IMC 3.0 Flashcards
? is the MC type of cardiomyopathy
Dx is confirmed w/ Echo findings of ?
How is severity and prognosis evaluated
Dilated after injury/damage leads to dilation all chambers
LV dilation, thinning
Global dysfunction
RV dysfunction
? defines the category of dilated cardiomyopathy
What characterizes this condition
What 3 nutritional diseases can cause this
LV enlargement
Dec myocardial contractility- systolic dysfunction
Thiamine/Selenium/Carnitine deficiency
? cardiac abnormalities can cause dilated cardiomyopathy
Define Quebec beer drinker cardiomyopathy
What can be seen on PE
Prolonged tachycardia
PVCs >15% of beats
Frequent RV pacing
Cobalt exposure induced dilated cardiomyopathy
MR TR Megaly JVD S3
What EKG findings are seen in dilated cardiomyopathy
What may be seen on CXR
What abnormal breathing pattern may be seen in advanced HF cases
LBBB
Arrhythmia
Sinus tach
Balloon heart:
Megaly, Effusions R>L
Cheyne Stokes breathing
Dilated cardiomyopathy Pts experiencing need ? lab drawn
Why
What is a non-invasive method to measure EF and monitor wall motion?
This method has fallen out of favor to ? test
BNP
Establish prognosis and disease severity
Radionuclide ventriculography
Cardiac MRI
What is the preferred diagnostic study for RV dysplasia in dilated cardiomyopathy
When is a biopsy most useful
What medication will be added to LAB Tx if increased contractility is needed
Cardiac MRI
Transplant rejections
Digitalis
How is dilated cardiomyopathy Tx
What is the next step if still Sxs
CCBs need to be avoided except for during ?
All diabetics w/ dilated cardiomyopathy need to be on ? med if ?
ACEI/BB/Loop diuretic
Add aldosterone antagonist
ARNI instead of ACEI/ARB
Afib/flutter
EF <40%, put on mineral corticoid antagonist
When/why would dilated cardiomyopathy Pt be placed on Ivabradine
What med is second line to Ivabradine
Why is this second line med used more often anyway?
Resting HR >70bpm,
LVEF <35% and
Chronic, stable HF
Digoxin
Decreases recurrent hospitalizations
Ventricular rate control in Afib
What medication combo is used in AfAm Pts w/ dilated cardiomyopathy that is usually avoided in this population?
When do dilated cardiomyopathy Pts need to have cardiac synchronization
When would an ICD implant be considered
Hydralazine-nitrate for abnormal NO utilization
Biventricular pacing if:
Significant MR and QRS >150msec
ASx ischemic cardiomyopathy
LVEF <30% on medical therapy
>40 days post-MI
? therapy is avoided all together in dilated cardiomyopathy Txs?
? adverse event is more common in dilated cardiomyopathy populations?
All Pts w/ AFib need Tx w/ ?
ImmSuppression
Arterial/pulmonary emboli
DOACs
Warfarin if MS
What 2 etiologies of dilated cardiomyopathy have better prognosis?
What 3 etiologies have poor prognosis?
When do Pts need to be referred
Peripartum
Stress induced
HIV
Infiltrative
Doxorubicin therapy
New/worsening Sxs
Continued Sxs and LVEF <35% for ICD consideration
Re-synchronization- if QRS >150msec and LBBB
The Sxs of HOCM are primarily related to ? and primarily include ?
What is the definition of HOCM
What causes the LV outflow tract to become obstructed?
Diastolic dysfunction; chest pain and dyspnea
LVH w/out press/vol overload
LV >1.5cm thick on echo
Septal block during systole
Anterior MV leaflet pulls inward
What is the end result of the cardiac hypertrophy during HOCM?
What causes HOCM
How is HOCM differentiated from Athletic Heart
Inc LV diastolic pressure
Autosomal dom mutation of sarcomeres:
myosin heavy chains
Ca regulation proteins
No diastolic dysfunction in athletes
What HOCM variety is more common in Asians
HOCM in older adults d/t HTN has ? distinct identifier
Initial Sx may be syncope which occurs d/t ?
