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Cardiovascular > Myocardial + Pericardial Dz > Flashcards

Myocardial + Pericardial Dz Flashcards

1
Q

Ventricular loading can be due to these two factors, which will result in drastically different phenotypes

A

Pressure load: requires an increase in fiber tension, leading to concentric hypertrophy

Volume load: requires increase shortening, leads to eccentric hypertrophy

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2
Q

What are examples of LV pressure loading?

What type of hypertrophy does this result in?

What type of heart sound can be heard as a result of LV pressure loading?

A

HTN - increased afterload
Aortic stenosis - obstruction of outflow

leads to concentric hypertrophy.

S4 kick

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3
Q

What are the pros (1) and cons (3) of concentric hypertrophy?

A

pros: allows heart to generate a higher systolic pressure without increasing individual scaromere tension requirements
bad: 1) makes LV less compliant, resulting in an increase in atrial/pulmonary pressures in order to maintain adequate LV filling/CO. 2) Ultimately leads to backward failure/pulmonary congestion as a result of impaired filling. 3) myocardium is more prone to ischemia

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4
Q

What are examples of LV volume loading?

What type of hypertrophy does this result in?

What type of heart sound can be heard as a result of LV volume loading?

A

AV fistula
Aortic/Mitral Regurgitation - to maintain adequate forward flow, the ventricles increases in size to maintain normal CO

Eccentric hypertrophy

S3 gallop

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5
Q

What are the pros (2) and cons (1) of eccentric hypertrophy?

A

pros: 1) increase CO without increasing shortening requirements, 2) less prone to ischemia compared to concentric hypertrophy
cons: can lead to LV systolic dysfunction (impaired ejection). Note that LV systolic dysfunction is not impaired

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6
Q

What are examples of RV pressure loading?

What type of hypertrophy does this result in?

A

cor pulmonale - failure of R side of the heart brought upon by long-term increases in BP in PULMONARY arteries

pumonary stenosis - obstruction of RV outflow tract

–> concentric hypertrophy

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7
Q

What are examples of RV volume loading?

What type of hypertrophy does this result in?

A

tricuspid regurgitation
atrial septal defect

–> eccentric hypertrophy

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8
Q

What are examples of ventricular underloading? What type of dysfunction is this also known as?

A

diastolic dysfunction

Ventricular underloading = decreased venous return limits ventricular pump function even though the myocardium function is normal.

Examples are:
mitral stenosis
hypovolemia
restrictive cardiomyopathy (non-dilated, rigid ventricle due to infiltrative disease ex: amyloidosis, sarcoidosis)
constrictive pericarditis (thickened, scarred pericardium due to inflammation and infetion)
RV infarction

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9
Q

What are 3 types of cardiomyopathy?

A

dilated - ventricular systolic dysfunction
hypertrophic - ventricular diastolic dysfunction
restrictive - stiffening

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10
Q

What are some causes of dilated cardiomyopathies?

A 
ABCCCD
Alcohol
Beriberi (def. in vitamin B1)
Coxsackie B
Cocaine
Chagas
Doxorubicin toxicity
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11
Q

What is the pathology of dilated cardiomyopathy?

A

dilated heart on ultrasound; balloon appearance on CXR

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12
Q

What is the pathophysiology of dilated cardiomyopathy?

A

failure of systolic contraction, resulting in LOW EJECTION FRACTION

eccentric hypertrophy

sarcomeres do not work as well -> decrease contractility, increase preload -> increase eccentric hypertrophy

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13
Q

What are the 4 clinical features of dilated cardiomyopathy?

A

1) congestive heart failure (LHF, RHF)

LHF: dyspnea, orthopnea, crackles, displaced apex, S3 gallop, enlarged heart + pulmonary congestion

RHF: peripheral edema, elevated JVP, hepatomeagly, enlarged RV

2) Systolic HF = large heart = LOW EF
3) Thromboembolism
4) Arrhythmias

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14
Q

How do you diagnose dilated cardiomyopathy?

A

ECHO - measure biventricular enlargement + calculate EF

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15
Q

How do you treat dilated cardiomyopathy?

A 
Na+ restriction
ACE inhibitors
Diuretics
Digoxin
heart transplant
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16
Q

What are some causes of hypertrophic cardiomyopathies?

A

familial/genetics (autosomal dominant)

17
Q

What is the pathology of hypertrophic cardiomyopathy?

