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57 Cards in this Set
- Front
- Back
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Cardiomyopathy types
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Dilated
----Ischemic and non ischemic Hypertrophic ----HCM Restrictive |
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Dilated Cardiomyopathy causes
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Idiopathic 50% of cases
Viral Hypertensive Alcoholic Chemotherapy agent related (adriamycin) Others refer to chart in textbook |
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Clinical Manifestations of Dilated Cardiomyopathy?
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CHF symptoms
-Dyspnea -Orthopnea -PND Fatigue |
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Physical Examination of Dilated Cardiomyopathy?
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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 |
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Labs of Dilated Cardiomyopathy?
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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 |
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ECG of Dilated Cardiomyopathy?
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Tachycardia
Bundle branch block, mostly LBBB NS ST-T changes LVH PVC’s |
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CXR of Dilated Cardiomyopathy?
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Cardiomegaly
Vascular cephalization Interstitial, pulmonary edema Pleural effusions |
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Echocardiogram of Dilated Cardiomyopathy?
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Diagnostic
Dilated LV Global or segmental hypokinesis MR Pulmonary HTN |
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Exam question: pleural effusion of CHF.
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right sided or bilateral
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pulmonary wedge pressure reflects LV filling pressure: above what pressure is "heart failure"?
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18 mmHg
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Dilated Cardiomyopathy Cardiac Cath and Hemodynamics
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Elevated LVEDP and wedge pressure
Pulmonary HTN LV systolic dysfunction, reduced EF MR Coronary arteries mostly normal in non ischemic CMO |
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Prototype of Hypertrophic Cardiomyopathy
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Prototype is the Obstructive form
-Hypertrophic Obstructive Cardiomyopathy (HOCM) -Old terminology: Idiopathic hypertrophic sub-aortic stenosis (IHSS) |
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causes of Hypertrophic Cardiomyopathy?
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Genetic/familial
Autosomal dominant with mixed clinical manifestations Half of cases cause is unknown |
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Clinical Manifestations of Hypertrophic Cardiomyopathy?
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Asymptomatic
Dyspnea Fatigue Angina pectoris Near syncope/syncope |
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Physical Findings of Hypertrophic Cardiomyopathy?
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Fourth heart sound
Systolic murmur -Increases with valsalva, decreases with squatting MR murmur also possible Bifid carotid pulse |
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Do you give digoxin to HOCM pt?
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no
no positive inotropes |
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ECG of Hypertrophic Cardiomyopathy?
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LVH
Prominent Q waves Deep T wave inversions |
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CXR of Hypertrophic Cardiomyopathy?
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Probably normal
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Echocardiogram of Hypertrophic Cardiomyopathy?
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Diagnostic
Asymmetric hypertrophy (ASH) Systolic Anterior motion of the MV (SAM) Normal systolic function to hypercontractile with LV chamber obliteration MR secondary to SAM |
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Asymmetric hypertrophy (ASH)?
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Septum to LV wall is 1.3 or greater
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Hypertrophic Cardiomyopathy Cardiac Cath, Hemodynamics
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Hypercontractile LV
MR LV outflow tract gradient Increased LVEDP and PWP Secondary PH |
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Classic example of Restricitve Cardiomyopathy
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Amyloidosis
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etiology of Restricitve Cardiomyopathy
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Amyloidosis is the classic example
Idiopathic Sarcoidosis Scleroderma Hemochromatosis Eosinophilic syndrome Carcinoid Endomyocardial fibrosis Metastatic disease Gaucher’s Hurler’s glycogen storage diseases |
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Clinical Manifestations of Restricitve Cardiomyopathy
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Fatigue
Dyspnea Weakness secondary to decreased BP |
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Physical Findings of Restricitve Cardiomyopathy
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Right sided CHF (Edema, neck vein distention, ascites, anasarca)
No typical cardiac exam findings |
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Labs of Restricitve Cardiomyopathy
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No specific lab abnormalities of restrictive CMO. BNP can elevated in any form of CHF
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ECG of Restricitve Cardiomyopathy
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No specific findings. Heart block possible in some infiltrative forms
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Chest x ray of Restricitve Cardiomyopathy
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CHF changes, mostly right sided type
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Echocardiogram of Restricitve Cardiomyopathy
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LVH
Granular sparkling changes in myocardium classic for amyloid |
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Restricitve Cardiomyopathy Cardiac Cath, Hemodynamics
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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 |
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Acute inflammation of the myocardium
Can be concomitant with endocarditis, pericarditis (pan carditis) |
Myocarditis
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Mechanisms of inflammation in myocarditis
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Mechanisms of inflammation
Direct infectious agent invasion Production of a myocardial toxin Immune mediated myocardial inflammation |
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infectious causes of myocarditis
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Viral most common in U.S. (adeno, coxsackie, influenza, CMV, echo, HIV
Other (Lymes, rickettsial, diptheria, fungal, trypanosoma [Chagas’] |
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Clinical Manifestations of myocarditis
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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 |
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Laboratory of myocarditis
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Testing for specific agents (eg Lyme’s titres, HIV, viral assays)
Elevated sed rate (not specific) No specific ECG, echo findings |
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Pericardial Diseases (4)
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Acute pericarditis
Chronic pericarditis Constrictive pericarditis Effusive pericarditis |
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Causes of Acute Pericardial Diseases.
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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 |
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Timing of Dressler's
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6 weeks post MI
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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 |
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Physical Findings of Acute Pericardial Diseases.
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Neck vein distention with tamponade
Pericardial friction rub pathognomonic -Three component rub |
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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 |
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Echo of acute pericardial disease
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Echocardiogram: possible pericardial effusion
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Labs of acute pericardial disease
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Elevated sed rate
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If you hear a friction rub, what is diagnosis?
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pericardial disease
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Clinical hemodynamic effects
of tamponade |
Decreased BP
Neck vein distention Diminished heart sounds Pulsus paradoxus --Usually respiratory systolic pressure change of > 10 |
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ECG, CXR, ECHO, Cath findings of tamponade
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ECG: electrical alternans
CXR: cardiomegaly Echo: large effusion, RA, RV, LA diastolic collapse Cath: equalization of chamber pressures |
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Treatment of tamponade
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Usually percutaneous pericardiocentesis
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Chronic pericardial inflammation resulting in fibrotic constriction with possible calcification of the pericardium
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Constrictive Pericarditis
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Causes of Constrictive Pericarditis
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Non specific chronic inflammatory such as viral
TB Post surgical Trauma Radiation |
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Clinical Manifestations of Constrictive Pericarditis
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Right sided CHF syptoms
Chest pain Fatigue, weakness |
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Physical Findings of Constrictive Pericarditis
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Neck vein distention
Kussmaul’s sign (paradoxical neck vein distention with inspiration) Pericardial diastolic knock, secondary to diastolic cessation of cardiac filling Diminished BP |
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during inspiration, neck veins are more distended (opposite of normal)
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Kussmaul's sign
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Chest X ray of Constrictive Pericarditis
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possible pericardial calcification
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CT scan of Constrictive Pericarditis
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calcium or pericardial thickening
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Cardiac Cath of Constrictive Pericarditis
TEST QUESTION |
Equalization of pressures
Dip and plateau (square root sign) Difficult to distinguish from restrictive CMO |
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Symptoms of chronic pericardial effusion
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May be asymptomatic with no need for treatment
CHF type of symptoms possible --Dyspnea, weakness, orthopnea, reduced BP |
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diagnostic tool for chronic pericardial effusion
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Pericardiocentesis
For example, when new finding, to r/o metastatic disease Usually effusion will come back |