Apical hypertrophy
Sigmoid interventricular septum w/ knob of cardiac muscle below AV
Dec diastolic filling
Tachycardia increases LV obstruction
? is a long term consequence and poor prognosis of HOCM
What PE findings may be seen
HOCM murmur needs to be differentiated from ? murmur
Afib from inc LA pressures
Bisferiens carotid pulse Apical lift Triple apical impulse S4 Inc A wave d/t dec RV compliance (a- atrial contraction, absent in afib)
AS
? EKG finding is nearly universal in HOCM Pts w/ Sxs
What other EKG finding may be noted
Echo is needed for Dx to differentiate HOCM from ? other inherited Dx
LVH
Septal dagger q-waves
Ventricular Noncompaction- trabeculation that partially fills LV
How is a HOCM Dx made and confirmed
? vascular anomaly may occur in these Pts
How is this Tx
What is avoided
Echo, catheterization
Arterial bridging- squeezing of coronary in systole
Initial Tx= BB
Verapamil/Diltiazem
Digoxin- inc contraction worsens obstruction
What Tx may help prevent hypertrophy/obstruction progression in HOCM
What Pts are best managed w/ implantable ICD
What Pts are eligible for ICD consideration
Dual chamber pacing
Malignant ventricular arrhythmia and/or unexplained syncope w/ +FamHx
Wall thickness of 30mm
Sudden death 1* relative
Unexplained syncope <6mon
What surgical Tx is avail to HOCM for severe/resistant Sxs
What procedure is done if MR is present
What non-surgical Tx is available
Myotomy-myomectomy
Alfieri stitch: ant/post leaflets together
Alcohol ablation via LCA
How are pregnant Pts w/ HOCM managed
What are the 6 high RFs for HOCM
When do these Pts need to be referred
Maintain BB regiment
1- personal Hx ventricular arrhythmia/survived death
2- FamHx sudden death
3- unexplained syncope
4- documented unstained V-tach
5- LV thickness of 30mm or >
6- SBP doesn’t dec by 20mm during treadmill stress test
Syncope has occured
Any 6 RFs
Difficult to control Sxs
Define Restrictive Cardiomyopathy
What other condition is usually present
Half of these cases are caused by but the ? is the MC cause in the world and US
Non-compliant ventricles that resist diastolic filling w/ preserved contractility, leading to RHF/diastolic HF
P-HTN
Half- idiopathic
World: tropical endomyocardial fibrosis
US: amyloidosis
What is the MC type of amyloid to cause Restrictive Cardiomyopathy
What causes familial amyloidosis in elderly AfAm
Restrictive Cardiomyopathy must be differentiated from ? Dx
Light chain- AL
Mutated transthyretin during production in liver
Constrictive pericarditis-
no ventricular interaction accentuated w/ inspiration
Inc pulm arterial pressure
Elevated BNP
What PE findings suggest Pts has amyloidosis infiltrates
What EKG combo is suggestive of a Restrictive Cardiomyopathy Dx
What is the non-invasive modality of choice to Dx transthyretin amyloidosis
Periorbital purpura
Thick tongue
Hepatomegaly
Low voltage + LVH
Tech-pyrophosphate (bone scan) to detect myocardial amyloid deposits
What is a useful screening test for Restrictive Cardiomyopathy
Biopsies from ? locations can confirm but not r/o systemic involvement
How is Restrictive Cardiomyopathy Tx
Cardiac MRI- abnormal texture
Rectal
Abdominal fat
Gingival biopsy
ACEI
BB/Verapamil
Loop/Tzd/Aldosterone antagonists
Tafamidis- transthyretin amyloidosis
What meds need to be avoided in Restrictive Cardiomyopathy Tx
When/why would CCS be sued
When is transplant considered
Digoxin- precipitates arrythmias
Sarcoidosis conduction anomalies
Priamry amyloidosis w/out systemic involvement
What is the MC form of an ASD
What is the other, less common form
What type of leaflet defect is present in the less common form
Ostium Secundum- midseptum
Ostium Primum- low septum
MV/TV clefts and VSD
ASDs are the second MC congenital heart defect behind ?
