PPP Cardio Flashcards
Pathophysiology of dilated cardiomyopathy?
2 Things
1) Impaired systolic function - impaired contraction and decreased LVEF <40%
2) Cardiac chamber dilation leading to progressive enlargement of 1 or both ventricles. Ventricular dilation results in decreased contractility, tricuspid, and mitral valve insufficiency, and decreased ejection fraction leads to systolic dysfunction
Epidemiology of dilated cardiomyopathy? What age range? What gender does it most affect?
90% of all cardiomyopathies, 20-60 yo, males
Etiology of dilated cardiomyopathy:
1) Most common cause?
2) Most common cause of infectious myocarditis?
3) When does it occur during pregnancy?
1) Idiopathic 50%
2) Viral most common (Coxsackievirus B and echovirus, Chagas disease, and more viruses)
3) Late pregnancy and early postpartum period
Etiology of dilated cardiomyopathy:
1) What toxic substances can cause?
2) Metabolic causes?
3) Medication causes?
1) Chronic alcohol abuse, cocaine, radiation
2) Thyroid disorders, Vitamin B1 (Thiamine) deficiency
3) Anthracyclines (doxorubicin), trastuzumab
Left sided heart failure clinical manifestations? Pulmonary or Systemic?
Dyspnea on exertion, fatigue, impaired exercise capacity. Orthopnea, paroxysmal nocturnal dyspnea. Pulmonary
Right sided heart failure symptoms? Pulmonary or Systemic?
Peripheral Edema, JVD, hepatomegaly, GI. Systemic
PE of dilated cardiomyopathy?
S3 gallop hallmark and represents rapid filling of a dilated ventricle.
Lateral displacement of PMI due to cardio enlargement
Mitral/Tricuspid regurgitation
Left sided failure crackles (rales) due to pulmonary edema
Right sided failure peripheral edema, JVD, positive hepatojugular reflux with inspiration, ascites
Medical treatment for dilated cardiomyopathy?
ACEI, BB, Mineralocorticoids (spironolactone/eplerenone), ARBs, diuretics, anticoagulation in pt with artificial valves, afib, and known mural thrombus
Medications to avoid for dilated cardiomyopathy?
NSAIDs -> can exacerbated HF
CCB -> no mortality benefit of nondihydropyridine
Antiarrhythmic agents
Gold standard for myocarditis?
endomyocardial biopsy
Pathophysiology of restrictive cardiomyopathy?
Diastolic dysfunction in a non-dilated, rigid right ventricle which impedes ventricular filling
Three leading causes of restrictive cardiomyopathy are?
Amyloidosis, Sarcoidosis, hemochromatosis
What lvls of BNP are suggestive of restrictive cardiomyopathy?
400 pg/mL or greater
In endomyocardial biopsy what is observed with amyloidosis and sarcoidosis?
Amyloidosis - apple-green birefringence with congo red stain under polarized light microscopy
Sarcoidosis - noncaseating granulomas
Treatment for Restrictive cardiomyopathy?
No specifics. Treat underlying cause
EX) glucocorticoids for sarcoidosis or therapeutic phlebotomy for hemochromatosis
Is hypertrophic cardiomyopathy autosomal or x-linked? dominant or recessive? What chromosome does it occur on?
Autosomal dominant on chromosome 14
What would you hear on PE with a patient with HOCM?
S4 and pulsus bisferiens
Best medications for HOCM?
Negative inotrophics such as BB, Nondihydropyridine CCB (Verapamil) and disopyramide
What is contraindicated for HOCM?
Exertion, strenuous exercise, Digoxin
Also avoid nitrates, diuretics, ACEi/ARBs (vasodilation exacerbates obstruction)
What diagnostic tools used to help evaluate atrial flutter?
ECG and TTE
What is CHA2DS2-VASc and the scoring?
CHF
Hypertension
A2 - Age >75
Dm
S2 - stroke/tia/thromboembolism
Vascular disease
A - age 65-74
Sc - sex category (female is +1)
Scoring
0 (Male) or 1 (Female) are low risk, no anticoagulant therapy
1 (Male) is moderate risk, oral anticoag should be considered
2 or greater is high risk, oral anticoag is recommended
What are the anticoagulant agents and their examples?
1) Non-vitamin K antagonist oral anticoagulants
a) Dabigatran - direct thrombin inhibitor
b) Factor Xa inhibitors - Rivaroxaban, Apixaban, Edoxaban
2) Warfarin
3) Dual antiplatelet therapy - Aspirin + Clopidogrel
Management for stable narrow vs stable wide vs unstable PSVT?
Stable narrow - Vagal maneuvers + IV Adenosine if vagal does not work
Stable wide - IV Nondihydropyridine or IV BB or Digoxin
Unstable - Synchronized Cardioversion
Definitive is catheter ablation
Differentiate between WAP and MAT
WAP - <100 BPM, >3 p wave morphology
MAT - >100 BPM, > 3 p wave morphology, usually with severe COPD
Management for MAT?
Treat underlying cause
Nondihydropyridine CCB, avoid BB if pulmonary diseases. Magnesium and Potassium repletion if deficient
WPW treatment? What to avoid?
IV Procainamide preferred, definitive is ablation
Avoid nodal blocking agents (BB/CCB/Digoxin) due to possible conduction down aberrant tract instead
Describe a Still murmur.
Most common innocent (physiologic) murmur. Musical, vibratory, noisy, twanging, low-pitched early to mid systolic ejection murmur that is best heard in the inferior aspect of left lower sternal border and apex.
Most common cause of right sided HF?
Left sided HF, pulmonary disease (COPD, pulmonary htn), and mitral stenosis
Most common cause of left sided HF?
CAD, htn (inc afterload), valvular disease, cardiomyopathies
