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Cardiology Week 5 > Pathophysiology of Heart Failure > Flashcards

Pathophysiology of Heart Failure Flashcards

1
Q

name the three major types of cardiomyopathy

A

dilated
hypertrophic
infiltrative/restrictive

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2
Q

4 common myocardial insult causes of dilated cardiomyopathy

A

late stage viral myocarditis
ethanol toxicity
toxic injury from cobalt or chemotherapeutics
post pregnancy

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3
Q

what causes 20-50% of dilated heart failure?

A

genetic linkages…mainly autosomal dominant

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4
Q

what type of proteins do genetic abnormalities causes dilated heart failure usually make?

A

cytoskeletal proteins connecting to contraction bands

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5
Q

in dilated cardiomyopathy, how is the heart sized?

A

still really big…like 800 grams

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6
Q

what type of hypertrophy occurs in dilated cardiomyopathy? in series or parallel?

A

eccentric hypertrophy…in series

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7
Q

what type of hypertrophy in pathological hypertrophy cardiomyopathy? in series or parallel?

A

concentric in parallel

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8
Q

what occurs between the myofibrils in dilated cardiomyopathy?

A

a lot of fibrosis

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9
Q

what viruses often cause myocarditis that leads to DCM? and what will you see histologically?

A

parvovirus b19
echovirus
HIV
Coxackievirus B

infiltration of lymphocytes in the myocardium

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10
Q

name a common drug that can lead to DCM?

A

doxorubicin

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11
Q

what is seen on EKG for DCM?

A

LVH signs…high R and S waves in V leads

T wave inversions and ST depressions

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12
Q

what two things must you do to diagnose DCM?

A

echocardiogram and see ejection fraction less than 40%

no significant CAD via stress test or cardiac cath

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13
Q

name three rare reversible causes of DCM?

A

tachycardia, alcohol use, and hyperthyroidism

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14
Q

how do we rule out hyperthyroidism as a cause of DCM?

A

check TSH levels

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15
Q

due to the poor blood flow in the heart, what is possible in DCM?

A

thrombosis…prophylactic treatment not indicated though

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16
Q

what genes products are usually affected in hypertrophic cardiomyopathy?

A

beta myosin heavy chains about 1/3 of cases

then tropomyosin and troponins..

pretty much any type of sarcomeric contractile protein

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17
Q

in hypertrophic cardiomyopathy, where is the hypertrophy most pronounced?

A

the LV and the IVS

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18
Q

due to LV hypertrophy, what else can enlarge in hypertrophic cardiomyopathy?

A

increased pressure in LA causes it to hypetrophy secondary to LV hypertrophy

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19
Q

explain the issue that arises with flow in hypertrophic cardiomyopathy..what is the name of this problem?

A

due to the narrowing of the aorta outflow tract, the velocity of flow causes a vacuum that sucks the anterior leaflet of the mitral valve over to the septal wall and it leads to mitral regurgitation…

this is called systolic anterior motion of the mitral valve (SAM)

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20
Q

what induces the SAM effect?

A

anything that leads to less blood volume

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21
Q

what are the changes in contractility and preload in HCM?

A

contractility stays the same, but preload drops because of the stiffness of the LV

22
Q

what does the diastolic dysfunction in HCM lead to in the lungs and how?

A

high pressure in LV backs up into LA and into pulmonary tract causing pulmonary edema

23
Q

what are the four most common symptoms of HCM?

A

dyspnea
angina
palpitations
sudden cardiac death

24
Q

why angina in HCM?

A

so much more tissue, so little vasculature so get some ischemic conditions

25
Q

how large must wall be to be HCM? and what other things to do for diagnosis of HCM?

A

more than 15 mm
genetic testing can be done
exclude other things like hypertension cause

26
Q

what is the cause of SuddenCardiacDeath from HCM?

A

an arrhythmia that is caused by the myofibrillar disarray and fibrosis

27
Q

what should we give to those at risk of SCD?

A

ICD

28
Q

what four things give high risk for SCD from HCM?

A

wall thickness over 30 mm
history of syncope
family history of SCD
previous V tach

29
Q

name three auscultation findings with HCM?

A

S4 from atrial contraction against stiff ventricle
holosystolic murmur of mitral regurg from SAM
crescendo-decrescendo murmur from turbulent out flow in aorta

30
Q

will you hear an S4 if someone is in a fib?

A

oh NO!

31
Q

if you hear a crescendo decrescendo systolic murmur…what two things are on the differential?

A

aortic stenosis and HCM

32
Q

what two maneuvers can you do to help determine if aortic stenosis versus HCM and why do these work with the murmur?

A

valsalva-decreased preload to the LV which means the HCM murmur will be louder, but aortic stenosis will not change

squat to stand- also decreases the preload and has same effect on the two murmurs

33
Q

describe the two surgical procedures for HCM

A

myectomy…cut out some of the increased size septum

alcohol septal ablation..inject alcohol to kill tissue…problem is this can lead to blocks since automaticity cells close bye

34
Q

name five infiltrative cariomyopathy causes

A 
cardiac amyloidosis
endocardial fibroelastosis
hemochromatosis
sarcoidosis
radiation injury
35
Q

where does amyloid accumulate in cardiac amyloidosis

A

interstitially…leads to myocyte atrophy

36
Q

what is the staining for amyloid?

A

congo red stain

37
Q

what color will myocardium be grossly with amyloidosis?

A

gray/pink

38
Q

what causes hemochromatosis heart failure?

A

excessive deposits of iron in the heart lead to myocyte hemosiderin and interstitial fibrosis

39
Q

what color is gross myocardium in hemochromatosis?

A

a darker brown muscle color

40
Q

what stain can you do for hemochromatosis? what color is the iron?

A

an iron stain…iron appears blue

41
Q

sarcoidosis HF is caused by formation of what in the myocardium?

A

granulomas

42
Q

what is endocardial fibroelastosis and what age does it affect?

A

less than 2 years old…

have abundance of fibroelastic tissue in the endocardium of usually the LV…can cause HF

43
Q

grossly, where do you see endocardial fibroelastosis and what color is it?

A

on the interior surface of the heart…will be whitish color from the fibrosis

44
Q

what is unique grossly about amyloidosis compared to other forms of HF?

A

the RV is involved more…almost even with LV changes…whereas in others it is mainly the LV

45
Q

EKG findings for amyloidosis

A

extremely low voltage throughout due to amount of proteins that inhibit electrical system to reach the leads

46
Q

what is the treatment for cardiac amyloidosis?

A

really not much…maybe a transplant

47
Q

how do we image cardiac sarcoidosis?

A

biopsy or nuclear/MRI imaging

48
Q

treatment for cardiac sarcoidosis?

A

glucocorticoids and standard heart failure meds

pacemaker and transplant if bad enough

49
Q

define arrhythmogenic RV cardiomyopathy

A

RV hypertrophy due to fatty infiltration in the RV

50
Q

what does arrhythmogenic RV cardiomyopathy often lead to?

A

ventricular arrhythmias, SCD and right heart failure

51
Q

what usuallt causes arrhythmogenic RV cardiomyopathy

A

genetic mutation for desmosome proteins

52
Q

what can you give treatment wise for arrhythmogenic RV cardiomyopathy

A

ICD for arrhythmias and tell them not to play sports

Cardiology Week 5 (10 decks)

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