IMC 3.0 Flashcards by brandon lovin

? 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

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? 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

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? 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

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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

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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

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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

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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

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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

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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

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? 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

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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

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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

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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

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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

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? 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)

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? 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

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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