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RCE Guidelines Studying > Laflamme- Chapter 5 (Cardiomyopathy and Pericardial Disease) > Flashcards

Laflamme- Chapter 5 (Cardiomyopathy and Pericardial Disease) Flashcards

1
Q

What are three phases of a Pericardial friction rub?

A

Atrial Kick, Ventricular systole, Ventricular filling

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2
Q

What are 8 indications to hospitalize with Pericarditis?

A
  • HD instability
  • Large effusion/Tamponade
  • Myocardial Involvement
  • Anticoagulated
  • Trauma associated
  • Recurrent/persistent despite outpatient management (7 days)
  • Fever
  • Immunosuppressed
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3
Q

What is difference between Incessant and Recurrent Pericarditis?

A

Incessant: Symptoms come back after withdrawal of treatment

Recurrent: Returns after 6 weeks of symptom free period

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4
Q

What is the normal amount of pericardial fluid?

A

-50 cc

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5
Q

What does the intrapericardial pressure need to be to cause tamponade?

A

-15-20mmhg, same as the diastolic pressure in the ventricles/atria

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6
Q

What do you see in JVP in tamponade?

A

-Attenuated y descent

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7
Q

What is the ddx for tamponade in the absence of pulsus? (8)

A
  • AR
  • ASD
  • Severe LV dysfunction
  • LVH
  • RVH
  • Severe Hypotension
  • Pericardial adhesions
  • Localized effusions
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8
Q

What is the Ddx of Pulsus (7)?

A
  • PE
  • RV failure
  • Ascites
  • Constriction
  • Lung disease (COPD, Asthma)
  • Chest wall deformity
  • Obesity
  • Severe Hypotension
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9
Q

Name 6 findings of Constriction on echo?

A
  • Septal E’ > 8
  • MV/TV inflow variation
  • Hepatic vein flow reversal in diastole with expiration
  • Abnormal septal motion
  • Predominance of diastolic flow in pulmonary veins
  • Pericardial thickening
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10
Q

What are 5 patterns of constriction seen on hemodynamic study

A
  • M/W sign in atria
  • Prominent Y descent in atria
  • Square root sign in ventricle/diastole
  • Equalization of pressures in ventricles with respirations
  • Equalization of end diastolic pressures
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11
Q

What is perioperative mortality of Pericardectomy?

A
  • 10-15%
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12
Q

What is obstructive HCM?

A

30mmhg

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13
Q

9 ways to tell the difference between athlete’s heart and HCM?

A
  • Scar on CMR
  • Diastolic dysfunction
  • LVEDD
  • Genetic testing
  • Asymmetric LVH
  • Extreme LVH (> 17mm)
  • VO2 Max > 110% predicted
  • SAM
  • Regression of LVH post stopping training
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14
Q

What is indication for septal reduction in HCM?

A

-NYHA II+ symptoms, LVOT-O > 50mmhg despite max therapy

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15
Q

What kind of conduction disease does septal myomectomy cause?

A

LBBB

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16
Q

What is pacemaker risk for septal ablation?

A

-10-20%

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17
Q

7 indications for ICD in HCM?

A
  • Arrest/VT (1)
  • FH SCD (2a)
  • Apical aneurysm (2a)
  • Unexplained syncope (2a)
  • EF < 50% (2a)
  • CMR scar++ (2b)
  • NSVT (2b)
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18
Q

What are two reasons for obesity related CMO (pathology)?

A
  • High CO state

- Myocardial fat infiltration

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19
Q

What 3 findings are characteristic of Early infection of Chagas CMO?

A

-Early Infection: Acute Myocarditis, Meningoencephalitis, Skeletal muscle involvement

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20
Q

What is characteristic of Latent infection of Chagas CMO?

A

-Mild lymphocytic myocarditis

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21
Q

What is characteristic of Chagas CMO?

A

-Dilatation of chambers, Ventricular dysfunction, ventricular arrhythmias, apical thrombus, heart block

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22
Q

6 differences between RCM and Constriction?

A
  • There is equalization of diastolic pressures in CP but not RCM
  • No respiratory variation
  • Septal E prime
  • Pericardial thickness
  • Biatrial enlargement
  • Abnormal respiratory movement of the septum
23
Q

What is inheritance and issue in Fabry’s disease?

A

-X-linked, alpha galactosidase A deficiency -> leading to accumulation of glycosphingolipids in lysosomes

24
Q

What level of Eos do you have to worry about Loefflers?

A

Eos > 1.5

25
Q

What are phases of Lofflers?

A

Myocarditis followed by the replacement of myocardium by thrombus -> then the formation of endomyocardial fibrosis

26
Q

How to treat lofflers?

