Myocardial and Pericardial Disease Flashcards
What is a common cause of secondary dilated cardiomyopathy?
Post-infectious myocarditis
What is the cause of primary dilated cardiomyopathy?
Unknown
How will a patient with dilated cardiomyopathy present?
Signs and symptoms of HF which usually develop slowly (Consistent with L sided and R sided HF symptoms)
What will you find on physical exam in a patient with dilated cardiomyopathy?
Cardiomegaly (displaced PMI) Pulsus alternans Low BP Sxs of HF S3 gallop, MR murmer Hepatomegaly HJR TR murmur (louder with inspiration)
What might you see on an echocardiography/doppler in a patient with dilated cardiomyopathy?
LV/RV dilation, Global LV dysfunction with reduced EF
Maybe mitral regurgitation
What would you expect on a CXR of a patient with dilated cardiomyopathy?
Cardiomegaly
Pulmonary congestion
Pleural effusions
Should you get a cardiac cath on a patient with dilated cardiomyopathy?
No! only when necessary to exclude alternative diagnosis
How do you treat dilated cardiomyopathy?
Similar to heart failure
ACEI or ARB
Beta blockers
Spironolactone
What are the only meds that will improve survival of patients with dilated cardiomyopathy?
ACEI (or ARBs), B-blockers, and spironolactone
What is the most common type of cardiomyopathy?
Dilated
How do you diagnose cardiac myopathy?
Cardiac ultrasound with doppler (echocardiogram)
How often is hypertrophic cardiomyopathy genetically transmitted?
50% of the time - autosomal dominant with high penetrance
Because hypertrophic cardiomyopathy is so easily inherited, what must you do when you have a patient with HCM?
Perform echocardiography on all siblings and offspring of patient with HCM
Always refer for genetic counseling
What is especially hypertrophic in patients with HCM?
The IVS is massively hypertrophied and is easily seen on cardiac ultrsound
What type of dysfunction is common in patients with HCM?
Diasolic dysfunction
What type of gene mutation causes spontaneous transmission of the hypertrophic cardiomyopathy gene?
De novo gene mutations
The LVOT obstruction in HCM is ______
Dynamic
What can change the obstruction of the LVOT in HCM?
Activity/rest
LV volume
What causes obstruction in HCM?
MV moves abnormally toward IVS and obstructs the LVOT
What is the definitive diagnosis of HCM?
Cardiac ultrasound
During childhood, most HCM patients are ____ but it may be detected in offspring of patients with known disease
Asymptomatic
What are the 3 most common symptoms of HCM?
Dyspnea, chest pain, and syncope (sudden death can also be a symptom… but is it really a symptom if you’re dead? idk)
What is one of the most common causes of sudden death in young athletes?
Hypertrophic cardiac myopathy
Sudden death commonly occurs during strenuous activity
What can lead to sudden decompensation and is a bad prognostic sign of hypertrophic cardiac myopathy?
Afib
Common physical exam findings of HCM
Bisferiens carotid pulse
Double or triple apical impulse
S4 and S3 gallops
Loud harsh aortic outflow murmur (crescendo-decrescendo)
Where is the cescendo-decrescendo murmur best heard?
Left sternal border
What increases the murmur of HCM?
Standing and valsalva
Hypovolemia, tachycardia, increase in cardiac contractility
What decreases the murmur of HCM?
Squatting
The murmur of HCM is the _______ of how aortic stenosis acts
OPPOSITE!! Very important!!
What is essential in management of HCM?
Minimize strenuous activity
What are the medications to manage HCM?
Beta blockers
CCBs
This is the only time you can add verapamil to beta blocker!!
What type of CCB should you NOT use with HCM?
DHP – can worsen symptoms
What are some interventional therapies for HCM?
Surgery or procedures to reduce septal muscle (myomectomy)
Dual chamber pacemaker
ICD in high risk patients
What is the hallmark of restrictive and infiltrative cardiomyopathies?
Abnormal diastolic function
What is the pathophysiology of restrictive and infiltrative cardiomyopathies?
Ventricular walls excessively rigid and impede diastolic filling; systolic function may be normal or reduced
What are the etiologies of restrictive and infiltrative cardiomyopathies?
