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46 Cards in this Set
- Front
- Back
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What is the definition of cardiomyopathy?
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Intrinsic or primary myocardial disease not secondary to congenital, hypertensive, coronary, valvular or pericardial disease.
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What are the functional classifications of cardiomyopathies?
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Hypertrophic, Dilated, Restrictive cardiomyopathy.
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Which type of heart failure will occur in a dilated cardiomyopathy?
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Systolic dysfunction, meaning that the EF will be decreased.
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What may be the causes of dilated cardiomyopathy?
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Idiopathic (50%)
Alcohol Familial Uncontrolled tachycardia Collagen vascular disease Infectious Neuromuscular disease Metabolic, uremia, nutritional deficiency Endocrine Peripartum Toxic Drugs Radiation induced |
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What are the signs and symptoms of dialted cardiomyopathy?
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Those of:
CHF. Systemic or pulmonary embolus. Arrhythmias. Sudden death. |
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Which laboratoty markers are increased in dilated cardiomopathies?
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BNP, due to CHF.
Cr due to renal hypoperfusion. LFTs due to liver congestion. Low bicarbs, due to tissue hypoperfusion and metabolic acidosis. Low Na due to dilutional hyponatremia? |
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How do we treat patients with dilated cardiomyopathy?
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First we try to treat or remove the underlying cause, and stress an absolute abstinence from alcohol.
Then we treat CHF. Anticoagulation for thromboembolic complications. Antiarrhythmic treatment. Immunization against influenzae and S. pneumoniae Consideration of surgical options. |
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What are the surgical options in dilated cardiomyopathy?
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Ventricular assist devices, transplant, volume reduction surgery, AICDs.
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What are usually the causes of death in dilated cardiomyopathy?
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Death from CHF or sudden cardiac death due to ventricular arrhythmias.
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Which is the infectious type of cardiomyopathy?
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Myocarditis.
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What can myocarditis lead to?
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Dilated cardiomyopathy.
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What is the etiology of myocarditis?
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Idiopathic
Infectious Viral: Coxsackie B, echovirus, poliovirus, mumps, HIV Bacterial: S. aureus, C. perfringens, C. diphteriae, Mycoplasma Funghi Spirochetal Chagas disease Toxic myocarditis can occur wiht catecholamines, chemotherapy and cocaine. Hypersensitivity myocarditis. Systemic diseases such as SLE etc... |
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What are the signs and symptoms of myocarditis?
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Constitutional symptoms such as fever, athralgia, malaise etc.
Acute CHF CHEST PAIN arrhythmias Systemic orpulmonary emboli Sudden death |
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What can be seen on ECG of a patient with myocarditis?
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Nonspecific ST-changes possibly condction defects.
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What are the abnormal blood tests in myocarditis?
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CK-MB elevation, TNI elevation, AST may be increased.
WBC incr. ESR incr. ANA may be present. RF. Complement levels. |
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What can be seen on Xray of a patient with myocarditis?
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Possibly incr. cardiothoracic index.
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What can be seen on echo in myocarditis?
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Dilated hypokinetic chambers.
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How is myocarditis managed?
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Bed rest! For months.
Treatment of CHF if present. Treatment of arrhythmias. Anticoagulate if arrhythmic. Treatment of underlying cause. |
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What is the usual prognosis of myocarditis?
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Most people recover from a self-limiting myocarditis.
Can result in sudden death in young adults. May progres to dilated cardiomyopathy. Few may have chronic myocarditis. |
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What is the definition of hypertrophic cardiomyopathy?
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Unexplained ventricular hypertrophy. (so not due to for example hypertension or aortic stenosis)
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Is the hypertrophy of the heart symmetrical?
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No usually hypertrophic cardiomyopathy is assymetrical.
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What is a probable cause of hypertrophic cardiomyopathy?
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A genetic defect involving one of the cardiac sarcomeric proteins.
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What is the prevalence of hypertrophic cardiomyopathy?
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1/1000
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What three patterns of hemodynamics can occur in hypertrophic cardiomyopathy?
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It can be obstructive (outflow tract), nonobstructive, or restrictive (inflow tract).
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What are the signs and symptoms of hypertrophic cardiomyopathy?
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Often asymptomatic.
Dyspnea on exertion, angina, presyncope/syncope, CHF, arrhythmias, SCD. |
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What is unique about the pulses in hypertrophic cardiomyopathy?
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Rapid upstroke, and bifid carotid pulse (in obstructive type)
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What can be typical on auscultation of a hypertrophic cardiomyopathic patient?
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Paradoxially split S2, S4, harsh systolic diamond-shaped murmur at LLSB or apex, enhached by squat to standing or Valsalva. Often with pansystolic murmur due to mitral regurgitation.
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Which medical factors can increase the obstruction?
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Volume depletion and strenous exertion.
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Which medical agents can be used in the treatment of hypertrophic cardiomyopathy?
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Beta-blockers.
Disopyramide. |
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What procedures can be undertaken in a patient refractory to drug treatment?
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Surgical myectomy.
Septal ethanol ablation. Dual chamber pacing. |
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What should be done with relatives to patients with hypertrophic cardiomyopathy?
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They should be screened every 5 years.
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What are the most important potential complications in hypertrophic cardiomyopathy?
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AF, VT, CHF, sudden cardiac death.
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What is the definition of restrictive cardiomyopathy?
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Impaired ventricular filling in a non-dilated, non-hypertrophied ventricle 2nd to myocardial abnormality.
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What are the myocardial abnormalities which lead to restrictive cardiomyopathies?
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Stiffening, fibrosis and or decreased compliance.
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Is the systolic dysfunction impaired in restrictive cardiomyopathy?
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Usually not.
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What are the etiologies of restrictive cardiomyopathies?
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Amyloidosis, sarcoidosis, scleroderma, idiopathic myocardial fibrosis, hemochromatosis, Fabry's disease, glyvogen storage diseases, endomyocardial causes, radiation heart disease, carcinoid syndomre.
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Which is the disease that RCM will mimic?
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CHF
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What will be the jugular venous pressure in a patient with RCM?
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Elevated, with prominent x and y descents.
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What can be heard on auscultation of a patient with RCM?
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S3, S4, Mitral regurgitation and tricuspid regurgitation.
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What can be seen on the ECG of a patient with RCM?
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low voltage, non-specific diffuse ST-changes and possibly nonischemic Q waves.
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What can be seen on chest xray in RCM?
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Mild cardiomegaly.
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What can be seen on echo in RCM?
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LVH, RVH, Left atrial enlargement and right atrial enlargement, valve thickening.
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For what do we do cardiac catheterization in RCM?
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To measure the elevated end-diastolic pressure.
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What must be exluded in RCM?
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Constrictive pericarditis.
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How do we treat RCM?
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First we treat the underlying disease.
Then we control HR, anticoagulate if in AF. Supportive care as for CHF. Heart transplant in end-stages. |
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What does the prognosis of RCM mainly depend on?
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On the etiology.
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