Cardio 2

Front 1

Whats the most common type of cardiomyopathy? What is pathogenesis?

Back 1

i)dilated cardiomyopathy ii)ischemia, infection, EtOH causes dysfcn of LV contractility

Front 2

What are some causes of dilate cardiomyopathy? x8

Back 2

i)CAD w/prior MI ii)toxic: EtOH, doxorubicin, adriamycin iii)metabolic: thiamine, uremia iv)infectious: viral, Chagas, lymes v)thyroid: hyper/hypothy vi)peripartum cardiomyopathy vii)Collagen Dz: SLE, sclero viii)catecholamine induced

Front 3

What are clinical features of dilated cardiomyopathy?

Back 3

i)signs and sxs of LHF and RHF ii)S3,S4 MR, TR

Front 4

How to DX? How to treat?

Back 4

i)DX: EKG, CXR and echo consistent w/CHF ii)Treat: digi, diuretics, vasodilator. Remove offending agent. Anticoagulate b/c high risk of embolus

Front 5

What is genetics of HOCM? What is pathophysiology?

Back 5

i)AD ii)Diastolic dysfcn due to stiff hypertrophied ventricle w/incr diastolic filling pressures; pressures increase w/HR and contractility (exercise) or decr LV filling (valsalva). iii)may have outflow tract obstruction b/c of asymmetry of IV septum

Front 6

What are clinical features of hocm: Sxs x3? Signs x4?

Back 6

i)dyspnea on exertion; dizzy after valsalva, arrhythmia (asystole, Ventricular arrhythmia) b/c constant elevated atrial pressure. ii)Signs: loud P4; systolic ejection murmur (incr w/standing); at left lower sternal border. Rapidly incr carotid pulse w/2 upstrokes.

Front 7

what are ways to increase LV filling and decr?

Back 7

i)incr: squat, lie down, straight leg raise, sustained hand grip (decr gradient acros aortic valve). ii)decr: valsalva and standing

Front 8

How to DX and treat HOCM?

Back 8

i)DX: echo; clinical dx and fam hx. ii)avoid strenuous exercise. If symptomatic: B block; then CCB; Surgery: myectomy of septum; mitral valve replacement possibly

Front 9

What is pathogenesis of restrictive cardiomyopathy

Back 9

i)infiltration of myocardium leading to impaired diastolic filling b/c of decr compliance. ii)systolic dysfcn usually in advanced dz

Front 10

What are causes of restrictive cardiomyopathy x6

Back 10

i)amyloidosis ii)sarcoidosis iii)hemochromatosis iv)scleroderma v)carcinoid syndrome

Front 11

what are clinical features of restrictive cardiomyopathy? How to DX?

Back 11

i)elevated filling pressures->dyspnea and exercise intolerance ii)rt sided signs and sxs present b/c of incr fill pressures. iii)DX: a)echo: thick myocard and possible systolic dysfcn; incr RA and LA size w/nl LV and RV size; amyloid: myocardium is brighter or has sparkled appearance. b)EKG: low volts or conduction abnl, arrhythmia, Afib. c)BX may be diagnostic

Front 12

How to treat restrictive cardiomyopathy?

Back 12

treat underlying cause. i)hemochroma: phlebotomy or deferoxamine ii)sarcoid: steroids iii)amyloid: none iv)Digitalis if systolic dysfcn is present. v)diuretics and dilators for pulm edema b/c decrease preload fucks up CO

Front 13

What is myocarditis? What are causes? what are clinical features? How to DX? How to treat?

Back 13

i)inflammed myocardium ii)virus (coxsack), bacteria (GAS, lyme), SLE, meds (sulfurs). iii)asympto or fatigue, fever, CP, pericarditis, CHF. iv)DX: elev cardiac enzymes; ESR. v)supportive

Front 14

What are causes of acute pericarditis? x7

Back 14

i)postviral/idiopathic ii)infectious: echo, coxsac, HIV, Hep A/B; TB; toxo. iii)Dressler's iv)radiation v)uremia vi)CVD vii)acute MI

Front 15

What is PX of acute pericarditis? What are complications? (x2)

Back 15

i)recover w/in1-3 weeks usually. ii)pericardial effusion; tamponade

Front 16

What are the manifestations of acute pericarditis? pain, ausculatation, EKG changes, other? x4

Back 16

i)CP: pleuritic (ass'd w/breathing); retrosternal and left precordial regions; positional: relieved by sitting up and leaning forward. ii)pericardial friction rub: scratching, high pitched sound w/3 parts (atrial systole, ventricular systole, early diastole) and heard best when sitting up iii)EKG changes: sequence is diffuse ST elevation and PR depression->ST segment back to normal-> T wave inverts ->T wave returns to normal. iv)pericardial effusion possible

Front 17

How to DX acute pericard?