Why do ASDs develop
What does this defect cause to occur
VSDs
IVC/SVC fail to fuse w/ atria
Left-Right shunt
RA/RV volume overload
Most Pts w/ ASDs are ASx until they’re ? old and then ? happens
Why are these Pts at risk for cerebral/systemic embolic events
What type of murmur is heard
30
>30: angina, dyspnea
>50: Afib, RVF
Paradoxical embolization
Widely split and fixed S2- lub dub-dub
Ejection murmur at pulmonic
What is seen on EKG of ASD
What EKG finding is found in nearly all ASD PTs
What is seen on CXR
RAD
RVH
rSR pattern, V1
RBBB
Megaly
RA/RV dilation
How is ASD Dx
How are these Tx
Define PDA
Echo w/ bubble contrast
Observation- <3mm self resolve; normal RA/RV size- serial Echo q3-5yrs
Transcatheter closure
Surgical: evidence of RV overload= repair 2-6y/o
Persistant connection between aorta and PA after birth; L to R shunt
How do Pts w/ PDA present
What are two classic findings seen on exam
How is this Tx
FTT
Poor feeding Tachy/Tachy
Wide pulse pressure (low DBP)
Machinery murmur at pulmonic area
Indomethacin w/ fluid restriction
Surgical/catheter correction
VSD is the MC ?
Smaller the defect has ? effect on the murmur
Pt with VSD high in septum presents w/ dec murmur and signs of AR and acute HF, what happened
Congenital heart defect
Pathological murmur of kids
Smaller= louder
Right coronary cusp of aortic cusp prolapsed into VSD, reduces shunt
What valve leaflet may be a part of the VSD anatomy
What medication is used for p-HTN in Pts that develop Eisenmenger Syndrome
What other PE finding is commonly seen w/ this holosystolic murmur
Septal leaflet of TV
Bosentan
Systolic thrill
How are VSDs Tx
What is a common complication after surgical correction
All VSD Pts w/ right to left shunts need to have ? added to IV orders
Observation
Infant w/ CHF and retarded growth= digoxin and diuretic
Medical failure- surgery <6mon old
Conduction disturbances
Filters to avoid contamination/air bubbles from becoming systemic
Define Aortic Coarctation
What is the usual presentation of this condition
What other vascular malformation are these Pts at risk for
Narrowing of aorta below origin of left subclavian
Systemic HTN- higher in arms compared to legs
Bicuspid AV
Berry aneurysm
What is seen on EKG of Aortic Coarctation
What is seen on CXR
What procedure is needed prior to percutaneous stenting
LVH
Rib scalloping- notches
Figure 3 sign
Cardiac cath
How are Coarctations Tx
What Tx is needed if defect is seen in neonates
When/why do Pts die from untreated cases
Balloon angioplasty w/ stent placement/surgery between 2-4y/o
Prostaglandin E1- keeps ducuts arteriosus open
Death by 50y/o d/t:
Rupture
Dissection
CVA
What is a common post-surgical complication of Coarctation repair
Unique fact about Tetrology of Fallot
What are the four characteristics
What fifth issue makes it Pentad of Fallot
HTN d/t permanent changes in RAAS
Only cyanotic congenital heart Dz on blue print
PS RVH Overiding VSD causing R to L shunt through VSD
ASD
What pallative procedure is done for Tetrology PTs to increase blood flow to affected lung
What two PE findings may be seen in these Pts
What spells are seen in these Pts as Peds
Blalock shunt- subclavian artery attached to PA
Modified- conduit made between two structures
Increased a-wave- atria contraction, absent in Afib
Rarely, c-wave= TR
Tet- hypercyanotic
What type of murmur is heard in Tetrology Pts
What is seen on CXR
What is the most common cause of death and how is this prevented
Systolic ejection murmur, LSB
Boot shaped heart
Sudden cardiac death/HF <20y/o; surgery <1y/o
What are 4 possible complications after surgical correction of Tetrology
What is a common EKG finding after repair
What screening is needed annually
Arrhythmia
HF
Outflow obstruction
PR
RBBB
EKG QRS width, >180msec increased risk for death
BNP for RV enlargement
