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57 Cards in this Set

  • Front
  • Back
Cardiomyopathy types
Dilated
----Ischemic and non ischemic
Hypertrophic
----HCM
Restrictive
Dilated Cardiomyopathy causes
Idiopathic 50% of cases
Viral
Hypertensive
Alcoholic
Chemotherapy agent related (adriamycin)
Others refer to chart in textbook
Clinical Manifestations of Dilated Cardiomyopathy?
CHF symptoms
-Dyspnea
-Orthopnea
-PND
Fatigue
Physical Examination of Dilated Cardiomyopathy?
Tachycardia
Decreased blood pressure
Neck vein distention
Diminished carotid upstroke
Displaced and enlarged PMI
Third heart sound
Systolic murmur
Possible right sided heave
Pulmonary rales
Diminished lung aeration
Ascites
Hepatomegaly
Peripheral edema
Anasarca
Cool, pale skin
Labs of Dilated Cardiomyopathy?
B-natriuretic peptide
-Usually elevated at baseline, increases further with decompensation (acute CHF)
-Levels greater than 500 usually with acute CHF
Hyponatremia
Pre-renal azotemia
-Ratio of BUN:Creat>20
Reduced bicarb
ECG of Dilated Cardiomyopathy?
Tachycardia
Bundle branch block, mostly LBBB
NS ST-T changes
LVH
PVC’s
CXR of Dilated Cardiomyopathy?
Cardiomegaly
Vascular cephalization
Interstitial, pulmonary edema
Pleural effusions
Echocardiogram of Dilated Cardiomyopathy?
Diagnostic
Dilated LV
Global or segmental hypokinesis
MR
Pulmonary HTN
Exam question: pleural effusion of CHF.
right sided or bilateral
pulmonary wedge pressure reflects LV filling pressure: above what pressure is "heart failure"?
18 mmHg
Dilated Cardiomyopathy Cardiac Cath and Hemodynamics
Elevated LVEDP and wedge pressure
Pulmonary HTN
LV systolic dysfunction, reduced EF
MR
Coronary arteries mostly normal in non ischemic CMO
Prototype of Hypertrophic Cardiomyopathy
Prototype is the Obstructive form
-Hypertrophic Obstructive Cardiomyopathy (HOCM)
-Old terminology: Idiopathic hypertrophic sub-aortic stenosis (IHSS)
causes of Hypertrophic Cardiomyopathy?
Genetic/familial
Autosomal dominant with mixed clinical manifestations
Half of cases cause is unknown
Clinical Manifestations of Hypertrophic Cardiomyopathy?
Asymptomatic
Dyspnea
Fatigue
Angina pectoris
Near syncope/syncope
Physical Findings of Hypertrophic Cardiomyopathy?
Fourth heart sound
Systolic murmur
-Increases with valsalva, decreases with squatting
MR murmur also possible
Bifid carotid pulse
Do you give digoxin to HOCM pt?
no

