above help risk stratify regarding who requires ICD

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16
Q

What drugs should be avoided in patients with HCM?

A

Avoid drugs that decrease pre-load because they decrease LV size and worsen LV function
E.g nitrates, diuretics + ACE-I
Also digoxin should not be used for rate control in AF as the ionotropic affects can exacerbate HF

17
Q

What is AVRC and what mutations is it often due to?

A

Myocardium of free wall is replaced by fibrofatty tissue

Mutations in cell adhesion genes in 40-60% of cases

18
Q

What is the murmur due to in HCM and what exacerbates it?

A

Outflow tract turbulence and mitral regurgitation
Valsalva and standing after squatting makes it more prominent
Squatting and hand grip makes it quieter

19
Q

What causes LVOT obstruction in HCM?

A

Thickened septum and systolic anterior motion of the mitral valve (SAM)

20
Q

When does dilated cardiomyopathy occur with pregnancy?

A

3rd trimester and up to 6 months postpartum

21
Q

What is the toxin responsible for alcoholic cardiomyopathy?

A

Acetylaldehyde - toxic metabolite of alcohol

22
Q

What is giant cell myocarditis?

A

A granulomatous disease associated with other autoimmune diseases. Causes progressive heart failure by development of diffuse granulomatous lesions and inflammatory infiltrate

23
Q

What percentage of dilated cardiomyopathies have an genetic component?

A

20-30%

24
Q

Principles of family screening in HCM?

A

If index patient has a proven mutation - genetically test 1st degree relatives for mutation
If no mutation test 1st degree relatives annually from age 12-18 (hypertrophy typically develops on adolescence) and every 5 years from 18 onwards.

Screen with ECG, ECHO and clinical examination

25
Q

What are two storage diseases that cause restrictive cardiomyopathy?

A

Fabrys (x-linked recessive, deficiency of lysosomal enzyme alphagalactocidase A)
Gaucher’s disease (deficiency of lysosomal beta-glucosidase)

26
Q

How does carcinoid syndrome cause cardiomyopathy?

A

Restrictive -serotonin secreted by tumor produces fibrous plaques in endocardium and right sided cardiac valves

27
Q

What is endomyocardial fibrosis?

A

Type of restrictive cardiomyopathy, very common in third world countries (up to 1/4 of CHF in these countries is due to this)
Characterised by apical fibrosis, freq associated with pericardial effusion

28
Q

What is takostubo cardiomyopathy? what is the prognosis?

A

Stress related cardiomyopathy
Apical ballooning associated with periods of emotional or physical distress
LV function usually returns to normal after 4-6 weeks
Most common in middle aged females

29
Q

What are the signs of myocarditis on cardiac MRI?

A

Increased T2 signal from odema, early contrast enhancement (hyperaemia) + late gadolinium enhancement (scarring, not in typical coronary territories and affects the epicardium to mid wall myocardium as compared with ischaemia where whole wall is affected)

30
Q

What causes of myocarditis often cause conduction abnormalities?

A

Sarcoidosis
Lyme disease
Giant cell myocarditis

31
Q

What is Chagas’ disease?

A

Protozoan Trypanosoma Cruzi

Causes acute myocarditis and can progress to heart failure with poor prognosis

32
Q

What does troponin rise in pericarditis indicate?

A

Involvement of the myocardium ie. myopericarditis

33
Q

What is the definition of cor pulmonalae?

A

Right heart failure secondary to pulmonary hypertension from either disease of pulmonary vasculature or lung parenchyma

34
Q

Indications for ICD for primary prevention in IHD

A

Greater then 40 days post MI and greater then 3 months after revascularisation
Ef less then 35, NYHA 2,3
Less than 30, NYHA 1
Less then 40 with NSVT or inducible VT at EPS
Despite maximal medical therapy

35
Q

Indication for primary prevention ICD for non-ischemic cardiomyopathy

A

EF less than 35, NYHA 2,3

On maximal medical therapy

Cardiology (6 decks)

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