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NU734 Acute Care I > NU 735: Cardiomyopathy > Flashcards

NU 735: Cardiomyopathy Flashcards

Cardiology

1
Q

Cardiomyopathy : what is it? **
symptoms?

A
  • Cardiomyopathy is disease of **heart muscle : heart unable to pump or fill or both.
    *
    * Exclude: CAD, Sructural Disease, Primarry Valvular disease and severe HTN.
  • Symptoms:
    1. * coughing
    2. Pleural Effusion     (excess fluid around lungs);
    3**. Ascites **(swelling in abdomen);
    4. **Tiredness & SOB;
    5. **Pulmonary edema: **(excess fluids in a lungs);

* Types: can be Ischemic or Nonishcemic Cardiomyopathy

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2
Q

Cadiomyopathy : Etiology

A
  • Pumping action of the heart grows weaker ;
  • Swelling in ankles and legs
  • Symptoms occur when hear Unable to pump or fill or both
  • Oxygenated blood unable to sink into systemic circulation to meet body’s demands leading to >
    Decompensation
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3
Q

Types of Cardiomyopathy

A

can be:
* Ischemic or
* Nonishcemic Cardiomyopathy

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4
Q

type: Ischemic Cardioyopathy

A

Diffuse Disfunction due to multi vassals’ disease (CAD)

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5
Q

Type: Nonishcemic Cardiomyopathy

A
  • Dilated :
  • Restrictive
  • Hypertrophic
  • Stress
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6
Q

Hypertrophic

A
  • Diastolic Dysfunction **
  • Risk of Sudden Death in Young Athletes
  • Thickened Left Ventricular Wall
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7
Q

Dilated

A
  • **Most Common Type **
  • Enlargement of all Cardiac Chambers
  • Systolic Dysfunction
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8
Q

Restrictive

Diastolic Dysfunction

A
  • Least Common
  • Rigid Ventricular Walls
  • **: Walls of ventricle become stiff, but not necessarily thickened. **
  • Diastolic Dysfunction
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9
Q

RT Side HF

Causes

A

*** Effecting Pulmonary System (lungs) - Heart not able to Pump :
Causes: **
* Pulmonary HTN,
* Pulmonary Valvular stenosis,
* large PE,
* Rt Ventricle Hypertrophy leading to CHF
* When RT Ventricle Fails this Known as Core Pulmonary
****Core Pulonary **

Core Pulmonary Symptoms

Pressure or tightness in the chest, rather than sharp or stabbing pain.
It can sometimes resemble angina-like pain due to the strain on the right side of the heart.
Pain may become more noticeable during physical exertion or when breathing deeply.
Occasionally, the pain can be accompanied by palpitations or a sensation of heart racing or irregularity.

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10
Q

RT HF S/s

A
  • JVD
  • Depended Edema
  • Ascites
  • Liver Congestion: signs related to impaired liver function
  • Anorexia, GI distress, Weight Loss
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11
Q

LT Side Causes

A
  • Occurs when Left Ventricle having a problem ejecting or filling blood
  • **Leading to Decrease Cardiac Output and Pulmonary Congestion **
  • Decreased CO> Activity Intolerance and signs of decreased *tissue perfusion * (CO> Tissue Perfusion)
  • Pulmonary Congestion Leading to >
  • Impaired Gas exchange and
  • Pulmonary Edema

Lead to > Impaired gas exchange **> cyanosis and signs of hypoxia (Pulmonary Congestion. > PUlmonary edema)

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12
Q

Left Side HF : S/s

A

> Pulmonary edema> Orthopnea> cough with frothy sputum > Paroxysmal nocturnal dyspnea.

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13
Q

Normal Heart: Systolic and Diastole

A

Normal Heart: Filling
**(Diastole) **> Ventricles Relaxes and expand to fill with blood
*** Pumping (Systole) **> Ventricles contract and pump out b/w 50% and 60% of the blood

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14
Q

Systolic HF (HFrEF)

A
  • **Weak Squaz **
  • Enlarged ventricle fill with blood;
  • Stretched ventricles are weaker,
  • Pumping out less blood than normal
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15
Q

Systolic HF (HFrEF): reserve HF

A
  • EF <50%
  • Heart Fails to Pump
  • Left ventricle looses it’s ability to contract normally
    Leading to heart cannot pump with enough force to pushing blood into systemic circulation

***** Cause **
* CAD (Most common )
* Cardiomyopathy: NiCM (DCM; )
* HTN
* AMI
* COPD
* Endocrine Disease : DM Hyperthyroidism
* Arrhythmias
* Valvular Disease: Aortic Stenosis , Mitral Regurgitatin