Back 17

i)EKG; echo if effusion suspected, but usually normal

Front 18

How to treat pericarditis?

Back 18

i)self ltd, goes away in 2-6 weeks. ii)treat underlying cause iii)NSAIDs iv)steroids avoided if possible

Front 19

What is pathophysiology of constrictive pericarditis?

Back 19

i)get fibrotic scarring, so pericardium becomes rigid ii)get restricted diastolic filling at the end of ventricular filling but not beginning (diff from tamponade).

Front 20

what are causes of constrictive pericarditis?

Back 20

i)idio ii)uremia, rads, TB, chronic pericardial effusion, PX SX of pericardium

Front 21

What are clinical features of constrictive pericarditis?

Back 21

i)pts look ill ii)initial manifestations: due to systemic venous pressure elevation (edema, ascites, hepatic congestion). iii)later: Left sided manifestations (cough, SOB, orthopnea). iv)Signs: JVD, Kussmaul's: JVD doesn't decrease on inspiration; pericardial knock (abrupt stop of filling); ascites.

Front 22

How to DX constrictive pericarditis?

Back 22

i)EKG: low QRS volt, T wave flat, LA abnormal. ii)Echo: thickened pericardium, can't exclude DX (CT/MRI are better!). iii)cardiac cath: equal diastolic p in all chambers; Sq root sign on ventricular p

Front 23

How to treat constrictive pericarditis?

Back 23

i)resection

Front 24

What is echo good for and bad for?

Back 24

i)pericardial effusion and cardiac tamponade ii)bad for pericarditis

Front 25

What are causes of effusion?

Back 25

i)pericarditis causes leading to effusion ii)Na and H2O retention states: CHF, cirrhosis, nephrotic syndrome. Often asympto

Front 26

What are clinical features of pericardial effusion?

Back 26

i)muffled heart sounds ii)soft PMI iii)dull left lung base

Front 27

How to DX effusion?

Back 27

i)echo is imaging of choice: as little as 20 ml ii)CXR: enlarged cardiac silhouette(esp w/o pulm vascular congestion) w/water bottle appearance. iii)EKG: not DX; low QRS volt and T wave flat. Electrical alternans is serious iv)Can use CT/MRI, but better w/echo. v)pericardial fluid analysis: clarifies cause of effusion: protein/glucose, CBC, cytology, sp gravity, HCT, gram, Acid fast

Front 28

How to treat effusion?

Back 28

i)pericardiocentesis: only if tamponade. ii)if small, then repeat echo in 2 weeks

Front 29

What is imp in tamponade in terms of danger

Back 29

Rate of fluid accum, not amt. i)200 ml developing rapidly->tamponade ii)2 L slowly allows stretching.

Front 30

What is pathophysiology of tamponade?

Back 30

i)impairment of diastolic filling b/c of effusion. ii)elevation and equalization of intracardiac and intrapericardial pressures: RV, LV, RA, LA, pulm A, pericardium equalize during diastole. Get impaired ventricular filling during diastole

Front 31

What are main causes of tamponade?

Back 31

i)trauma to thorax ii)iatrogenic: central line, pacemaker, pericardiocentesis. iii)pericarditis iv)post mi and rupture

Front 32

What are clinical features of tamponade?

Back 32

i)incr JVP. Get prom x descent w/absent y descent. ii)narrowed pulse pressure (b/c decr SV) iii)pulsus parodoxus: exaggerated decr in arterial press during inspire (>10mmHg): strong pulse on inspire, weak on expire. iv)muffled heart sounds v)tachypnea, tachycardia, hypotension w/shock

Front 33

What is beck's triad for tamponade?

Back 33

i)JVD ii)muffled heart sound iii)hypotension

Front 34

How to DX tamponade?

Back 34

i)echo: best test ii)CXR: enlarged silhouette iii)EKG: electrical alternans (alternate beat variation in direction of EKG waveforms: b/c of pendular swinging of heart w/in pericardial space, causing motion artifact. Not good for DX iv)cardiac cath: equalization of pressures in all chambers. elevated RAP w/loss of y descent

Front 35

How to treat tamponade?

Back 35

i)nonhemorrhage tamponade: if stable, monitor w/echo, CXR, EKG. If RF also, dialysis more helpful than centesis. b)not stable: centesis, fluid challenge if that doesn't help. ii)hemorrhagic (trauma): need surgery for repair; centesis only is during wait for surgery. don't delay surgery