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Clin Med Cardio Exam 2 > Myocardial and Pericardial Disease > Flashcards

Myocardial and Pericardial Disease Flashcards

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1
Q

What is a common cause of secondary dilated cardiomyopathy?

A

Post-infectious myocarditis

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2
Q

What is the cause of primary dilated cardiomyopathy?

A

Unknown

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3
Q

How will a patient with dilated cardiomyopathy present?

A

Signs and symptoms of HF which usually develop slowly (Consistent with L sided and R sided HF symptoms)

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4
Q

What will you find on physical exam in a patient with dilated cardiomyopathy?

A 
Cardiomegaly (displaced PMI)
Pulsus alternans 
Low BP
Sxs of HF
S3 gallop, MR murmer
Hepatomegaly
HJR
TR murmur (louder with inspiration)
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5
Q

What might you see on an echocardiography/doppler in a patient with dilated cardiomyopathy?

A

LV/RV dilation, Global LV dysfunction with reduced EF

Maybe mitral regurgitation

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6
Q

What would you expect on a CXR of a patient with dilated cardiomyopathy?

A

Cardiomegaly
Pulmonary congestion
Pleural effusions

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7
Q

Should you get a cardiac cath on a patient with dilated cardiomyopathy?

A

No! only when necessary to exclude alternative diagnosis

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8
Q

How do you treat dilated cardiomyopathy?

A

Similar to heart failure
ACEI or ARB
Beta blockers
Spironolactone

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9
Q

What are the only meds that will improve survival of patients with dilated cardiomyopathy?

A

ACEI (or ARBs), B-blockers, and spironolactone

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10
Q

What is the most common type of cardiomyopathy?

A

Dilated

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11
Q

How do you diagnose cardiac myopathy?

A

Cardiac ultrasound with doppler (echocardiogram)

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12
Q

How often is hypertrophic cardiomyopathy genetically transmitted?

A

50% of the time - autosomal dominant with high penetrance

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13
Q

Because hypertrophic cardiomyopathy is so easily inherited, what must you do when you have a patient with HCM?

A

Perform echocardiography on all siblings and offspring of patient with HCM

Always refer for genetic counseling

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14
Q

What is especially hypertrophic in patients with HCM?

A

The IVS is massively hypertrophied and is easily seen on cardiac ultrsound

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15
Q

What type of dysfunction is common in patients with HCM?

A

Diasolic dysfunction

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16
Q

What type of gene mutation causes spontaneous transmission of the hypertrophic cardiomyopathy gene?

A

De novo gene mutations

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17
Q

The LVOT obstruction in HCM is ______

A

Dynamic

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18
Q

What can change the obstruction of the LVOT in HCM?

A

Activity/rest

LV volume

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19
Q

What causes obstruction in HCM?

A

MV moves abnormally toward IVS and obstructs the LVOT

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20
Q

What is the definitive diagnosis of HCM?

A

Cardiac ultrasound

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21
Q

During childhood, most HCM patients are ____ but it may be detected in offspring of patients with known disease

A

Asymptomatic

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22
Q

What are the 3 most common symptoms of HCM?

A

Dyspnea, chest pain, and syncope (sudden death can also be a symptom… but is it really a symptom if you’re dead? idk)

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23
Q

What is one of the most common causes of sudden death in young athletes?

A

Hypertrophic cardiac myopathy

Sudden death commonly occurs during strenuous activity

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24
Q

What can lead to sudden decompensation and is a bad prognostic sign of hypertrophic cardiac myopathy?

