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Clin Med-Cardio pt 2 > Myocardial and Pericardial lecture > Flashcards

Myocardial and Pericardial lecture Flashcards

1
Q

What is the cause of primary dilated cardiomyopathy?

A

Idiopathic-unknown cause

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2
Q 
Toxic- alcohol, adriamycin, etc
Post-partum (third trimester or after birth)
Post infectious- myocarditis*
Endocrine
"Ischemic cardiomyopathy"
A

Secondary dilated cardiomyopathy

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3
Q

Patients present with signs and symptoms of HF which usually develops slowly.

A

Dilated cardiomyopathy

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4
Q

In dilated cardiomyopathy, left or biventricular failure, ______ dysfunction predominates.

A

Systolic

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5
Q

Right or Left dilated cardiomyopathy?

DOE, orthopnea, PND, weakness, fatigue, peripheral edema, etc.

A

Left sided

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6
Q

Right or Left dilated cardiomyopathy?

unexplained weight gain, peripheral edema, abdominal fullness (hepatomegaly, ascites).

A

Right sided

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7
Q

Cardiomegaly (PMI displaced laterally), low pulse amplitude (pulsus alternans when severe), often with ↓BP, pulmonary congestion, crackles, S3 gallop, MR murmur.

A

(left) Dilated cardiomyopathy

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8
Q

Elevated JVP, hepatomegaly, HJR, pitting edema, TR murmur.

A

(right) Dilated cardiomyopathy

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9
Q

right sided murmurs get louder with..

A

inspiration

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10
Q

Echocardiography/Doppler: LV/RV dilation, global LV dysfunction with reduced EF; Mitral regurgitation common.

A

Dilated cardiomyopathy

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11
Q

CxR: Cardiomegaly, pulmonary congestion, pleural effusions.

A

Dilated cardiomyopathy

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12
Q

Do you need to do a cardiac cath in a pt with dilated cardiomyopathy?

A

NO! Only used to rule out other dx

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13
Q 
Tx like HF:
Afterload reduction: ACEI or alternatives (ARB’s)
Preload reduction: Diuretics, nitrates
Beta Blockers
Spironlolactone- class III and IV NYHA criteria
Digoxin 
ICD’s if indicated, +/- antiarrhythmics
Anticoagulation unless contraindicated*
A

Dilated cardiomyopathy

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14
Q

If dilated cardiomyopathy pt has an EF of 35% or less…

A

use ICD

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15
Q

Only meds that may improve survival rate in dilated cardiomyopathy:

A

ACEi (or ARB)
Beta blockers
Spironolactone

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16
Q

Genetically transmitted in >50% of cases.
Autosomal dominant with high penetrance.
*may require genetic counseling
(remaining cases occur spontaneously)

A

Hypertrophic cardiomyopathy

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17
Q

Marked increase in left ventricular mass, especially the septum - marked hypertrophy; remaining LV segments hypertrophied to a lesser degree; often called *ASH. Hypertrophy is unrelated to pressure overload; often present at birth, progressively worsens during childhood.

A

HCM

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18
Q

LV cavity small, systolic function normal or hyperdynamic early on.
Diastolic dysfunction common
Obstructive (below AoV) and non-obstructive forms

A

HCM

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19
Q

Asymmetric septal hypertrophy, AKA

A

HCM

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20
Q

When present LVOT obstruction is dynamic and varies with activity/rest, and LV volume.
Obstruction: MV moves abnormally towards the IVS, obstructing the LVOT.

A

HCM

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21
Q

Pathology: myocardial fiber hypertrophy and disarray, primarily in IVS.
Mitral valve often thickened and moves abnormally as noted above, well seen on echocardiogram.

A

HCM

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22
Q

Often asymptomatic in childhood; may be detected via ultrasound in the offspring of patients with known disease.
Symptoms: dyspnea, chest pain and syncope are most common. In some, sudden death may be presenting symptom. One of few causes of sudden death in young athletes.

A

HCM

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23
Q

Sudden death often occurs during strenuous activity.
Arrhythmias are common: ventricular and supraventricular; Afib may lead to sudden decompensation and is a bad prognostic sign.

