Cardiomyopathies And Hf

Front 1

Young patient with harsh mid-systolic murmur at base of heart. What is the dx, risks and possible treatment?

Back 1

HCM
mostl likely for sudden death are young and familial
Only treatment is cardiac transplant
Beta bockers and verapamil can be used for symptom control.
Valsalva & standing increase
Handgrip decreases

Front 2

Describe the murmur of HCM.

Back 2

Harsh mid systolic murmur at base,
Increases with Valsalva and decreases with handgrip
Bifid upstroke of pulse
double or triple tap PMI

Front 3

Why are nitrates and diuretics dangerous in HCM?

Back 3

Decreaces LV volume which increases gradient

Front 4

What are the 3 major causes of restrictive cardiomyopathy?

Back 4

Amyloidosis
Hemochromotosis
Lipid Storage Disease

Front 5

How can restrictive cardiomyopathy vs constrictive pericarditis vs tamponade be differentiated?

Back 5

CT may show thinckened myocardium with granularity. Pericarium > 5mm thick means constrictive pericarditis
2 hallmarks of constrictive pericarditis are:
Kussamal sign = JVP distension with inspiration
Large x and y descents
Tamponade
Hypotentsion
Pulses paradox
JVP all the time

Front 6

What are the most common causes of dilated cardiomyopathy?

Back 6

Alcohol
Cocaine
Amphetamine
Glue sniffers (Organic solvents)
Chemo
Peripartum
Late hemochromatosis
Defeciencies of Selnium and Carnitine

Front 7

What is the treatment for dilated cardiomyopathy?

Back 7

Most important is Coumadin to prevent mural thrombi
Stop exposure to caustive agent if possible
Diuretics, ACE inhibtiors, Beta blockers

Front 8

What are the causes of pericarditis?

Back 8

Usually idiopathic
open heart surgery
radiotherapy
coccidiomycosis
TB

Front 9

What sound occurs just before S2 in constrictiver pericarditis?

Back 9

Loud pre-systolic knock caused by rapid diastolic filling

Front 10

List the physical exam hallmarks of tamponade

Back 10

Soft, distant heart sounds
Hypotension
Pulses Paradox
JVP distension

Front 11

What are some causes of pericarditis/tamponade?

Back 11

Free wall rupture in trauma, post-MI develops quickly
trauma, post surgical, idiopathic, viral, neoplastic, hypothyroid, renal failure, TB

Front 12

Pt with sig medical hx presents with pericardial effusion. Pericardiocentis is diagnositic what do they have?

Back 12

Cancer

Front 13

List the NYHA clasifications of Heart Failure?

Back 13

I Cardiax sz no limitations in physical activity
II Slight physical activity limitations comfortable at rest
III Marked limitations of activity, still comfortable at rest
IV Sx present at rest

Front 14

What are the 4 major causes of low-output HF? %?

Back 14

CAD 40%
Dilated cardiomyopathy 30%
Valvular HD 15%
Hypertension 10%

Front 15

What are the major causes of death in pts with HF?

Back 15

Actual HF 50%
Arrhythmias 40%

Front 16

List poor prognositic signs in HF?

Back 16

Low sodium
high BUN
Low K
+/- Magnesium
High catecholamine levels
Exercise tolerance not closely associated with prognosis
High BNP or less ANP

Front 17

Describe the results of decreased CO on the kidneys?

Back 17

Decreased CO → ↓renal perfusion → renin release↑ → agngiotensin → angiotensin I → angiotensin II (lungs) → ↑aldosterone → ↑Na retention

Front 18

What is the effective of BNP & ANP?

Back 18

↑ excretion of Na & water
causes vasodilation
inhibits aldosterone

Front 19

What percentage of HF is caused by dyastolic dysfuntion? How would you recognize

Back 19

30%
LVEDP of >20 mmhg is considered diastolic heart failure

Front 20

Describe actions of ACE inhibiors in HF

Back 20

http://www.cvpharmacology.com/vasodilator/ACE.htm
Are vasodilators by blocking formation of Angiotensin II → ↑renin
decrease arrhythmias

Front 21

What is a serious side effect of ACE inhibitors?

