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49 Cards in this Set
- Front
- Back
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Describe the clinical characteristics of pts with Idiopathic Dilated Cardiomyopathy
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• Sx of left heart failure
• Sx of right heart failure • Systolic dysfunction • Signs of peripheral EMBOLIZATION (acute neurological deficit, flank pain/ hematuria, abdominal pain, pulseless cyanotic extremity) |
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Describe the clinical profile of Hypertrophic Cardiomyopathy (HCM):
Sx? Relieved by? |
• Syncope/ Near syncope
• Sudden DEATH These sx arise 2° to atrial and ventricular dysrhythmias, often during exercise • DOE • CP poorly relieved w/ NTG • CP relieved by lying down is pathognomonic for HCM (but rarely seen) • Palpitations (atrial and ventricular dysrhythmias) |
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Describe the defining characteristics of Idiopathic Dilated Cardiomyopathy (IDC). What is the most common etiology?
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Characterized by:
• Dilation of all 4 chambers • Hypertrophy • SYSTOLIC pump failure Highly associated with VIRAL myocarditis |
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Describe the EKG findings in Hypertrophic Cardiomyopathy
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• Septal Q waves > 0.3 mV
• Afib • PVCs Note: The dx of HCM should be considered in any young person with EKG findings suggestive of previous MI but who does not have a h/o MI |
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Describe the heart sounds of HCM and associated provocative maneuvers
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• S4 gallop
• Prominent SEM from LV outflow obstruction and MR The SEM is increased w/ maneuvers that DECREASE LVEDV (eg, Valsalva, exercise...) |
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How can Restrictive Cardiomyopathy be differentiated from Constrictive Pericarditis?
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RC has a gallop rhythm and Kussmal's sign (JVD on inspiration). CP does not.
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How is CHF treated in myocarditis? What med is particularly beneficial?
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Tx CHF with the usual protocol. Note:
• Digoxin should be used w/ caution as the inflamed myocardium is very sensitive to it • ACE-I are particularly BENEFICIAL -- they decrease cellular necrosis and inflammation |
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Which dz does rheumatic fever cause over 90% of all cases?
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• Mitral stenosis (> 90%)
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State the causes of LV failure
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• Ischemic heart dz (most common)
• DILATED cardiomyopathy • HTN • Mitral or aortic valve dz • High output states • Coarctation |
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State the causes of myocarditis
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Viral (most common cause):
• Coxackie • Echo Bacterial: • ß-hemolytic strep (Rheumatic Fever) • Borrelia burgdorferi (Lyme Dz) Parasites |
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State the causes of RV failure
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• LV failure
• Pulmonary arterial HTN (+ RVF = cor pulmonale) • RESTRICTIVE or INFILTRATIVE cardiomyopathy • Myocarditis • MI • PE • COPD • Tricuspid/ pulmonic dz |
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State what happens to the pulse pressure in:
Aortic stenosis Aortic regurg -- Acute Aortic regurg -- Chronic |
Aortic Stenosis -- Narrowed
Aortic Regurg, Acute -- Nl Aortic Regurg, Chronic -- Wide |
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What are the cardiac findings seen in the 2nd stage of Lyme disease?
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FLUCTUATING AVB that may present as SYNCOPY and may require temporary pacing
• Develops 4 wks after bite Myocarditis |
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What are the clinical characteristics of Restrictive Cardiomyopathy?
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Sx of both right and left-sided heart failure
Note: Sx are very similar to Idiopathic Dilated Cardiomyopathy, but RIGHT-sided CHF sxs predominate |
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What are the defining cardiac structural characteristics of Hypertrophic Cardiomyopathy (HCM)?
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HCM is characterized by LEFT ventricular hypertrophy (LVH) WITHOUT associated ventricular dilatation.
The hypertrophy is asymmetric (SEPTUM > free wall) • Atrial dilatation • Nl ventricle size • Impaired diastolic relaxation • Restricted LV filling |
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What are the defining characteristics of Restrictive Cardiomyopathy?