A

Afib

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25
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)
26
Where is the cescendo-decrescendo murmur best heard?
Left sternal border
27
What increases the murmur of HCM?
Standing and valsalva Hypovolemia, tachycardia, increase in cardiac contractility
28
What decreases the murmur of HCM?
Squatting
29
The murmur of HCM is the _______ of how aortic stenosis acts
OPPOSITE!! Very important!!
30
What is essential in management of HCM?
Minimize strenuous activity
31
What are the medications to manage HCM?
Beta blockers CCBs This is the only time you can add verapamil to beta blocker!!
32
What type of CCB should you NOT use with HCM?
DHP -- can worsen symptoms
33
What are some interventional therapies for HCM?
Surgery or procedures to reduce septal muscle (myomectomy) Dual chamber pacemaker ICD in high risk patients
34
What is the hallmark of restrictive and infiltrative cardiomyopathies?
Abnormal diastolic function
35
What is the pathophysiology of restrictive and infiltrative cardiomyopathies?
Ventricular walls excessively rigid and impede diastolic filling; systolic function may be normal or reduced
36
What are the etiologies of restrictive and infiltrative cardiomyopathies?
``` Amyloidosis Hemochromotosis Fairy disease Gaucher disease Endomyocardial Fibrosis Loeffler endocarditis Hypereosinophilia disease ```
37
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 ```
38
Random... What do you not want to use with HCM?
DHP CCB
39
What are the echo-doppler findings going to be for a patient with restrictive cardiomyopathy?
LV wall thickening; decreased diastolic relaxation
40
What types of regurgitation are common with restrictive cardiomyopathy?
Tricuspid and mitral
41
What is the treatment for restrictive cardiomyopathy?
There is no specific treatment; Calcium channel antagonists may improve diastolic function in selected individuals
42
Most common cause of myocarditis?
Viral
43
Most common viruses that causes myocarditis?
Coxsackievirus (B moreso than A) | HIV
44
Prodromal viral syndrome followed by chest pain, dyspnea, palpitations that progress to HF
Myocarditis
45
Treatment for myocarditis?
Supportive | AVOID NSAIDS
46
Syndrome due to inflammation of the pericardium characterized by chest pain, a pericardial friction rub, and serial ECG abnormalities
Acute pericarditis
47
Most common cause of pericarditis?
Viral! Cocksackie B most common Uremia Post MI Neoplastic disease
48
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
49
The pain from acute pericarditis may be similar to that of ____
Myocardial infarction
50
What is pathognomonic for pericarditis?
Pericardial friction rub - scratching, grating, high pitched sound due to friction between pericardium and epicardium
51
What two components do you usually hear when auscultating for pericarditis?
Ventricular systole and early diastole
52
Where is the pericardial friction rub best heard for pericarditis?
Left lower sternal border Best heard with patient sitting, leaning forward, in full expiration
53
What EKG changes will you see in a patient with acute pericarditis?
Initially diffuse ST segment elevation in all leads except **aVR and V1**
54
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
55
How do you treat acute pericarditis?
Bed rest until pain and fever resolved - 2-4 weeks Hospitalize only if suspect MI
56
What do patents rapidly respond to with pericarditis?
NSAIDs Don't use if there is evidence of myocarditis!
57
What should be AVOIDED in patients with pericarditis?
Anticoagulants
58
Can occur with all forms of pericarditis - symptoms include chest pressure, dyspnea, hiccups, nausea, and. fullness, and cough
Pericardial effusion without cardiac compression
59
What will you see on CXR in a patient with a pericardial effusion (without cardiac compression)?
Cardiomegaly if more than 250cc fluid
60
What will you see on ECG in a patient with pericardial effusion without cardiac compression?
NSST-T changes; DECREASED QRS VOLTAGE
61
What is the best technique to diagnose pericardial effusion?
Echocardiogram
62
What can an echocardiogram determine the presence of in a pericardial effusion?
Tamponade
63
What is a pericardial effusion WITH compression called?
Cardiac tamponade
64
Increasing pericardial fluid raises intrapericardial pressure resulting in compression of the heart
Cardiac tamponade
65
What does a cardiac tamponade limit? What does this lead to?
Ventricular diastolic filling Leads to reduction of stroke volume and cardiac output!
66
What happens with cardiac tamponade pressures?
LV and RV diastolic pressures will equilibrate LA and RA pressures will elevate
67
What is seen on echocardiogram when assessing a patient for cardiac tamponade?
RA and RV collapse
68
What is becks triad and what is it a sign of?
Decline in arterial pressure Elevation of systemic venous pressure Quiet heart Cardiac tamopnade?
69
What is pulsus paradoxus?
When inspiration leads to a marked decrease in LV volume resulting in a systolic BP drop of greater than 10mm
70
What is diagnostic of a cardiac tamponade?
Echocardiogram
71
How do you treat a cardiac tamponade?
Pericardiocentesis Pericardectomy or pericardotomy are necessary in 25% of recurrent tamponade cases

Clin Med Cardio Exam 2 (6 decks)

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