no positive inotropes
ECG of Hypertrophic Cardiomyopathy?
LVH
Prominent Q waves
Deep T wave inversions
CXR of Hypertrophic Cardiomyopathy?
Probably normal
Echocardiogram of Hypertrophic Cardiomyopathy?
Diagnostic
Asymmetric hypertrophy (ASH)
Systolic Anterior motion of the MV (SAM)
Normal systolic function to hypercontractile with LV chamber obliteration
MR secondary to SAM
Asymmetric hypertrophy (ASH)?
Septum to LV wall is 1.3 or greater
Hypertrophic Cardiomyopathy Cardiac Cath, Hemodynamics
Hypercontractile LV
MR
LV outflow tract gradient
Increased LVEDP and PWP
Secondary PH
Classic example of Restricitve Cardiomyopathy
Amyloidosis
etiology of Restricitve Cardiomyopathy
Amyloidosis is the classic example
Idiopathic
Sarcoidosis
Scleroderma
Hemochromatosis
Eosinophilic syndrome
Carcinoid
Endomyocardial fibrosis
Metastatic disease
Gaucher’s Hurler’s glycogen storage diseases
Clinical Manifestations of Restricitve Cardiomyopathy
Fatigue
Dyspnea
Weakness secondary to decreased BP
Physical Findings of Restricitve Cardiomyopathy
Right sided CHF (Edema, neck vein distention, ascites, anasarca)
No typical cardiac exam findings
Labs of Restricitve Cardiomyopathy
No specific lab abnormalities of restrictive CMO. BNP can elevated in any form of CHF
ECG of Restricitve Cardiomyopathy
No specific findings. Heart block possible in some infiltrative forms
Chest x ray of Restricitve Cardiomyopathy
CHF changes, mostly right sided type
Echocardiogram of Restricitve Cardiomyopathy
LVH
Granular sparkling changes in myocardium classic for amyloid
Restricitve Cardiomyopathy Cardiac Cath, Hemodynamics
Equalization of chamber pressures
-LVEDP,PWP,PA diastolic, RV diastolic, RA
“Dip and plateau” wave form finding, the so called square root sign
-Very similar findings also noted in constrictive pericarditis
Acute inflammation of the myocardium
Can be concomitant with endocarditis, pericarditis (pan carditis)
Myocarditis
Mechanisms of inflammation in myocarditis
Mechanisms of inflammation
Direct infectious agent invasion
Production of a myocardial toxin
Immune mediated myocardial inflammation
infectious causes of myocarditis
Viral most common in U.S. (adeno, coxsackie, influenza, CMV, echo, HIV
Other (Lymes, rickettsial, diptheria, fungal, trypanosoma [Chagas’]
Clinical Manifestations of myocarditis
Majority will be sub-clinical
Ultimately, “idiopathic CMO”
Mostly manifested by the general or non cardiac effects of the underlying illness
Symptoms can range up to severe CHF
Laboratory of myocarditis
Testing for specific agents (eg Lyme’s titres, HIV, viral assays)
Elevated sed rate (not specific)
No specific ECG, echo findings
Pericardial Diseases (4)
Acute pericarditis
Chronic pericarditis
Constrictive pericarditis
Effusive pericarditis
Causes of Acute Pericardial Diseases.
Idiopathic
Viral
---Coxsackie A and B, echo, influenza, EBV, varicella, HIV
---Other infectious: fungal, bacterial, Lyme’s, rickettsial
TB
MI (Dressler’s, post-pericardiotomy syn)
Uremia
Autoimmune (RA, SLE, MCTD, PAN, Wegener’s, Scleroderma)
Neoplastic (Lung, breast, leukemia, lymphoma, melanoma)
Myxedema
Trauma
Radiation
Prior surgery
Timing of Dressler's
6 weeks post MI
Clinical Manifestations
of Acute Pericardial Diseases.
Asymptomatic to tamponade
Classic viral type symptoms
-Fever
-Sharp chest pain, worse with lying and respiration, eased with sitting up
Physical Findings
Physical Findings of Acute Pericardial Diseases.
Neck vein distention with tamponade
Pericardial friction rub pathognomonic
-Three component rub
ECG: 4 stage evolution of acute pericardial disease


(TEST QUESTION)
I. Diffuse ST elevation (concave), upright T’s
II. Back to baseline, isoelectric
III. Isoelectric with T wave inversion
IV. Isoelectric with T wave upright
Echo of acute pericardial disease
Echocardiogram: possible pericardial effusion
Labs of acute pericardial disease
Elevated sed rate
If you hear a friction rub, what is diagnosis?
pericardial disease
Clinical hemodynamic effects
of tamponade
Decreased BP
Neck vein distention
Diminished heart sounds
Pulsus paradoxus
--Usually respiratory systolic pressure change of > 10
ECG, CXR, ECHO, Cath findings of tamponade
ECG: electrical alternans
CXR: cardiomegaly
Echo: large effusion, RA, RV, LA diastolic collapse
Cath: equalization of chamber pressures
Treatment of tamponade
Usually percutaneous pericardiocentesis
Chronic pericardial inflammation resulting in fibrotic constriction with possible calcification of the pericardium
Constrictive Pericarditis
Causes of Constrictive Pericarditis
Non specific chronic inflammatory such as viral
TB
Post surgical
Trauma
Radiation
Clinical Manifestations of Constrictive Pericarditis
Right sided CHF syptoms
Chest pain
Fatigue, weakness
Physical Findings of Constrictive Pericarditis
Neck vein distention
Kussmaul’s sign (paradoxical neck vein distention with inspiration)
Pericardial diastolic knock, secondary to diastolic cessation of cardiac filling
Diminished BP
during inspiration, neck veins are more distended (opposite of normal)
Kussmaul's sign
Chest X ray of Constrictive Pericarditis
possible pericardial calcification
CT scan of Constrictive Pericarditis
calcium or pericardial thickening
Cardiac Cath of Constrictive Pericarditis

TEST QUESTION
Equalization of pressures
Dip and plateau (square root sign)
Difficult to distinguish from restrictive CMO
Symptoms of chronic pericardial effusion
May be asymptomatic with no need for treatment
CHF type of symptoms possible
--Dyspnea, weakness, orthopnea, reduced BP
diagnostic tool for chronic pericardial effusion
Pericardiocentesis

For example, when new finding, to r/o metastatic disease
Usually effusion will come back