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26 Cards in this Set
- Front
- Back
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Presentation of Cardiomyopathies
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Dyspnea on exertion
Heart failure Arrhythmias, Syncope, Sudden Cardiac Death Embolic phenomena |
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What are the Functional Classifications of Cardiomyopathies?
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Dilated Cardiomyopathy
Restrictive Cardiomyopathy Hypertrophic Cardiomyopathy |
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Dilated Cardiomyopathy
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Systolic dysfunction
Reduced Ejection Fraction Thin walls, dilated ventricles |
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Restrictive Cardiomyopathy
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Diastolic dysfunction
Thickened or normal walls Ejection Fraction may be normal |
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Idiopathic Dilated Cardiomyopathy
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Incidence 8/100 000 per year
- May be the result of viral myocarditis or toxic myocarditis but etiology no longer apparent at time of presentation. - 3X more common in males and African Americans - Genetic predisposition, sometimes familial. |
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Treatment of Idiopathic Cardiomyopathy
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Treatment if no reversible cause is the same as for CHF in general:
- Beta Adrenergic Blocker (Carvedilol, Metoprolol) - Angiotensin converting enzyme inhibitor (Enalapril, Captopril, Ramipril) - Aldosterone antagonist (Spironolactone) - Consider implantable cardioverter defibrillator. |
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Viral Myocarditis
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- Multiple viruses but most commonly enterovirusses (Coxsackie B - 50% of all cases).
- Immunologic mechanism - develops weeks after the original infection. |
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Who is at risk for more aggressive and fulminant viral myocarditis?
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infants
pregnant women |
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Who has enhanced suspectibility to viral myocarditis?
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those exposed to:
radiation malnutrition steroids exercise previous MI |
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Viral Myocarditis
Microscopic Appearance |
- monocytes infiltrate the heart muscle
- myocytes lose the normal striations and appear vacuolated with necrosis |
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Infectious Causes of Myocarditis
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Viral
- Coxsackie B, Influenza, HIV, CMV, Hepatitis , Polio Rickettsia - Rocky Mountain Spotted Fever Bacterial - Diphtheria (25%), Streptococcal Rheumatic Fever. Spirochetal - Lyme Disease (heart block) Protozoal - Trypanosomiasis (Chaga’s Disease T. cruzi) |
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How does Peripartum Cardiomyopathy differ from Idiopathic Cardciomyopathy?
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- Clear relationship to recent pregnancy with a high risk of relapse on subsequent pregnancies.
- Embolic phenomena are more common (stroke, peripheral occlusion) - Better Prognosis (1/3 recover completely, 1/3 stabilize, 1/3 progress) |
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What is a good prognostic sign in Peripartum Cardiomyopathy?
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Evidence of inflammation on heart biopsy is a good prognostic sign
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Peripartum Cardiomyopathy
Clinical Associations |
1. Multiparity
2. Advanced maternal age 3. Twin pregnancies 4. Pre - eclampsia Onset from third trimester up to several months post partum. |
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Peripartum Cardiomyopathy
Therapy |
- Normal CHF Tx (no ACEI or ARBs)
- Anticoagulation x 6 months - Surgical sterilization is highly recommended because high risk of relapse with more pregnancies |
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Hypertrophic cardiomyopathy
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- Genetic condition: Autosomal Dominant (50%)
- Cardiac muscle disease characterized by abnormal hypertrophy, mainly involving the ventricular septum |
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Hypertrophic cardiomyopathy
Histology |
Myofibrillar disarray
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Hypertrophic cardiomyopathy
Functional Abnormalities |
1. Outflow tract obstruction
2. Diastolic dysfunction 3. Atrial and Ventricular arrhythmias |
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What will an echo report say if they want you to think hypertrophic cardiomyopathy?
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- Asymetrical hypertrophy
- Systolic anterior motion of anterior leaflet of mitral valve with outflow obstruction and mitral regurgitation |
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Hypertrophic cardiomyopathy
History |
- Can be asymptomatic.
- Dyspnea, chest pain, syncope. - Important cause of sudden death in young athletes |
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Hypertrophic cardiomyopathy
Examination |
- Loud fourth heart sound
- brisk bifid carotid pulse - harsh systolic ejection murmur like aortic stenosis but doesn’t usually radiate to the neck and it is labile and varies with maneuvers. It increases on standing (decreased afterload), diminishes with raising of the legs (increased afterload). - Sometimes also pansystolic murmur (mitral regurg) |
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What to look for in history of the patient with suspected cardiomyopathy?
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- Heart failure
- Angina - Rash, fever recent infection - Travel, exposure - Toxins - alcohol, cocaine, chemotherapy - HIV risk factors - Past medical history (HIV, Sarcoidosis, Lyme Disease, renal failure, Thyroid disease) - Recent pregnancy - Family History |
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What to look for on physical exam of patient with suspected cardiomyopathy?
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- Heart failure
- Valvular abnormalities, Hypertrophic cardiomyopathy - Associated diseases (Hepatitis, Kaposi sarcoma, Lyme disease, connective tissue disease etc.) |
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What to look for on CXR of patient with suspected cardiomyopathy?
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Cardiomegaly
less common: Sarcoid Wegeners Granulomatosis |
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What labs do you do when you suspect cardiomyopathy?
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- Renal and liver function
- Iron profile - Thyroid function - HIV, hepatitis screen - Others: Heavy metal screen, Lyme titers, etc. |
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What is dx for cardiomyopathy?
What other procedures can you do? |
echocardiogram
... you can also do: - Cardiac catheterization, coronary angiography - Cardiac MRI - Cardiac Biopsy |
