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Myocarditis/Cardiomyopathy/Endocarditis > Myocarditis/Cardiomyopathy > Flashcards

Myocarditis/Cardiomyopathy Flashcards

1
Q

What is Cardiomyopathy?

A

Structural/functional abnormality of heart muscle in the absence of:

  • CAD
  • HTN
  • Valvular disease
  • Congenital heart disease
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2
Q

What are the three main structural/functional categories of cardiomyopathy?

A
  1. Dilated
  2. Hypertrophic
  3. Restrictive
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3
Q

What is the most common cardiomyopathy

A

Dilated

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4
Q

Define Dilated cardiomyopathy

A

Thin, enlarged ventricular wall, systolic dysfunction

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5
Q

Define hypertrophic cardiomyopathy

A

Myocardial hypertrophy (thick muscle) in the absence of HTN or aortic stenosis

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6
Q

Define restrictive cardiomyopathy

A

Nondilated ventricles, impaired filling, reduced diastolic function

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7
Q

Define Heart Failure

A
  • Systemic perfusion being inadequate to meet the body’s metabolic demand
  • Due to any structural or functional cardiovascular abnormality causing a supply/demand mismatch
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8
Q

What is the main cause of dilated cardiomyopathy?

A

Idiopathic

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9
Q

What are the other non-idiopathic causes for dilated cardiomyopathy?

A 
"ABCD PIG": 
Alcohol
Beriberi (thiamine deficiency)
Coxsackie B, Chagas disease
Drugs: doxorubicin (anthracycline), cocaine
Pregnancy
Infection
Genetic
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10
Q

What is the most common cause of heart failure due to systolic dysfunction?

A

Ischemic cardiomyopathy

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11
Q

What is a common cause of dilated cardiomyopathy?

A

Ischemic cardiomyopathy

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12
Q

How is Ischemic cardiomyopathy characterized?

A

LVEF≤35-40%

  • coronary artery disease
  • often occurs after MI
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13
Q

Treatment for ischemic cardiomyopathy

A 
Aspirin
High-intensity statin
Beta-blocker
ACE-inhibitor
Loop diuretic if fluid overload
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14
Q

How is hypertensive cardiomyopathy characterized?

A

Concentric LVH

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15
Q

What can lead to hypertensive cardiomyopathy?

A

Uncontrolled and sustained HTN over a long time period

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16
Q

Define alcoholic cardiomyopathy

A

Excessive alcohol use leads to myocardial dysfunction

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17
Q

Who is at risk for alcoholic cardiomyopathy?

A

> 90g (7-8 drinks) per day for at least 5 years

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18
Q

When would you see a prolonged QTc (precursor to ventricular arrhythmias)

A

Alcoholic cardiomyopathy

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19
Q

Define Peripartum Cardiomyopathy

A
  • Development of heart failure late in pregnancy or within 5 months of giving birth
  • LVEF<45% with or without dilation
  • Most common w/in 1 month postpartum
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20
Q

What are the risk factors for Peripartum Cardiomyopathy?

A
  • age>30
  • African descent
  • Cocaine abuse
  • Multiple fetuses
  • Preeclampsia/eclampsia
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21
Q

What is the treatment for Peripartum Cardiomyopathy?

A

Heart transplant performed in 1/3

  • diuretics
  • Beta-blockers
  • ACEi (DO NOT BREAST FEED)
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22
Q

Define Takotsubo Cardiomyopathy

A
  • “Stress Cardiomyopathy” –>Catecholamine induced
  • transient LV dysfunction
  • on Echo: systolic apical ballooning
  • Substernal pain
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23
Q

Investigation findings of Takotsubo Cardiomyopathy

A
  • Troponin levels often 7x the upper limit of normal
  • ECG with ST-elevation is common (Transient)
  • Echocardiography shows apical ballooning pattern, decreased LVEF
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24
Q

What age group does dilated cardiomyopathies occur in?

A

Age 20-60

25
Q

Physical exam findings in dilated cardiomyopathy- Vitals

A
  • Hypotensive
  • Tachycardic (cardiogenic shock)
  • Tachypnea
26
Q

Signs of left sided HF in dilated cardiomyopathy?

A

Pulmonary congestion:

  • Productive cough
  • Dyspnea (at rest, exertional, lying flat)
  • Crackles or wheezing
27
Q

Signs of right sided HF in dilated cardiomyopathy

A
  • raised JVP
  • Hepatojugular reflux
  • Peripheral oedema (pitting)
28
Q

Diagnostic findings on a CXR in dilated cardiomyopathy

A
  • Enlargement of cardiac silhouette
  • Pulmonary vascular congestion
  • Pleural effusion (R sided)
  • Kerley B lines
29
Q