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16
Q

Diastolic (HFpEF): Preserve EF

A
  • Preserve EF but Ventricle Stiff so cannot fill the way it needs to
  • EF WNL
  • Heart Fails to fill
    Thickened and stiff ventricle fill with blood less than normal ;
    Thickened Ventricles contract normally
    However, have less blood to pump out
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17
Q

HFpEF/ CAuses

A
  • CHronic HTN
  • NICM
  • Aotic Stenosis
  • Obesity
  • Afib
  • Pericarditis
  • CKD
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18
Q

Ischemic Types of Cardiomyopathy:

A

Primary vs Secondary

19
Q

Primary Cardiomyopathy

A
  • Caused by genetic vs acquired vs mixed genetic & acquired
  • Condition predominantly affects the myocardium (heart muscels )
20
Q

Secondary Cardiomyopathy

A

Caused by a systemic disease process affecting the myocardium
* Condition involves multiorgan & myocardial damage
Examples: hemoptysis,
* Toxic cardiomyopathy: chemotherapy; heavy metal, cocaine, chemical agents
* Infiltrative Cardiomyopathy: condition when abnormal substances accumulate in the heart muscle (sarcoidosis
* Alcoholic Cardiomyopathy: damage to heart muscles
* Endocrine: Pheochromocytomia (tumor of adrenal glands); Hyper or Hyothyroidism

21
Q

Ejection Fraction (EF)

A

on average it b/w Normal 55-65% conflicted agreements
**% how much blood pump out by Left Ventricle with each contraction
**

22
Q

Cardiac Output

A

Cardiac Output = (Heart Rate x Stroke Volume)/1000
Amount of blood heart pump thru circulatory system per 1 mint
Normal 4-8 L/min
It’s not the same as EF/cannot be used intercanthal.*

23
Q

Cardiac Index

A

Cardiac Output/Body Surface Area
Is an assessment of CO based on pt’s size which is body surface area
Normal 2.5-4.0 L/min/m2

24
Q

Stroke Volume

A
  • (Cardiac Output/Heart Rate) x 1000
  • Amount of blood ejected from each ventricle with each cardiac cycle
  • Normal 60-100 mL/beat
25
Q

Preload

A

is based on volume of blood available at the end of diastole and muscle stretch

26
Q

Contractility:

A

force of which muscles contrast

27
Q

Afterload:

A

arterial pressure in which heart will contrast against

Medications such as excite Anatrops agents (Atropine and Dopine ) : medications that increase contractility there fore increase cardiac output . Positive effects
Chronotropic agents (ex BBB) : may change HR and Heart Rhythms by effectine electrolyte conduction system. BBB have negative chronotropic effect Negative effect

28
Q

Types of Nonischemic Cardiomypathy

A

Dilated :
* Restrictive
* Hypertrophic
* Stress

29
Q

Dilated Cardiomyopathy ( DCM)
what is it?

A
  • **Most Common Type **
  • Enlargement of all Cardiac Chambers
  • Systolic Dysfunction
30
Q

*

DCM:
Causes ?

A
  • H**ereditary (30%) , **
    * Idiopathic ( don’t know why):
    1. Infectious (HIV ) ,
    1. Endocrine (DM, thyroid, lupus) ,
    1. Infiltrative,
    2. Inflammatory (lupus)
  • **Heriditary: 30% cause hereditary; **
  • Autosomal dominant occasionally
  • Autosomal recessive
  • Autosomal (no sex chromosomes); Dominant means single copy of disease associated with mutation enough to couse
  • Recessive disease ( 2 copies needed to cause a disease )
31
Q

DCM Hallmark Signs

A
  • **Hallmark signs LV thickenss **
  • LV dilation, thinning & global dysfunction
  • See on ECHO
  • RV dysfunction:

**Prognosis
50% mortality at 5 years
**

32
Q

Dilated Cardiomyopathy
Diagnositic Findings

A

EKG/ECG
* Sinus tachycardia
* LBBB
* Atrial arrythmias
Echocardiogram
* LV dysfunction & dilation
Chest X-ray
* Cardiomegaly
* Pleural effusions R>L Gravity
Cardiac MRI
* Identify inflammatory or infiltrative diseases

