IMC 2.0 Flashcards
Define Cardiomyopathy
? is the MC type of cardiomyopathy
What causes this MC type to develop
Heart muscle dz
Dilated; Systolic dysfunction
Injury/damage (CAD/MI/ETOH) to myocardium leading to weakened ventricular contractions
? is the primary indication for cardiac transplant
This condition is also the MC cause of ?
Idiopathic dilated cardiomyopathy
Heart failure
What is the hallmark of Dilated Cardiomyopathy
What are the possible etiologies of this Dz
What infections can cause this
Dilation and impaired contraction of one/both ventricles
PG CEVICHE:
Post-partum Genetics
Chemo ETOH Viral Ischemic Cocaine Heavy-metal Endocrine
Chagas HIV Lyme
What is seen on PE for Dilated Cardiomyopathy
What is the main Dx modality
What would be seen on CXR
Left sided HF:
Dyspnea Fatigue S3 gallop
Cardiomegaly
Echo: ventricular dilation and dysfunction (EF 40% or
How is Dilated Cardiomyopathy Tx
What medication is used if increased contractility is needed
What mnemonic can be used to Tx
Loop + ACEI + BB
Digitalis
AABCD:
Anti-coagulation ACEI BBs CCBs Diuretic/Digoxin
What is the MC form of HOCM
How is this conditions passed along
What would be seen on PE since most of these are ASx
Septal hypertrophy- narrows LV outflow tract
Autosomal dominant defect of sarcomeric proteins
Bifid carotid pulse
S4 gallop
Dyspnea w/ exertion
What type of murmur does HOCM present with
What causes murmur to be louder/quieter
These characteristics are exact opposite of ? murmur
High pitched cresc-decresc at LLSB
Inc: Valsalva/Stand
Dec: Squat, Grip, Leg raise
AS:
Dec w/ valsalva
Inc w/ squat
Dec w/ stand
How is HOCM differentiated from Athletic Heart
How does HOCM appear on EKGs
What is the Dx test of choice
Athletes won’t have diastolic dysfunction
Septal depolarization: dagger-like septal q-waves w/ LVH
TTEcho
How is HOCM Tx
What drugs need to be avoided
What drug is c/i
Metoprolol and/or Verapamil to dec contractility/HR
Nitrates
Decreasing preload: diuretics, ACEIs, ARBs
Digoxin
When is implantable de-fib considered for HOCM Tx
What definitive tx options are available
+ syncope
sudden arrest
LV >30mm thick
Surgical (septal myectomy- considered best) or,
Alcohol ablation of hypertrophy
Metoprolol
Verapamil
Digoxin
Class 2, decreases HR, increases PR
B1 selective
Class 4; greater action on heart than peripheral vessels
Dose reduction needed in hepatic dzs
Derived from Foxglove; inhibits NaKATP in cardiac membrane to dec intracellular K levels to increase contraction w/out increasing O2 demands
Overcome/inhibited by sympathetic nervous system
HypoK= inc effect of medication
Antidote: Digoxin Immune Fab (Digibind)
Define Constrictive Cardiomyopathy
What is the MC etiology of this world wide
What other etiologies can cause this
RHF w/ Hx of infiltrative process
Tropical Endomyocardial Fibrosis
Amyloidosis-MC
Sarcoidosis
Rad/Chemo
What will be seen on PE of Restrictive Cardiomyopathy
What abnormals will be seen
How is this Dx
What is the next step if Dx is doubtful?
P-HTN w/ normal EF, size and wall thickness
Large atria
Early diastolic filling
Echo: dilated atria, hypertrophy, ‘starry night/speckle pattern’
MRI- abnormal textures
What could be seen on EKG of Restrictive Cardiomyopathy
This can mimic ? other Dx, so what test is used to differentiate
What is used for Txs
Non-specifics w/ low voltage waves
Constrictive pericarditis- cardiac MRI
Diuretics if edema/pulmonary congestion present
Rate/Rhythm: BB/Verapamil
Define an ASDn and the MC type
What type of murmur does this defect produce and
What condition can chronic defects develop into
Non-cyanotic defect w/ diastolic L-R shunt causing volume over load to RA/RV d/t failure of foramen ovale to close;
Osteum Secundum
Wide-fixed split S2: lub, dub-dub
at Pulmonic area
Eisenmenger’s: chronic L-R shunting causing cyanosis/clubbing that dec as shunt progresses
ASDs are the second most common defects behind ? defect
Most Pts w/ small ASDs can be ASx until ? age, but then develop ?
What abnormal clot event can ASDs allow to happen
VSD
<30: ASx
>30: dyspnea, angina
>50: Afib, RVF
Paradoxical embolization
How are ASDs definitively Dx
What can be seen on EKG
What would be seen on CXR
Echo
R axis deviation
RVH
RBBB w/ rSR pattern in V1
Cardiomegaly w/ dilated RA/RV
How are ASDs Tx
<3mm- spontaneous closure, usually by 3y/o
ASx and small: observe w/ serial Echos
Med/Large w/ evidence of RV volume overload on echo- closed between 2-6y/o
Coarctations of the aorta present w/ Sxs of ? and PE findings of ?
Half of Pts w/ have ? defect which puts the at increased risk to develop ?
What will be seen on EKG/CXR
L sided HF;
Bounding Arm BP > Leg BP
Bicuspid aorta:
Berry aneurysm
EKG: LVH
CXR: notched ribs, figure-3 sign of aorta
How is a Dx of Coarctated Aorta made
How are these Tx
How are these Tx if found in neonates
Echo
Ages 2-4y/o: balloon angioplasty w/ stent placement/surgical repair
Prostaglandin E-1- keeps ductus arteriosus open
When is emergent surgical repair of an aortic coarctation warranted
What happens if these are left untreated
Circulatory shock
Cardiomegaly
Severe HTN/CHF
Death by 50y/o d/t:
Aortic rupture/dissection
CVA
What are the 3 types of aortic coarctations by location
Preductal: narrowing proximal to ductus arteriosus; life threatening, Turners/Intracranial aneurysm
Ductal: narrowing at insertion of ductus arteriosus, appears when ductus closes
Post-Ductal: narrowing distal to ductus arteriosus; MC in adults
Define a PDA
What ‘saying’ is used to remember this type of defect’s murmur
How do Pts present
Blood flows aorta to L Pulm Artery causing transient systolic murmur d/t
Patent for your machine- machinery like murmur at 1st ICS LSB
Poor feeding
FTT
Tachy/Tachy
What are the two “classic findings” of a PDA
What would be seen on EKG
What is best for Dx
Wide pulse pressure w/ low DBP
Harsh, continuous machinery murmur at 2nd ICS (pulmonic)
Normal/LVH
Echo