Diagnostic findings on an EKG in dilated cardiomyopathy

A
  • LVH
  • Conduction delay
  • Arrhythmias
30
Q

What are the effects of ACE inhibitors in treating dilated cardiomyopathy

A

-Reduce preload and afterload by vasodilation–> BP reduction

31
Q

What are the effects of Beta Blockers in treating dilated cardiomyopathy

A

Reduce detrimental effects on the heart from catecholamine stimulation

  • Slow HR to increase diastolic perfusion
  • Decrease after load
32
Q

When do we use Beta blockers in treating dilated cardiomyopathy

A

HFrEF and LVEF ≤40%

33
Q

Contraindications for beta blockers in dilated cardiomyopathy

A

HR<50
2nd or 3rd degree AV block
Asthma is a contraindication; COPD is NOT

34
Q

What are the surgical options for dilated cardiomyopathy

A
  • LVAD
  • Cardiac resynchoronization therapy (CRT)
  • Automatic implantable cardioverter-defibrillator (AICD)
  • Heart transplantation
35
Q

What is hypertrophic cardiomyopathy caused by?

A

Genetic disease of heart muscle (myocardium)

  • Autosomal dominant
  • Mutation in sarcomere protein genes
36
Q

Define hypertrophic cardiomyopathy

A

Unexplained LV hypertrophy without dilation of the ventricles or a cardiovascular disease that could cause the degree of hypertrophy seen

37
Q

What is diagnostic of hypertrophic cardiomyopathy

A

> 15 mm LV wall thickness

Seen on transthoracic echocardiogram

38
Q

What are the two classifications of hypertrophic cardiomyopathy

A
  1. Obstructive

2. Non-obstructive

39
Q

Define obstructive hypertrophic cardiomyopathy

A
  • midsystolic obstruction of flow through the LV outflow tract
  • as a result of systolic anterior motion of the mitral valve (SAM) toward the septum
40
Q

What is the number one risk for sudden cardiac death?

A

History of syncope
and/or
Family history of sudden death

41
Q

Hypertrophic cardiomyopathy sx’s

A 
Fatigue
Dyspnea
Angina 
Palpitations
Presyncope or syncope
Orthopnea and paroxysmal nocturnal dyspnea (PND)
Dizziness
42
Q

What is a systolic ejection crescendo-decrescendo murmur indicate?

A

Hypertrophic cardiomyopathy

Aortic Stenosis

43
Q

What is diagnostic of Hypertrophic cardiomyopathy

A

> 15mm LV wall

Transthoracic echocardiogram

44
Q

What is the treatment for pt’s with symptomatic arrhythmias in hypertrophic cardiomyopathy

A

beta-blocker (Sotalol) or anti-arrhythmic (amioderone)

45
Q

What is the treatment for pt’s with arrhythmias sustaining frequent shocks from ICD with hypertrophic cardiomyopathy

A

Antiarrhythmic therapy:

  • Sotalol (BB)
  • Amiodarone
46
Q

What is the treatment for pt’s with HCM and Atrial Fibrillation, despite CHADS2VASc score

A

Anticoagulation

47
Q

Non-pharmacologic treatment for hypertrophic cardiomyopathy

A
  • Surgical septal myectomy

- Alcohol septal ablation

48
Q

How is restrictive cardiomyopathy characterized?

A

Non-dilated, non-hypertrophied ventricles with impaired LV filling
=Diastolic dysfunction

49
Q

What is the most common cause of secondary restrictive cardiomyopathy in the US?

A

Amyloidosis

50
Q

What diseases cause secondary restrictive cardiomyopathy

A

Sarcoidosis
Scleroderma (Progressive Systemic Sclerosis)
Haemochromatosis
Metastatic malignancy
Radiation induced
Drug induced (chloroquine, hydroxychloroquine)

51
Q

Clinical presentation of restrictive cardiomyopathy?

A 
Progressive exercise intolerance and SOB
Fatigue
Orthopnea
Palpitations (frequently causes atrial fibrillation)
Thromboembolic complications
Orthostatic hypotension 
Syncope
52
Q

Amyloidosis systemic signs

A

easy bruising

periorbital purpura macroglossia

53
Q

+ Kussmaul Sign

A

JVP fails to fall during inspiration

rises do to Right Ventricular Failure

54
Q

Define cardiac amyloidsosis

A
  • Multisystem deposition of amyloid fibrils

- Amyloidosis is a systemic disease, with cardiac infiltration being common

55
Q

Myocarditis

A

-An inflammatory infiltrate of the myocardium with necrosis and/or degeneration of adjacent myocytes not typical of the ischemic damage associated with coronary artery disease

56
Q

What is the most common cause of myocarditis in developed countries?

A

Viral infections (adenovirus, Coxsackie B, HIV, EBV, HCV, etc)

57
Q

In developing countries, what are causes of myocarditis

A
  • Rheumatic carditis
  • Chagas disease
  • Complications of HIV are more common
58
Q

What is the gold standard diagnostic test for myocarditis?

A

Endomyocardial Biopsy

59
Q

When is Endomyocardial Biopsy indicated?

A
  1. New onset fulminant HF within 2 weeks with hemodynamic compromise
  2. New onset HF with failure to respond to treatment

Myocarditis/Cardiomyopathy/Endocarditis (3 decks)

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