A

HCM

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24
Q

Pulse brisk, often with bisferiens carotid pulse.
Double or triple apical impulse due to atrial filling wave and early and late systolic impulses.
Loud S4 and S3 gallops.

A

HCM

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25
Q

Loud harsh aortic outflow murmur (crescendo-decrescendo) best heard along left sternal border with characteristic features; MR common.

A

HCM

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26
Q

The murmur of HCM is increased with….

A

Standing and valsalva

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27
Q

HCM and… hypovolemia, tachycardia or increase in cardiac contractility (inotropes, exercise) causes…

A

increase in murmur

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28
Q

LVH with secondary ST-T changes common. Septal Q waves may mimic MI.

A

HCM

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29
Q

Must minimize strenuous physical exertion

***BETA BLOCKERS ARE CORNERSTONE THERAPY

A

HCM

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30
Q

What class of drug can be used instead of or along with beta blockers in treating HCM

A

Calcium channel blockers

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31
Q

Don’t use what class of calcium channel blockers in HCM

A

Dihydro CCBs

32
Q

myomectomy, alcohol ablation used as surgical tx for..

A

HCM

33
Q

Dual chamber pacemaker may improve septal motion and decrease progression of obstruction if severe

A

HCM

34
Q

Which HCM patients may be candidates for implantable cardiac defibrillators (ICD)?

A

High risk!! (vtach, aborted sudden death)

or fam hx of sudden death

35
Q

Hallmark: Abnormal diastolic function.

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

A

Restrictive and infiltrative cardiomyopathies

36
Q 
Amyloidosis
Hemochromatosis
Fabry Disease
Gaucher Disease
Endomyocardial Fibrosis-Loeffler Endocarditis-hypereosinofilia syndrome

…all causes of?

A

Restrive and infiltrative cardiomyopathies

37
Q

Jugular venous distention
S3 and/or S4
Inspiratory increase in venous pressure (Kussmaul’s sign)
Findings of Rt. Heart Failure may predominate i.e. edema, hepatomegaly.
Symptoms include dyspnea, exercise intolerance and fatigue.

A

Restrictive cardiomyopathy

38
Q

AKA Stress Cardiomyopathy: ∼90% cases are women, often associated with a significant stressful event.

A

Tako-tsubo Cardiomyopathy

39
Q

Presentation mimics STEMI: Chest pain, SOB, ECG changes with modest elevation of troponins.
Echocardiogram: Marked LV dysfunction with anterior, apical and inferior ballooning, marked ↓EF.

A

Tako-tsubo Cardiomyopathy

40
Q

Absence of obstructive CAD at catheterization.

Pathophysiology: stressful event leads to outpouring of catecholamines →transient LV insult.

A

Tako-tsubo Cardiomyopathy

41
Q

A primary inflammatory process of the myocardium, most often caused by an infectious agent.

A

Myocarditis

42
Q

Unrecognized myocarditis may be the initial event culminating in an…

A

idiopathic dilated cardiomyopathy

43
Q

Most common type of myocarditis?

A

Viral

44
Q 
Coxsackievirus (B>A)***
CMV
Echovirus*
Adenovirus*
HIV*
Influenza
Infectious mononucleosis
Rubella, Rubeola
A

Viral causes of myocarditis

45
Q

Chest pain, fatigue, dyspnea, palpitations are common initial symptoms. Often progresses to HF.

A

Myocarditis

often start asymptomatic

46
Q

The initial presentation of myocarditis might be..

A

Heart failure

47
Q

Exam : Tachycardia, elevated temp, muffled heart sounds; signs of HF in severe cases.

A

Myocarditis

48
Q

Avoid which type of drugs in myocarditis

A

NSAIDS

49
Q

Tx for myocarditis

A

Supportive treatment only

tx HF if present

50
Q

This drug class may make myocardial damage worse

A

NSAIDS

51
Q

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

A

Acute pericarditis

52
Q

Viral most common; same spectrum of viruses as seen with myocarditis- Coxsackie B most common.

