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

Myocardial and Pericardial Disease Flashcards

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
Q

Common physical exam findings of HCM

A

Bisferiens carotid pulse
Double or triple apical impulse
S4 and S3 gallops
Loud harsh aortic outflow murmur (crescendo-decrescendo)

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26
Q

Where is the cescendo-decrescendo murmur best heard?

A

Left sternal border

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27
Q

What increases the murmur of HCM?

A

Standing and valsalva

Hypovolemia, tachycardia, increase in cardiac contractility

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28
Q

What decreases the murmur of HCM?

A

Squatting

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29
Q

The murmur of HCM is the _______ of how aortic stenosis acts

A

OPPOSITE!! Very important!!

30
Q

What is essential in management of HCM?

A

Minimize strenuous activity

31
Q

What are the medications to manage HCM?

A

Beta blockers
CCBs

This is the only time you can add verapamil to beta blocker!!

32
Q

What type of CCB should you NOT use with HCM?

A

DHP – can worsen symptoms

33
Q

What are some interventional therapies for HCM?

A

Surgery or procedures to reduce septal muscle (myomectomy)
Dual chamber pacemaker
ICD in high risk patients

34
Q

What is the hallmark of restrictive and infiltrative cardiomyopathies?

A

Abnormal diastolic function

35
Q

What is the pathophysiology of restrictive and infiltrative cardiomyopathies?

A

Ventricular walls excessively rigid and impede diastolic filling; systolic function may be normal or reduced

36
Q

What are the etiologies of restrictive and infiltrative cardiomyopathies?

A 
Amyloidosis
Hemochromotosis
Fairy disease
Gaucher disease
Endomyocardial Fibrosis
Loeffler endocarditis
Hypereosinophilia disease
37
Q

Findings of restrictive cardiomyopathy

A 
JVD
S3 and/or S4
Inspiratory increase in venous pressure (Kussmaul's sign)
Rt heart failure (edema, hepatomegaly)
Dyspnea, exercise intolerance, fatigue
38
Q

Random… What do you not want to use with HCM?

A

DHP CCB

39
Q

What are the echo-doppler findings going to be for a patient with restrictive cardiomyopathy?

A

LV wall thickening; decreased diastolic relaxation

40
Q

What types of regurgitation are common with restrictive cardiomyopathy?

A

Tricuspid and mitral

41
Q

What is the treatment for restrictive cardiomyopathy?

A

There is no specific treatment; Calcium channel antagonists may improve diastolic function in selected individuals

42
Q

Most common cause of myocarditis?

A

Viral

43
Q

Most common viruses that causes myocarditis?

A

Coxsackievirus (B moreso than A)

HIV

44
Q

Prodromal viral syndrome followed by chest pain, dyspnea, palpitations that progress to HF

A

Myocarditis

45
Q

Treatment for myocarditis?

A

Supportive

AVOID NSAIDS

46
Q

Syndrome due to inflammation of the pericardium characterized by chest pain, a pericardial friction rub, and serial ECG abnormalities

A

Acute pericarditis

47
Q

Most common cause of pericarditis?

A

Viral! Cocksackie B most common

Uremia
Post MI
Neoplastic disease

48
Q

Pain is intense and is aggravated by lying supine, with inspiration, coughing, swallowing, laughing

Improved with sitting up, leaning forward, and shallow inspiration

A

Acute pericarditis

49
Q

The pain from acute pericarditis may be similar to that of ____

A

Myocardial infarction

50
Q

What is pathognomonic for pericarditis?

A

Pericardial friction rub - scratching, grating, high pitched sound due to friction between pericardium and epicardium

51
Q

What two components do you usually hear when auscultating for pericarditis?

A

Ventricular systole and early diastole

52
Q

Where is the pericardial friction rub best heard for pericarditis?

A

Left lower sternal border

Best heard with patient sitting, leaning forward, in full expiration

53
Q

What EKG changes will you see in a patient with acute pericarditis?

A

Initially diffuse ST segment elevation in all leads except aVR and V1

54
Q

What will you find on echo-doppler in a patient with pericarditis?

A

Normal LV size and function – this will rule out myocarditis!!

Could see a small pericardial effusion

55
Q

How do you treat acute pericarditis?

A

Bed rest until pain and fever resolved - 2-4 weeks

Hospitalize only if suspect MI

56
Q

What do patents rapidly respond to with pericarditis?

A

NSAIDs

Don’t use if there is evidence of myocarditis!

57
Q

What should be AVOIDED in patients with pericarditis?

A

Anticoagulants

58
Q

Can occur with all forms of pericarditis - symptoms include chest pressure, dyspnea, hiccups, nausea, and. fullness, and cough

A

Pericardial effusion without cardiac compression

59
Q

What will you see on CXR in a patient with a pericardial effusion (without cardiac compression)?

A

Cardiomegaly if more than 250cc fluid

60
Q

What will you see on ECG in a patient with pericardial effusion without cardiac compression?

A

NSST-T changes; DECREASED QRS VOLTAGE

61
Q

What is the best technique to diagnose pericardial effusion?

A

Echocardiogram

62
Q

What can an echocardiogram determine the presence of in a pericardial effusion?

A

Tamponade

63
Q

What is a pericardial effusion WITH compression called?

A

Cardiac tamponade

64
Q

Increasing pericardial fluid raises intrapericardial pressure resulting in compression of the heart

A

Cardiac tamponade

65
Q

What does a cardiac tamponade limit? What does this lead to?

A

Ventricular diastolic filling

Leads to reduction of stroke volume and cardiac output!

66
Q

What happens with cardiac tamponade pressures?

A

LV and RV diastolic pressures will equilibrate

LA and RA pressures will elevate

67
Q

What is seen on echocardiogram when assessing a patient for cardiac tamponade?

A

RA and RV collapse

68
Q

What is becks triad and what is it a sign of?

A

Decline in arterial pressure
Elevation of systemic venous pressure
Quiet heart

Cardiac tamopnade?

69
Q

What is pulsus paradoxus?

A

When inspiration leads to a marked decrease in LV volume resulting in a systolic BP drop of greater than 10mm

70
Q

What is diagnostic of a cardiac tamponade?

A

Echocardiogram

71
Q

How do you treat a cardiac tamponade?

A

Pericardiocentesis

Pericardectomy or pericardotomy are necessary in 25% of recurrent tamponade cases

Clin Med Cardio Exam 2 (6 decks)

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