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DIASTOLIC restriction of ventricular filling:
• end diastolic volume is low • end diastolic ventricular pressure is high • cardiac output is decreased Note: This clinical picture mimics CONSTRICTIVE PERICARDITIS |
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What are the echo and cardiac enzyme findings in myocarditis?
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Echo:
• Dilated chambers (similar to Idiopathic Dilated Cardiomyopathy) • Either diffuse hypokinesis or focal wall motion abnormalities Cardiac Enzymes: • Rise and fall SLOWLY over a period of days, unlike the rapid rise of AMI |
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What are the echo findings in Restrictive Cardiomyopathy?
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• Thickened walls
• Normal ventricular cavity • Moderate to markedly dilated atria |
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What are the signs of prosthetic valve dysfxn 2° to thrombus formation?
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Signs of Thrombus:
• CHF (acute onset) • HoTN (acute onset) Signs of Embolic events: • Paralysis • CVA • Abdominal pain • Flank pain/ hematuria • Chest pain • Ischemic extremity |
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What are the sx of myocarditis?
With what condition is it often present? |
Often presents with PERICARDITIS
Sx: • Hx of preceding/ concurrent viral illness • Fever • CP • Signs/ sx of CHF • Palpitations/ dysrhythmias |
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What are the two most common symptoms seen in rheumatic fever?
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1 Polyarthritis
2 Carditis |
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What dx should be considered in a pt presenting in CHF with no evidence of cardiomegaly or systolic dysfxn?
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Restrictive cardiomyopathy
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What is Hamman's Crunch?
In which pt position is it best heard? |
A crunching noise synchronous with the heartbeat.
Associated with pneumo-mediastinum or pneumo-pericardium. Best heard with pt in the LEFT LATERAL RECUMBENT position. |
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What is Kussmaul's sign?
It which conditions is it found? |
Kussmaul's Sign -- JVD (increase in CVP) with inspiration
Seen in: • Restrictive cardiomyopathy • Pericardial tamponade |
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What is Pulsus Alternans, and in which condition is it typically found?
Pulsus Paradoxus? |
PULSUS ALTERNANS:
• Alternating STRONG and WEAK beats of an arterial pulse waveform • Indicative of LEFT VENTRICULAR DYSFUNCTION PULSUS PARADOXUS: ('Pulsus-Paradoxus-Pericardial') • Exageration of the nl pulse during inspiration, where the pulse becomes WEAKER during INSPIRATION and stronger during expiration • Seen in PERICARDIAL TAMPONADE and OBSTRUCTIVE LUNG disease |
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What is the correlation between pt's age, degree of hypertrophy, and severity of sx in Hypertrophic Cardiomyopathy?
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Directly correlated
Older the pt --> the more hypertrophy --> the worse the sx |
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What is the most common cause of dilated cardiomyopathy?
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IDIOPATHIC
Another common cause is viral myocarditis, but this is not as common as idiopathic |
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What is the most common cause of myocarditis in the US? Name the agent.
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Coxsackie B virus
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What is the most common dysrhythmia seen in Idiopathic Dilated Cardiomyopathy?
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Afib
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What is the most common tumor to cause heart failure?
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Left atrial myxoma
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What is the treatment of Idiopathic Dilated Cardiomyopathy?
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Alleviate the sx of fluid overload:
• Diuretics • Digoxin • Vasodilators (nitrates, ACE-I) Anticoagulants in pts with evidence of thrombi, embolism or afib |
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What is the treatment of myocarditis?
What drugs are CONTRAINDICATED? |
Tx:
• Tx is primarily SUPPORTIVE • High dose IVIG shown to be beneficial in peds (esp w/ Kowasaki's) • Interferon is under investigation Contra-I in EARLY myocarditis: • Steroids • NSAIDS |
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What is the treatment of Restrictive Cardiomyopathy?
What should not be used? |
Tx is aimed at alleviating sxs. Tx usually includes:
• Diuretics • Digoxin (only beneficial if LVH is present) Do NOT use vasodilators. They reduce afterload but produce HoTN and have not been found to be beneficial. |
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What is the tx of HCM?
