Myocarditis and Cardiomyopathy Flashcards

1
Q

What is acute myocarditis

A

acute inflammation of cardiac muscle usu viral etiology

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2
Q

what is the typical etiology of acute myocarditis

A

viral

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3
Q

myocarditis focal or diffuse

A

BOTH FOCAL AND DIFFUSE

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4
Q

types of patients who can present with acute myocarditis

A

healthy young adults and children

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5
Q

types of preceding symptoms in acute myocarditis

A

50% have preceding respiratory/GI symptoms within 2 weeks

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6
Q

common symptoms of Acute myocarditis

A

fever
chest pain with ECG changes (due to concurrent pericarditis)
arrhythmia (w/ or w/o palp or syncope)
Heart failure (adults)

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7
Q

what symptoms of acute myocaridtis can have high mortality

A

low ejection fraction
heart failure

but can recover and develop chronic dilated cardiomyopathy

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8
Q

Myocarditis is often ____

A

an autoimmune reaction due to coxsackie B virus with similar immunologically to cardiac myosin

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9
Q

Physcial exam in acute myocarditis

A

S3
pulm congestion/edema
mitral regurgitation

incr troponin
global ventricular dysfunction ECG

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10
Q

Most common type of cardiomyopathy

A

dilated cardiomyopathy

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11
Q

which chambers involved in dilated cardiomyopathy

A

LV always but usu all 4 chambers

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12
Q

three types of cardiomyopathy

A

1) dilated
2) hypertrophic
3) restrictive

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13
Q

part of heart affected in HCM

A

LV hypertrophied NOT DILATED
hypertrophy of IV septum

muscle fiber and collagen disorganized

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14
Q

part of heart affected in restrictive cardiompathy

A

infiltration/fibrosis of ventricles NO DILATION

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15
Q

PRESENTATION OF DILATED CARDIOMOPATHY

A

heart failure with

1) large silent heart
2) impaired systolic function (poor contract LV)

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16
Q

etiology of dilated cardiomyopathy

A

1) usually idiopathic

2) genetic, viral, ischemic

17
Q

dilated cardiomyopathy on CXR

A

1) enlarged heart (cardiomegaly)

2) congested lung field

18
Q

dilated cardiomyopathy on ECHO

A

both ventricle dilated and more spherical

diffuse poor wall motion

low ejection fraction

19
Q

other clinical effects of dilated cardiomyopathy

A

1) arrhythmia- injury, fibrosis, dilation - atrial fibrillation, ventricular arrhythmia
2) thromboembolism from ventricle- dilation, poor contraction, abnormal surface

20
Q

effects of angiotensin II

A

1) vasoconstriction
2) incr aldosterone release
3) Na+ reabsorption
4) fibrosis
5) incr sympathetic activity
6) hypertrophy

21
Q

lab test elevated in patients with CHF but not asymptomatic LV dysfunction

22
Q

TREATMENT FOR DILATED CARDIOMYOPATHY

–> TREATING HEART FAILURE1

A

1) DIURETICS
2) ace inhibitors
3) beta blocker
4) aldosterone antag
5) vasodilator
6) inotrope
7) LVAD, transplant

23
Q

other treatments beside treating heart failure for dilated cardiomyopathy

A

1) anticoagulation
2) anti arrhythmic (drug, ICD)
3) anti-infalmmatory, immunosuppressive

24
Q

what is hypertrophic cardiomyopathy

A

eccentric hypertrophy involving IV septum NO DILATION

25
what is dysfunctional in HCM
diastolic dysfunction dynamic (aortic) outflow obstruction NORMAL OR INCR SYSTOLIC FUNCTION
26
inheritance of HCM
autosomal dominant
27
what happens strcuturally HCM WITHOUT AORTIC OUTFLOW DYSFUNCTION
diastolic dysfunction due to 1) impaired diastolic relaxation 2) incr stiffness 1) incr LV diastolic pressure - -> incr pulm venous/capillary pressure
28
usual symptom of HCM WITHOUT AORTIC OUTFLOW OBSTRUCTION
dyspnea on exertion not susceptible to sudden death
29
WHAT HAPPENS in HCM obstructive
1) asymmetric myocardial hypertrophy 2) diastolic dysfunction 3) incr systolic dysfunction 4) dynamic LV outflow obstruction MITRAL VALVE PARTIALLY BLOCKS OUTFLOW TRACT BELOW AORTIC VALVE during mid-late systole --> syncope/SUDDEN DEATH
30
clinical manifestation of HCM obstructive
VARIABLE 1) dyspnea -- incr LV filling P 2) angina- hypertrophic LV, incr systolic LV P 3) sudden death- arrhythmia
31
why is there dyspnea in HCM obstructive
incr LV filling pressure
32
why is there angina in HCM obstructive
hypertrophic LV | incr systolic LV pressure
33
treatment for HCM obstrcutive
1) avoid sports and extreme exerton 2) decr contractility with beta blockers/verapamil (decr outflow obstruct) 3) surgical myomectomy or alcohol ablation 4) ICD - ventricular pacing
34
restrictive cardiomyopathy is mostly caused by ___
infiltrative amyloidosis sarcoidosis
35
what happens in restrictive cardiomyopathy
decr ventricular filling due to stiff ventricles (NOT DILATED) normal systolic fxn
36
how to diagnose restrictive cardiomyopathy
1) echo with doppler of ventricular filling | 2) MRI
37
how to treat acute myocarditis?
1) ACE inhibitor | 2) beta blocker to prevent remodeling
38
what age population is associated with sudden death from HCM? what age assoc with stroke/heart failure
sudden death = young people up to age 40 stroke/heart failure = old people
39
histology of HCM
1) disorganized myocytes = reentry paths 2) remodeled coronary arteriole = impair coronary perfusion 3) replacement fibrosis