Non-ischemic cardiomyopathy cases Flashcards
What is cardiomyopathy?
Abnormal myocardial tissues leading to structural
heart disease.
What is heart failure?
Constellation of signs/symptoms related to structural heart disease. Symptoms result from an inability to contract or inability to fill.
59 y/o male with h/o hypertension and diabetes presents with progressive shortness of breath and lower extremity swelling over the past 2 weeks. Echocardiogram shows a dilated ventricular cavity and a left ventricular ejection fraction (LVEF) of 20%. Is this pt is heart failure?
Yes, most likely a pumping problem.
72 y/o male with h/o peripheral neuropathy and chronic kidney disease with progressive shortness of breath and lower extremity swelling over the past 2 weeks. Echocardiogram shows a thick-walled, small ventricular cavity and a left ventricular ejection fraction (LVEF) of 70%. Is this pt in heart failure?
Yes, most likely a filling problem.
Difference between cardiomyopathy and heart failure?
Cardiomyopathy is structural and Heart Failure is the symptoms
What are the symptoms of heart failure?
- Dyspnea on exertion
- Orthopnea- Difficulty breathing when lying flat ask “How many pillows…?”
- Paroxysmal nocturia dyspnea (PND) - Waking up at night due to shortness of breath
- Lower extremity edema/swelling
- Ascites
- Decreased appetite/anorexia
- Weakness/fatigue
What are signs of pulmonary congestion?
- Rales (Crackles)
* Decreased breath sounds from pleural effusion
When do pt get pulmonary congestion?
left sided heart failure
What are signs of right sided heart failure?
• Systemic congestion – Dependent (pitting) edema – Jugular venous distension – Hepatomegaly – Splenomegaly – Ascites – Anorexia
Myocardial pathology can cause decrease in contractility or compliance. This decreases does what to stroke volume?
decreases
Decreased stroke volume can do what to filling pressure and CO?
increases ventricular filling pressure and decreases forward CO
A decrease in CO results in what symptoms?
fatigue and weakness
Increased ventricular filling pressure does what to the vascular system?
Causes pulmonary or systemic congestion
Decreasing afterload in a pt with heart failure can help increase what?
Stroke volume
What are the 3 major types of nonischemic cardiomyopathy?
- Dilated Cardiomyopathy (DCM)
- Restrictive Cardiomyopathy (RCM)
- Hypertrophic Cardiomyopathy (HCM)
What is the etiology of dilated cardiomyopathy?
- alcohol
– Coxsackie virus (Viral Myocarditis)
– Idiopathic
– Pregnancy
What is the etiology of restrictive cardiomyopathy?
– Amyloidosis
– Hematochromatosis
What is the etiology of hypertrophic cardiomyopathy?
myosin gene mutation
What are the characteristics of dilated cardiomyopathy?
• Increased left ventricular chamber size
• Decreased left ventricular ejection fraction (LVEF)
• “Pumping problem”
• Multiple Causes
• Key physical exam findings:
– S3 gallop
– Soft S1
Peripartum cardiomyopathy usually happens when and what is the prognosis?
– Must occur in the last month of pregnancy or within 5 months of delivery
– 50% improve, 25% persist, 25% get worse
How much alcohol do you have to drink to get dilated cardiomyopathy?
– Related to average daily intake and duration of drinking
• 80-90 gm ethanol/day for > 5years (1 L wine, 8 beers, ½ pint hard liquor daily)
How do you fix alcohol related cardiomyopathy?
Stop drinking stupid (abstinence)
How does viral myocarditis dilated cardiomyopathy present?
– 2 week viral pro-drome
– Chest pain, Heart failure, Elevated markers of myocardial damage (troponin)
– Gradations in clinical presentation
Do pt with viral myocarditis dilated cardiomyopathy completely recover?
– May or may not regain normal LV systolic function
• Sicker at presentation better overall prognosis
What is restrictive cardiomyopathy?
- Small left ventricular chamber size, thick walls
* “Filling problem”
What is the equation for CO?
CO = HR x SV
Restrictive cardiomyopathy is usually an infiltrate process by what?
– Amyloid (transthyretin deposits)
– Hemachromatosis (iron deposits)
What are key exam findings in amyloid restrictive cardiomyopathy?
- Systemic disease(Nerve, liver, kidney, pancreas, and skin pathology)
- Diagnostic clue: low voltage ECG
What stain should you use to find amyloid?
congo red stain (polarized light)
What happens in hypertrophic cardiomyopathy?
- Asymmetric left ventricular hypertrophy (wall thickness).
- Typically involves the interventricular septum.
- Can cause left ventricular outflow track obstruction
What usually causes sudden death in young athletes?
hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is what kind of inheritance?
a bad one… but really..
autosomal dominant
Key exam findings with hypertrophic cardiomyopathy?
Harsh systolic murmur at the left sternal border that increases in intensity with Valsalva or when rising from a seated to standing position
