S2: Ch1 Cv 2-1

Front 1

295. Where is the site of the block usually w/Mobitz II?

Back 1

a. His-Purkinje system.

Front 2

296. Tx of Mobitz II?

Back 2

a. Pacemaker implantation is necessary.

Front 3

297. Third-degree (Complete) AV block?

Back 3

a. Absence of conduction of atrial impulses to the ventricle; no correspondence between P waves and QRS complexes.

Front 4

298. What types of heart block require pacemaker?

Back 4

a. Mobitz type II and 3rd-degree.
b. A ventricular pacemaker (escape rhythm) maintains a ventricular rate of 25-40 bpm.

Front 5

299. General characteristics of Dilated cardiomyopathy?

Back 5

a. Most common type of cardiomyopathy.
b. An insult (e.g., ischaemia, infarction, alcohol, and so on) causes dysfunction of left ventricular contractility.
c. Poor prognosis- many die w/in 5 yrs of the onset of sx.

Front 6

300. Causes of dilated cardiomyopathy?

Back 6

a. CAD
b. Other causes include:
1. Toxic: alcohol, doxorubicin, Adriamycin
2. Metabolic: thiamine or selenium deficiency, hypophosphatemia, uraemia.
3. Infectious: Viral, Chagas’ disease, Lyme disease, HIV.
4. Thyroid: hyper/hypo
5. Peripartum cardiomyopathy
6. Collagen vascular disease: SLE, Scleroderma
7. Prolonged, uncontrolled tachycardia
8. Catecholamine-induced: pheochromocytoma, cocaine
9. Familial/genetic
10. Idiopathic

Front 7

301. Clinical features of dilated cardiomyopathy?

Back 7

a. Sx and signs of left and right-sided CHF develop.
b. S3,S4, and murmurs of mitral or tricuspid insufficiency may be present.

Front 8

302. Diagnosis of Dilated cardiomyopathy?

Back 8

a. ECG, CXR, and echocardiogram results consistent w/CHF.

Front 9

303. Tx of dilated cardiomyopathy?

Back 9

a. Similar to tx of CHF: digoxin, diuretics, vasodilators, and cardiac transplantation.
b. Remove the offending agent if possible.
c. Anticoagulation should be considered bc pts are at increased risk of embolization.

Front 10

304. General characteristics of hypertrophic cardiomyopathy?

Back 10

a. Most cases are inherited as an autosomal dominant trait.

Front 11

305. Pathophys of Hypertrophic cardiomyopathy?

Back 11

a. The main problem is diastolic dysfunction due to a stiff, hypertrophied ventricle w/elevated diastolic filling pressures.
b. These pressures increase further w/factors that increase due to a stiff, hypertrophied ventricle (e.g., the Valsalva maneuver).
c. Pts may also have a dynamic outflow obstruction due to asymmetric hypertrophy of the IV septum.

Front 12

306. Symptoms Hypertrophic Cardiomyopathy?

Back 12

a. Dyspnea on exertion
b. Chest pain (angina)
c. Syncope (or dizziness) after exertion or the Valsalva maneuver
d. Palpitations
e. Arrhythmias (AFib, ventricular arrhythmias)-due to persistently elevated atrial pressures.
f. Cardiac failure due to increased diastolic stiffness
g. Sudden death-sometimes in a young basketball player; may be the first manifestation of disease.

Front 13

307. Signs of Hypertrophic Cardiomyopathy on physical exam?

Back 13

a. Sustained PMI
b. Loud S4
c. Systolic ejection murmur
i. Decreases w/squatting, laying own, or straight leg raise (due to increased LV filling)
ii. Intensity increases w/Valsalva and standing (decreases LV size and thus decreases left ventricular filling.
iii. Decreases w/sustained handgrip (increased systemic resistance leads to decreased gradient across aortic valve.
iv. Best heard at left lower sternal border.

Front 14

308. Pulse w/Hypertrophic cardiomyopathy?

Back 14

a. Rapidly increasing carotid pulse w/2 upstrokes (bisferious pulse).

Front 15

309. Diagnosis of hypertrophic cardiomyopathy?

Back 15

a. Echo establishes dx.
b. Clinical diagnosis and family hx.

Front 16

310. Tx of Hypertrophic cardiomyopathy in asymptomatic pts?

Back 16

a. Generally do not need tx, but this is controversial.
b. All pts should avoid strenuous exercise.

Front 17

311. What should be the initial DOC in Tx of Hypertrophic cardiomyopathy in symptomatic pts?

Back 17

a. β-blockers
b. They reduce sx by improving diastolic filling (as HR decreases, duration of diastole incrases), and also reduce myocardial contractility and thus oxygen consumption.

Front 18

312. Tx of Hypertrophic cardiomyopathy in symptomatic pts?

Back 18

a. β-blockers.
b. Calcium channel blockers (Verapamil)
c. Diuretics-used if fluid retention occurs.
d. If AFib is present, treat accordingly.
e. Surgery
f. Pacemaker implantation has had variable results.

Front 19

313. When should Calcium channel blockers be used in Hypertrophic cardiomyopathy in symptomatic pts?

Back 19

a. If pt is not responding to β-blockers.
b. Reduce sx by similar mechanism as β-blockers.

Front 20

314. Surgery for Tx of Hypertrophic cardiomyopathy in symptomatic pts?

Back 20

a. Myomectomy has a high success rate for relieving symptoms. It involves the excision of part of the myocardial septum. It is reserved for pts w/severe disease.
b. Mitral valve replacement may improve symptoms.

Front 21

315. General characteristics of Restrictive Cardiomyopathy?

Back 21

a. Infiltration of myocardium results in impaired diastolic ventricular filling due to decreased ventricular compliance.
b. Systolic dysfunction is variable and usually occurs in advanced disease.

Front 22

316. Causes of Restrictive Cardiomyopathy?

Back 22

a. Amyloidosis
b. Sarcoidosis
c. Hemochromatosis
d. Scleroderma
e. Carcinoid syndrome
f. Idiopathic

Front 23

317. Clinical features of Restrictive Cardiomyopathy?

Back 23

a. Elevated filling pressures causes dyspnea and exercise intolerance.
b. Right-sided signs and symptoms are present for the same reason.

Front 24

318. Diagnosis of Restrictive Cardiomyopathy?

Back 24

a. Echo: Thickened myocardium and possible systolic ventricular dysfunction.
b. Increased Right and Left Atrium size w/normal LV an RV.
c. In amyloidosis, myocardium appears brighter or may have a sparkled appearance.
d. ECG
e. Endomyocardial biopsy may be diagnostic.

Front 25

319. Restrictive Cardiomyopathy on ECG?

Back 25

a. Low voltages or conduction abnormalities, arrhythmias, AFfib.