Back 21

Renal compromise in bilateral renal steonosis.
Patients with bilateral renal artery stenosis may experience renal failure if ACE inhibitors are administered. The reason is that the elevated circulating and intrarenal angiotensin II in this condition constricts the efferent arteriole more than the afferent arteriole within the kidney, which helps to maintain glomerular capillary pressure and filtration. Removing this constriction by blocking circulating and intrarenal angiotensin II formation can cause an abrupt fall in glomerular filtration rate. This is not generally a problem with unilateral renal artery stenosis because the unaffected kidney can usually maintain sufficient filtration after ACE inhibition; however, with bilateral renal artery stenosis it is especially important to ensure that renal function is not compromised.

Front 22

When should digoxin be used in HF?

Back 22

Very little inotropic effect
EF< 40% despite ACE, Beta blockes & diuretics
Resets barorecepors, dampens renin-angiotensin system

Front 23

Pt with Class IV HF on ACE, Beta blocker, digoxin. Now with infection and worsening HF what other agents could be used?

Back 23

Dopamine < 2ug/kg/min
Dobutamine does not have vasoconstrictor effect that doamine has
Amirone- thrombocytopenia
Milirone - cAMP
Nesiritide - BNP
Hydralazine + nitrates

Front 24

What does dompamine do at low does (< 2ug//kg/ min)?

Back 24

Dosages from 2 to 5 μg/kg/min are considered the "renal dose."[citation needed] At this low dosage, dopamine binds D1 receptors, dilating blood vessels, increasing blood flow to renal, mesenteric, and coronary arteries; and increasing overall renal perfusion.[39] Dopamine therefore has a diuretic effect, potentially increasing urine output from 5 ml/kg/hr to 10 ml/kg/hr

Front 25

What does dompamine do at does (2-5ug//kg/ min)?

Back 25

Intermediate dosages from 5 to 10 μg/kg/min additionally have a positive inotropic and chronotropic effect through increased β1 receptor activation. It is used in patients with shock or heart failure to increase cardiac output and blood pressure.[39] Dopamine begins to affect the heart at the lower doses, from about 3 mcg/kg/min IV.

Front 26

What does dompamine do at does (>10ug/kg/ min)?

Back 26

mainly an alph-agonist effect & causes vasoconstriction

Front 27

What is a major side effect of amrinone? What could be used instead?

Back 27

Thrombocytopenia (2.4%)
Milrinone (inotropic//vasodilator) though the cAMP inhibition

Front 28

What is Nesiride? What are its effects?

Back 28

Natrecor increases BNP
- improved clinical status
- decreased PCWP
- decreased PAP
- increased stroke volume
- NO increase in HR

Front 29

What does Hydralazine do?

Back 29

Arterial vasoldilator reduces after load frequently used with nitrates to reduce preload also

Front 30

In what clinical conditions is High output HF seen?

Back 30

large AV shunts
severe hepatic hemangionams
Paget disease
hyperthyroidism
beriberi
carcinoid
anemia

Front 31

List 4 types of medications that should be stopped in pts with HF?

Back 31

NSAIDS
Antiarrhtymics
Calcium channel blockers
Glitizone insulin sensitizing agents

Front 32

What are the most common causes of low output HF?

Back 32

CAD (40%)
Dilated cardiomyopathy (30%)
Valvular Heart Dz (15%)
HTN (10%)

Front 33

What is the treatment sequence in acute pulmonary edema

Back 33

Dangle Legs
Oxygen
Morphine
Lasix for venodilation
Consider digoxin (?)
IV nitro or nitroprusside (BP >100)
Dobutamine BP <90
Aminophyllline to improve respiratory muscle function