A

-Anticoagulation, Corticosteroids, Hydroxyurea

27
Q

Name 6 cardiac manifestations of Sarcoid?

A
  • LV dilatation
  • LV dysfunction
  • VT
  • Bradyarrhythmias
  • RWMA
  • Myocarditis
28
Q

What is the pathology of Carcinoid syndrome?

A

-Gi or Bronchial tumor -> release of serotonin by the tumore -> increase urinary 5-HIAA

29
Q

Management of Carcinoid syndrome?

A
  • Somatostatin analogs
  • Embolization of liver metastases
  • TVR is severe symptoms
30
Q

What is the triangle of dysplasia in ARVC?

A
  • RV inflow tract
  • RVOT
  • RV apex
31
Q

Inheritance of ARVC?

A

Autosomal Dominance

32
Q

What are the 4 phases of ARVC?

A

Asymptomatic -> VT -> RHF -> BiV failure

33
Q

What are the major features of AARVC?

A
  • Regional akinesia/WMA
  • <60% of myocytes with fatty replacement
  • TWI V1-V3 (in absence of RBBB)
  • Epsilon wave
  • VT with LBBB morphology
  • Family history
34
Q

What is pathology of LV non compaction?

A
  • Thin epicardial layer with thick non compacted endomyocardial layer
  • (non compacted / compacted layer) > 2 ( >2.3 in diastole)
35
Q

What is the Dallas criteria in Myocarditis?

A

-Presence of inflammatory cells and myocyte necrosis on biopsy in a pattern not consistent with Coronary disease

36
Q

4 types of myocarditis that require immunosuppression?

A
  • Giant Cell myocarditis
  • Sarcoidosis
  • Eosinophilic myocarditis
  • Autoimmune myocarditis (SLE)
37
Q

Indications for endomyocardial biopsy?

A
  • HF for < 2 weeks with hemodynamic instability
  • 2 weeks to 3 months with LV dilatation and ventricular arrhythmias or AV block
  • > 3 months with LV dilatation and ventricular arrhyhtmias or Av block (sarcoid, chagas)
38
Q

Name 8 risk factors for Anthracycline CMO?

A

> 350 mg/m2

Females

> 65 years

LVEF <55%

RF for ischemic heart disease

Concomitant radiation, Tratzumad

39
Q

Echo surveillance during Anthracycline therapy?

A
  • Baseline

- 240 mg/m2 and then every 50mh/m2 more

40
Q

What radiation dose put one at risk for cardiac calcification?

A

> 30 gray

41
Q

What % of myxomas in LA compared to RA?

A

80% compared to 10%

42
Q

What is recurrence of atrial myxoma after resection?

A

3%

43
Q

What does Lipomatous Hypertrophy of the Interatrial septum look like?

A

Dumbell appearance, thickening spares the fossa ovale

44
Q

5 Bacteria that cause Pericarditis?

A
  • Staph
  • Strep
  • TB
  • Lyme
  • Mycoplasma
  • Meningococcus
  • Coxiella
45
Q

2 Parasites that cause Pericarditis?

A
  • Toxoplasmosis
  • Echinococcus
  • Chagas
46
Q

5 Inflammatory causes of Pericarditis?

A
  • RA
  • SLE
  • Sarcoidosis
  • IBD
  • PAN
  • Takayasu’s Arteritis
  • Scleroderma
  • Sjrogen
  • GCA
  • Acute Rheumatic fever
47
Q

Name 5 medications that can cause Pericarditis?

A
  • Hydralazine
  • Procainamide
  • Doxorubicin / Anthracyclines
  • Cyclosporine
  • Cyclophosphamide
  • Clozapine
  • 5FU
48
Q

What is Lake Louise Criteria?

A
  • T2 weighted imaging positive indicated Edema
  • Early T1 weighted imaging positive indicated inflammation in non coronary distribution
  • LGE indicating fibrosis in non coronary distribution
49
Q

3 complications of congenital absent Pericardium?

A

Chest pain

Hernia/Strangulation of a part of the heart

Syncope/Sudden Death

Pericardioplasty if symptomatic absent pericardium

50
Q

What are three mechanisms of metastasis to the heart?

A
  • Direct Extension
  • Hematogenous
  • Extension via the IVC
51
Q

What % of primary cardiac tumors are benign?

A

75%

52
Q

How big does a mass have to be to be seen on imaging?

A

1 cm or larger

53
Q

What is incidence of myxoma recurrence after resection?

A

3%

54
Q

Where do Angiosarcomas present most of the time (Which chamber?)

A

RA (90%)

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