33
Q

Dilated Cardiomyopathy
Signs and Symptoms

A

Biventricular heart failure findings
Rales, JVP, S3, ascites, peripheral edema
Cheyne-Stokes respirations: This refers to a pattern of breathing characterized by alternating periods of deep, rapid breathing followed by periods of shallow breathing or even temporary cessation of breathing (apnea).
Pulsus alternans: regular alternation of strong and weak beats despite a regular rhythm. It can be felt during a pulse examination where the amplitude of the pulse alternates noticeably between beats.
Pallor
Cyanosis

34
Q

Restrictive CardiomyopathyOverview

Dyastolic

A
  • Relatively uncommon
    *** Most frequent cause is Amyloidosis **(infiltrative disease of deposition of amyloid proteins deposit in tissues and organs like heart, lungs, liver, NS, Kidney)
  • Other causes
  • **Storage within myocytes **( hemochromatosis where iron store within myocytes; or fibrotic issues like post radiation or Scleroderma )
    Fibrotic changes like post radiation or Scleroderma ) Tissues become stiff leading to diastolic function
  • Diastolic dysfunction develop RT side symproms
    Must distinguish between pericarditis
    **In pericarditis during respiration interaction b/w ventricles is more noticeable;
    In Restrictive Cardiomyopathy this interaction is absent
    **Absence of ventricular interaction during respiration
    **
35
Q

REstricted Cardiomyopathy
Dx Findings

A

* EKG/ECG
Low voltage
Echocardiogram
* LVH thick
* Bright myocardium “speckled” appearance
* Bi-atrial enlargement
**Cardiac MRI with contrast **
* Diffuse hyperenhancement
Bone Scan
* Deposits in the myocardium

36
Q

Restricted Cardiomyopathy
S/S

A

Right sided symptoms
* * * * Edema, abdominal discomfort, ascites, elevated JVP

Pulmonary hypertension
Mild/Moderate cardiomegaly
Angina
Syncope
Peripheral neuropathy

Amyloid findings
* * * * Periorbital purpura, thickened tongue and hepatomegaly

37
Q

Hypertrophic Cardiomyopathy
Overview . Causes

A
  • I**nherited autosomal dominant trait
  • Elderly individuals**
  • Risk for young Athlets sudden death
  • Hypertension

Left ventricular hypertrophy (LVH)
* No pressure or volume overload
* Nonuniformed
**Left ventricle >1.5 cm thick : dx when on EHO **
Left ventricle outflow obstruction (compromise flow and increase after flow . If untreated LV become dysfunctional

38
Q

Hypertrophic CardiomyopathyDiagnostic Findings

A

EKG/ECG
* LVH, atrial fibrillation, ventricular arrythmias
Echocardiogram
LVH, enlarged atria, elevated EF (hyperdynamic)
**Cardiac MRI (out pt ) **
* Confirm hypertrophy
Myocardial perfusion imaging (Lexi scan)
* Septal wall ischemia
Cardiac catheterization
Supports diagnosis & +/- CAD

39
Q

Hypertrophic Cardiomyopathy
S/s

A
  • Dyspnea
  • Chest pain
  • Syncope
  • Coronary arterial bridging
  • S4
    Dyspnea and chest pain most common
40
Q

Stress CardiomyopathyOverviewAKA Broken Heart Syndrome

A
  • Takotsubo or “broken heart” syndrome
  • Caused by a high catecholamine surge
    2/3 report stressful event either physical

Left ventricle acutely suggest a rounded ampulla
Resembles the takotsubo pot the Japanese use for octopus

  • Key feature
    *
    Myocardial stunning not following coronary artery ischemia (Myocardial stunning refers to the temporary loss of contractile function in the heart muscle (myocardium) that persists after the restoration of normal blood flow (reperfusion) to the heart. It
  • Predominantly affects women, primarily postmenopausal
  • Higher rates of neurologic & psychiatric disorders
41
Q

Stress Cardiomyopathy
DX and Clinical Findings

A

EKG/ECG
ST elevation & anterior T-wave inversion

Echocardiogram
LV apical dyskinesia

Signs & Symptoms
Typical of ACS

42
Q

Cardiomyopathy
Diagnostic Testing

A
  • Non-invasive imaging & laboratory
    CXR, EKG, CBC, CMP, TSH, BNP, UA

Echocardiogram
* Reduced EF proceed to 3
*
Stress test
Lexiscan, dobutamine stress echo, treadmill
Normal, proceed to 5
**Abnormal, proceed to 4

Left & right heart catheterization
Cardiac MRI
Abnormal, proceed to 6
Myocardial biopsy
**Transesophageal echocardiogram (to r/o endocarditis or cardioversion ) **
IE, valvular abnormality, cardiovert

43
Q
A

NU734 Acute Care I (18 decks)

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