A

Pericarditis

53
Q

Tx for Pericarditis ONLY!

A

NSAIDs

must make sure pt does not also have myocarditis

54
Q 
Idiopathic (non specific)
Tuberculosis
Acute bacterial infections
Fungal
Uremia-untreated or with dialysis.
Radiation
Autoimmune-RA, SLE, scleroderma, PAN
A

Causes of pericarditis (other than viral causes)

55
Q

Chest pain-frequent; quality and location variable; retrosternal and often left sided.
Pain is intense-aggravated by lying supine, with inspiration, coughing, swallowing, laughing; improved sitting up, leaning forward, shallow inspiration.

A

Pericarditis

56
Q

Pain worse laying down, better sitting up

Feels better to breathe shallow

A

Pericarditis

57
Q

Pericardial Friction Rub- pathognomonic-scratching, grating, high pitched sound due to friction between the pericardium and epicardium.
*hear 2 components (systole and diastole)

A

Pericarditis physical exam

58
Q

Best heard with diaphragm at LLSB, best heard w patient sitting, leaning forward in full expiration

A

Pericardial friction rub

59
Q

ST elevation everywhere except aVR, V1 (occasionally aVL)

**every other lead will have significant ST elevation

A

Pericarditis

60
Q

how do you tell MI vs pericarditis EKG?

A

MI is localized ST elevation!! you can tell if its anterior, lateral, etc.

Pericarditis is almost everywhere! ST elevation seen in all leads except aVR, V1 and aVL

61
Q

All patients with pericarditis must have a…

A

Echo-doppler (cardiac ultrasound)

must make sure no pericardial effusion

62
Q

Determine etiology where possible.
Bed rest until pain and fever resolved.
Pain rapidly responds to NSAIDs**

A

Pericarditis

63
Q

Oral _____ should be avoided in patients with pericarditis

A

anticoagulants

64
Q

Pericarditis symptoms usually resolve in….

A

2-4 weeks

65
Q

Colchicine can be used to tx..

A

Pericarditis

66
Q

Can occur with all forms of pericarditis

Symptoms (if present) include chest pressure, dyspnea, hiccups, nausea, abd. fullness, cough.

A

Pericardial effusion

67
Q

Best diagnostic to dx pericardial effusion?

A

Echo!

68
Q

CXR- mild cardiomegaly if greater than 250 cc fluid

A

Pericardial effusion

69
Q

Increasing pericardial fluid raises intrapericardial pressure resulting in compression of the heart.
***There is progressive limitation of ventricular diastolic filling leading to reduction of stroke volume and cardiac output.

A

Cardiac tamponade

fatal if not recognized and aggressively treated

70
Q

Hemodynamics - marked elevation and equilibration of LV and RV diastolic pressures; LA and RA pressures elevated.
**marked decrease in CO

A

Cardiac tamponade

71
Q

Echo shows RA and RV collapse

*Beck’s triad: decline in arterial pressure, elevation of systemic venous pressure, quiet heart

A

Cardiac tamponade

72
Q

Decline in arterial pressure
Elevation of systemic venous pressure
Quiet heart

A

Beck’s triad

*seen in cardiac tamponade

73
Q

Classic physical finding of cardiac tamponade**

A

Pulsus paradoxus

74
Q

Pulsus paradoxus has a systolic BP drop greater than…

A

10 mm

75
Q

may be life saving; IV fluids given to increase preload; *should be done with Rt Ht Cath to optimize hemodynamics
*subxiphoid approach with flouroscopic guidance is successful in 95%

fluid is cultured and sent for cytology and chemistry analysis.

A

Pericardiocentesis

done in cardiac tamponade

76
Q

Obliteration of the pericardial space with fusion of the pericardium to the epicardium.
*Restriction of filling of all cardiac chambers.

A

Constrictive pericarditis

77
Q

Initial episode of pericarditis/effusion proceeds to a chronic stage with fibrosis, calcification and marked thickening of the pericardium.

A

Constrictive pericarditis

Clin Med-Cardio pt 2 (11 decks)

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