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42 Cards in this Set
- Front
- Back
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what is the definition of cardiomyopathy?
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Primary myocardial dysfunction resulting in impairment of contractile or lusitropic (relax ability) function or both
Primary structural myocardial alteration resulting in chamber dilation or hypertrophy with or without obstruction to outflow |
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what are the four types of structural cardiomyopathy?
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dilated, restrictive/ infiltrative, hypertrophic, arrhythmogenic RV myopathy
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what classifications of cardiomyopathy are associated w/ systolic dysfunction? diastolic dysfunction?
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systolic: dilation
diastolic: hypertrophy and restrictive diastolic dysfunction |
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what type of cardiomyopathy accounts for 60% of all cardiomyopathies?
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dilated cardiomyopathy
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what are the 6 key aspects of hx?
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functional limitation, fatigue, orthopnea, dependent edema, anorexia, sleep disturbance.
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what are the 6 key findings on examination for dilated cardiomyopathy?
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JVD, S3 at apex, anterior chest wall heave, laterally displaced PMI, basilar pulmonary rales, hepatomegaly/peripheral edema.
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what are the 6 key findings on examination for restrictive cardiomyopathy?
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JVD when decompensated
S4 at apex PMI in normal position basilar pulmonary rales peripheral edema hepatic enlargement less common |
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what are the 6 key findings on examination for hypertrophic cardiomyopathy?
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systolic murmur in second parasternal interspace in obstructive forms
hyperdynamic precordium normal PMI carotid upstroke may be bifid S4 at apex |
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what are the 3 primary etiologies of DCM?
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familial, RV arrhythmogenic dysplasia, muscular dystrophy
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what are the 7 secondary etiologies of DCM? which one is seen most often?
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ischemia-- MC
infection valvular heart disease (AI, MI) toxins endocrinoopathy post-partum CT dz |
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what endocrine disorder can cause DCM independent of CAD?
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diabetes mellitus
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what does local angiotensin cause that eventually leads to the myocardial dysfunction?
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remodeling
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what are four etiologies of restrictive cardiomyopathy (RCM)?
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infiltrative dz (sarcoidosis, amyloidosis, tb, hemochromatosis)
endomyocardial fibrosis early MI scarring CT dz |
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what is the etiology of obstructive cardiomyopathy?
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genetic disorder
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what is non-obstructive hypertrophy?
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diffuse myopathy w/ diastolic dysfunction and normal systolic function
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what is the most useful tool in diagnosing cardiomyopathy?
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echocardiography
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On CXR the heart is normal sized, but they exhibit all other symptoms of cardiomyopathy, which phase of the heart cycle has a problem?
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diastolic
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On CXR the heart is big and floppy and they exhibit all other symptoms of cardiomyopathy, which phase of the heart cycle has a problem?
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systolic
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when is stress testing contraindicated in cardiomyopathy suspicions?
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1) pt is in active CHF
2) diagnosis of hypertrophic obstructive cardiomyopathy |
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what are the 4 classes determined by the NY heart assoc for cardiomyopathy?
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1: dz w/ no sxs
2: dz w/ mild sxs 3: dz w/ mod sxs 4: dz w/ sxs at rest |
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what is step 2 of the therapeutic approach for txing cardiomyopathy?
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address all acute reversible factors: HTN, ischemia, uncontroleld diabetes, anemia, fever
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what is step 3 of the therapeutic approach for txing cardiomyopathy?
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investigate the specific pathologic diagnosis (ECG, Echo, CXR)
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what is step 4 of the therapeutic approach for txing cardiomyopathy?
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investigate the etiology (lab eval--> thyroid fxn, ana/ esr, viral titers; consider stress testing/angiography)
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what is the therapy for DCM?
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preload reduction
afterload reduction contractility maintain sinus rhythm device therapy |
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what is the therapy for RCM?
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gentle diuresis (starling forces)
maintain sinus rhythm |
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what is the therapy for hypertrophic cardiomyopathy?
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B-blocker or Ca2+ channel block to blunt contractility in HOC
defribrillator in high risk pts surgical: septal ablation or excision in HOC |
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how can you reduce preload in cardiomyopathy pts?
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diuresis, nitrates, salt/fluid restriction, spironolactone, morphine acutely
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what is the only different between ACE-I and angiotensin receptor blockers besides their MOA?
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angiotensin receptor blockers do not make the pt cough
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in DCM, what two types of afterload reduction must they be given?
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ACE-I and ARB
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what is useful when ACE-I or ARB is contraindicated? what else can it be used for?
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hydralazine (alpha blocker), it is also beneficial for CM pts on top of an ACE-I or ARB.
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what is the only oral inotrope? what are the other inotropes?
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digoxin
IV: dobutamine, milrinone, amrinone |
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for DCM pts what type of B-blocker must they have? how does it work?
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3rd gen: upregulates receptors that became resistant to the positive effects of catecholamines.
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what are the 3 b-blockers used in cardiomyopathy?
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carvedelol, bucindolol, metoprolol
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what is the purpose of BNP?
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Brain natriuretic peptide--. causes salt diuresis in the event of fluid overload.
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what mechanical intervention is indicated for temporary hemodynamic support?
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intra-aortic balloon counterpulsation
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what does left ventricular assist device serve as?
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bridge to transplantation
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what are the symptoms of heart failure?
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weakness, fatigue, changes in exercise tolerance and senosrium, dyspnea, tachypnea, diaphoresis, sacral edema, crackles, rhonchi
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what are the causes of Left ventricular diasolic dysfunction?
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CAD, HTN, valvular dz, cardiomyopathy, LVH, diabetes, age
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what are the sxs specially for right-sided heart failure?
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Peripheral edema
Hepatomegaly Ascites JVD Anorexia, N/V |
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what are the sxs specially for left-sided heart failure?
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Exertional Dyspnea
Orthopnea PND Weakness Laterally displaced PMI |
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what are the hallmarks of therapy for DCM?
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A- ACE inhibitors
B- B-blockers C- Cholesterol-lowering agents D- diuretics |
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prognosis is worse for which type of cardiomyopathy? which prognosis is better?
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DCM (tx is better)
RCM (tx feels worse) |