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ß-Blockers:
• Improve sx are the mainstay of tx • Reduce exertion-related outflow obstruction and decrease myocardial O2 consumption Ca Ch Bl: • Useful in select pts who fail ß-Bl • Contra-I in CHF Amiodarone: • Tx of choice for ventricular dysrhythmias • Used for pts who fail ß-Bl and Ca Ch Bl |
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What is the value of obtaining an LDH level in assessing a pt with prosthetic valve complications?
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The level of LDH directly correlates with the severity of hemolysis
Note: hemolysis rarely occurs with tissue prosthetic valves, only mechanical ones |
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What medical conditions are associated with the following parasites:
Taenia solium Taenia saginata Trypanosoma cruzi? |
Tenia solium:
• NEUROCYSTICERCOSIS • An extremely common cause of seizures worldwide • Associated with eating RAW PORK Taenia saginata: • Beef tapeworm • Causes self-limited GASTROENTERITIS Trypanosoma cruzi: • Causes Chagas disease • CARDIOMYOPATHY • Mega-esophagus |
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What surgical procedure can be effective in HCM pts who fail medical tx?
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Septal myomectomy
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What therapy should be immediately administered if bleeding complications occur during thrombolysis?
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• Stop the infusion
• Give Amikar (aminocaproic acid) • Xfuse FFP • Xfuse cryoprecipitate |
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What type of cardiomyopathy is most commonly seen 2° to toxins?
Name some toxins |
Dilated Cardiomyopathy
• EtOH • Cocaine • Lithium • Doxorubicin/ Daunorubicin Tip: • 'Td' (Toxin, Dilated) • 'CoLD alcohol' (Cocaine, Lithium, Doxo/Dauno, EtOH) |
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Which 2 diagnoses should be entertained in a pt who becomes acutely hypotensive after receiving vasodilator tx (for the tx of, say, pulmonary edema)?
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HCM
Aortic stenosis |
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Which cardiomyopathy exhibits a 50% autosomal dominant transmission pattern?
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HCM
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Which cardiomyopathy exhibits a disorganized whorled pattern to the myocardial fibers?
Which area of the heart is affected to the greatest extent? |
Hypertrophic Cardiomyopathy (HCM)
The SEPTUM is most greatly affected |
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Which cardiomyopathy is associated with the peripartum period?
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Dilated cardiomyopathy
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Which cohort of MEDICAL patients are at particular risk for developing pericardial effusion and tamponade?
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RENAL FAILURE patients
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Which drugs are contra-I in HCM?
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Agents that INCREASE CONTRACTILITY:
• Digoxin • Isoproterenol Agents that REDUCE PRELOAD: • Nitrates • Vasodilators • Lasix Agents that INCREASE AFTERLOAD: • Phenylephrine (Decreased LV volume = increased outflow obstruction) |
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Which heart muscle diseases are most commonly associated w/ Restrictive Cardiomyopathy?
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'MRI' -- Metabolic | restrictive | Infiltrative
Metabolic: • Hemochromatosis • Glycogen storage dz Type II Infiltrative: • Amyloidosis (the most common infiltrative cause of RC in the western hemisphere) • Sarcoidosis • Endomyocardial fibrosis (most common cause of RC worldwide) |
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Which maneuvers increase and decrease the murmur of MVP?
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Murmur INCREASE:
• Valsalva • Decrease ventricular volume --> increase duration of MVP Murmur DECREASE: • Squat • Increase ventricular volume --> decrease duration of MVP |
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Which meds and PE maneuvers INTENSIFY the murmur of idiopathic hypertrophic cardiomyopathy?
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Meds that INCREASE CONTRACTILITY
• Digoxin Meds that DECREASE PRELOAD: • Nitrates • Diuretics Agents that INCREASE AFTERLOAD: • Phenylephrine Maneuvers that DECREASE PRELOAD: • Valsalva |
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With which presentation and or lab findings should you consider ordering a Mg level?
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• Ventricular dysrhythmia
• Hypokalemia |