A

myofibrillar disarray + concentric hypertrophy

myofibrillar disarray impairs tension development, so the heart compensates by via concentric hypertrophic to maintain a normal tension development

18
Q

What is the pathophysiology of hypertrophic cardiomyopathy? (2)

A

non-obstructive = diastolic dysfunction due to increased LV stiffness/decreased compliance = leads to impaired filling. The heart compensates by increasing tension to generate a higher filling pressure to restore normal filling + CO

obstructive = aortic stenosis or sub-aortic stenosis, where the latter is caused by hypertrophied septum, which impinges upon the mitral valve during systole and causes a dynamic obstruction to LV outflow

19
Q

What are the clinical features of hypertrophic cardiomyopathy?

A 
General: 
angina
dyspnea
syncope, esp. following exercise
heart murmur + S4 gallop @ lower L sternal border

If diastolic HF (impaired filling)
+ systemic edema
+ pulmonary congestion and dyspnea
+ CXR: small heart but NORMAL EF

if Systolic HF (impaired ejection)

  • dyspnea, orthopnea, S4 gallop
  • CXR: pulmonary congestion but normal heart size
20
Q

How do you diagnose hypertrophic cardiomyopathy?

A

ECHO - look for LVH and calculate normal or increased EF

21
Q

How do you treat hypertrophic cardiomyopathy?

A

b blockers to

  • relax myocardium
  • increase diastolic filling time
  • relief ischemia (angina) and decrease outflow obstruction
22
Q

What is the etiology of systolic dysfunction?

A

Diastolic dysfunction:
Forward failure - decrease CO due to poor emptying
Backward failure - increase filling pressure/fluid retention

Diastolic dysfunction:
Forward failure - decrease CO due to small heart size
Backward failure - increase filling pressure/poor pressure

23
Q

What are the 3 types of pericardial disease?

A

chronic constrictive pericarditis
acute pericarditis
pericardial tamponade

24
Q

What is the etiology of acute pericarditis?

A

infection, toxic uremia (end stage renal dz), metastatic carcinoma, direct injury/trauma, autoimmune, idiopathic

25
Q

What 3 types of pathology characterize acute pericarditis?

A

Effusions:

serous - early phase; serous effusion due to inflammation

serofibrinous - more intense inflammatory process that induces the accumulation of yellow/brown turbid fluid

purulent/suppurative - pus associated with bacterial infection

all lead to scarring and ultimately produce constrictive pericarditis

26
Q

What are the 2 main clinical signs of acute pericarditis?

A

substernal, respirophasic, pleuritic pain that is worse in supine or during inspiration

pericardial rub - triphasic cardiac sounds (systole, diastole, and atrial kick; loudest at L sternal border

27
Q

How is acute pericarditis diagnosed?

A

ECG: diffuse ST Elevation (concave) or diffuse T wave inversion

CXR/ECHO: presence of pericardial effusions

28
Q

How do you treat acute pericarditis?

A

antibiotics (if due to an infection), pericardial drainage, dialysis (for pericarditis caused by uremia)

29
Q

What is the etiology of pericardial tamponade?

A

trauma that causes acute hemorrhage/rapid accumulation of fluid in the pericardial sac –> leads to compression of the heart –> leads to cardiogenic shock due to inadequate filling of the arteries

30
Q

What is the 3 major pathophysiological findings of pericardial tamponade?

A

1) thickened pericardium - leads to underfilling, decreased CO
2) obstructive flow from systemic veins into arteries - leads to increased JVP and decreased arterial pressure
3) compensation - increased sympathetic discharge + increase venous + pressures

31
Q

What is Beck’s triad? What does it characterize?

A

characterizes pericardial tamponade

1) hypotension with paradoxical pulse (>10mmHg decrease in BP upon inspiration)
2) kussmaul’s sign - paradoxical rise in JVP during inspiration
3) quiet precordium - heart sounds are insulated by the pericardial effusions

32
Q

How to you treat pericardial tamponade?

A

pericardiocentesis

33
Q

What is constrictive pericarditis? What does it lead to? How does it present?

How do you treat it?

A

fibrotic pericardium –> decreased diastolic ventricular filling (ventricular underloading) –> diastolic heart failure

presents as RHF because of the disproportionate increase of diastolic pressures in the R heart

treat with pericardiectomy

34
Q

What are the clinical signs of constrictive pericarditis?

A

RHF with concentric hypertrophy (normal EF)
paradoxical pulse

Kussmaul’s sign - paradoxical rise in JVP during inspiration

Pericardial knock - high pitch sound in early diastole when there is a sudden cessation of rapid ventricular diastolic filling

Cardiovascular (8 decks)

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