Amyloidosis Hemochromotosis Fairy disease Gaucher disease Endomyocardial Fibrosis Loeffler endocarditis Hypereosinophilia disease
Findings of restrictive cardiomyopathy
JVD S3 and/or S4 Inspiratory increase in venous pressure (Kussmaul's sign) Rt heart failure (edema, hepatomegaly) Dyspnea, exercise intolerance, fatigue
Random… What do you not want to use with HCM?
DHP CCB
What are the echo-doppler findings going to be for a patient with restrictive cardiomyopathy?
LV wall thickening; decreased diastolic relaxation
What types of regurgitation are common with restrictive cardiomyopathy?
Tricuspid and mitral
What is the treatment for restrictive cardiomyopathy?
There is no specific treatment; Calcium channel antagonists may improve diastolic function in selected individuals
Most common cause of myocarditis?
Viral
Most common viruses that causes myocarditis?
Coxsackievirus (B moreso than A)
HIV
Prodromal viral syndrome followed by chest pain, dyspnea, palpitations that progress to HF
Myocarditis
Treatment for myocarditis?
Supportive
AVOID NSAIDS
Syndrome due to inflammation of the pericardium characterized by chest pain, a pericardial friction rub, and serial ECG abnormalities
Acute pericarditis
Most common cause of pericarditis?
Viral! Cocksackie B most common
Uremia
Post MI
Neoplastic disease
Pain is intense and is aggravated by lying supine, with inspiration, coughing, swallowing, laughing
Improved with sitting up, leaning forward, and shallow inspiration
Acute pericarditis
The pain from acute pericarditis may be similar to that of ____
Myocardial infarction
What is pathognomonic for pericarditis?
Pericardial friction rub - scratching, grating, high pitched sound due to friction between pericardium and epicardium
What two components do you usually hear when auscultating for pericarditis?
Ventricular systole and early diastole
Where is the pericardial friction rub best heard for pericarditis?
Left lower sternal border
Best heard with patient sitting, leaning forward, in full expiration
What EKG changes will you see in a patient with acute pericarditis?
Initially diffuse ST segment elevation in all leads except aVR and V1
What will you find on echo-doppler in a patient with pericarditis?
Normal LV size and function – this will rule out myocarditis!!
Could see a small pericardial effusion
How do you treat acute pericarditis?
Bed rest until pain and fever resolved - 2-4 weeks
Hospitalize only if suspect MI
What do patents rapidly respond to with pericarditis?
NSAIDs
Don’t use if there is evidence of myocarditis!
What should be AVOIDED in patients with pericarditis?
Anticoagulants
Can occur with all forms of pericarditis - symptoms include chest pressure, dyspnea, hiccups, nausea, and. fullness, and cough
Pericardial effusion without cardiac compression
What will you see on CXR in a patient with a pericardial effusion (without cardiac compression)?
Cardiomegaly if more than 250cc fluid
What will you see on ECG in a patient with pericardial effusion without cardiac compression?
NSST-T changes; DECREASED QRS VOLTAGE
What is the best technique to diagnose pericardial effusion?
Echocardiogram
What can an echocardiogram determine the presence of in a pericardial effusion?
Tamponade
What is a pericardial effusion WITH compression called?
Cardiac tamponade
Increasing pericardial fluid raises intrapericardial pressure resulting in compression of the heart
Cardiac tamponade
What does a cardiac tamponade limit? What does this lead to?
Ventricular diastolic filling
Leads to reduction of stroke volume and cardiac output!
What happens with cardiac tamponade pressures?
LV and RV diastolic pressures will equilibrate
LA and RA pressures will elevate
What is seen on echocardiogram when assessing a patient for cardiac tamponade?
RA and RV collapse
What is becks triad and what is it a sign of?
Decline in arterial pressure
Elevation of systemic venous pressure
Quiet heart
Cardiac tamopnade?
What is pulsus paradoxus?
When inspiration leads to a marked decrease in LV volume resulting in a systolic BP drop of greater than 10mm
What is diagnostic of a cardiac tamponade?
Echocardiogram
How do you treat a cardiac tamponade?
Pericardiocentesis
Pericardectomy or pericardotomy are necessary in 25% of recurrent tamponade cases
