Cardiomyopathies Flashcards Preview

6902 test 2 > Cardiomyopathies > Flashcards

Flashcards in Cardiomyopathies Deck (28)
Loading flashcards...
1
Q

Dilated cardiomyopathy

A

Primary CM

LV or Biventricular dilation
systolic dysfunction
thin wall with dilation of LV

Chambers are enlarged but hypokinetic resulting in clot formation

2
Q

Concentric LVH

A

response to increased workload such as increased afterload

3
Q

Eccentric hypertrophy

A

thinned LV wall

caused by fluid overload

4
Q

Dx of DC

A
ECG shows LBBB
afib
Chest xray shows enlarged chambers
Echo - RWMA that do not correlate to CAD
Angio- normal
right heart cath - high PAOP, high SVR, low CO
5
Q

Apical ballooning/Takosubo

A

temporary DCM
stress
women > men
high catecholamine state so inotropes are contraindicated and negative inotropes are used like BB, CCB,

IABP

6
Q

Medical treatment of DC

A

similar to HF
risk of embolization and need anticoagulation
AICDs

7
Q

Hypertrophic CM

A

ventricular tachyarrhythmias
sudden death
progressive diastolic HF

most common genetic CV disease
can result in LVOT obstruction, ischemia, arrhythmias

During systole, a hypertrophied septum accelerates blood flow (venture effect) through a narrowed LVOt.

8
Q

Dx of HCM

A

Echo
Obsturction with gradients of 30 mmHg is significatnt
50 mmHg mandates surgical or PCI

9
Q

Drug of choice for HCM

A

amiodarone

10
Q

HCM complications

A

avoid Valsalva bc increases the LVOT

Increase in HR and contractility or decrease in preload after afterload will worse LVOT obstruction

Maintain NSR

11
Q

What should cause you to think HCM in young person?

A

LV hypertrophy on ECG

systolic murmur

12
Q

Medical mgmt. of HCM

A
BB to reduce tachycardia
Afib
CCB to improve diastolic relation
antyi-arrhythmics
Diuretics
13
Q

Septal ethanol ablation

A

reduce the size of the ventricular septum

14
Q

Anesthesia for HCM

A
optimize preload
avoid increases in contractility
avoid increase in HR
prevent afterload reductions
prevent SNS activation by relieving anxiety and pain

Regional and GA are safe

Induction - do not cause SVR drops or increase HR and contractility

Myocardial depression is beneficial

Blunting DL is essential

PPV and large TV can cause preload drops and worsen LVOT - so use faster, small TV

Lap surgeries with insufflation can reduce preload and worsen the reflective HR increase and contractility changes

avoid histamine releasing drugs

15
Q

If hypotension occurs in HCM pt

A

avoid inotropic agents - ephedrine, dopamine, dobutamine, NE as they worsen the LVOT

Use vasopressin or phenylephrine

Vasodilators will worsen obstruction

16
Q

Pregnant and HCM

A

hypotension treated with phenylephrine
pulmonary edema - treat with phenylephrine and esmolol to slow HR and prolong diastole and decrease contractility

diuretics can worsen the event by increasing HR

labor produces catecholamine release

epidural anesthesia encourage

oxytocin can cause vasodilation and tachycardia

17
Q

Septal myopathy

A

via aortic approach
more efficacious than ethanol ablation

CPB
TEE used
risk of HB during the procedure

18
Q

Peripartum cardiomyopathy

A

rare
EF < 45%

treatment same as HF
diuretics
vasodilators like NTG and hydralazine

ACI teratogenic

19
Q

Secondary cardiomyopathy with restrictive physiology

A

causes: amyloidosis - speckled protein deposits in ventricle

HF w/o cardiomegaly or systolic dysfunction

Myocardium becomes stiff

Diastolic dysfunction but normal systolic

Both ventricles affected

afib common

20
Q

Dx of secondary cardiomyopathy w restrictive physiology

A

no evidence of hypertrophy

CXR can show pulmonary congestion and pleural effusions w/o cardiomegaly

ECHO shows diastolic dysfunction with normal EF

21
Q

anesthesia for secondary SM with restrictive

A

same as for pts with tamponade

Avoid los of NSR and bradycardia

Preload is important

22
Q

Acute pericarditis

A

viral infection
after myocardial infarct
Chest pain, pericardial friction rub, diffuse ST elevation
Angina worsens w inspiration, better when pt leans forward

treated w/ SNAIDS

23
Q

Pericardial effusion

A

more fluid than normal in pericardial sac

if chronic, large volume accommodation is possible

not evident on CXR until 1-2L develop
l
US can detect sooner

24
Q

Tamponade

A

effusion under pressure

as little as 100 mL acute incrase can cause tamponade

CVP is elevated

Kussamaul’s sign - distension of jugular vein during inspiration

Pulsus paradoxus - when SBP changes more than 10 mmHg during inspiration

Beck’s triad

Echo = can detect 20 ML

CXR - water bottle heart

25
Q

Beck’s triad

A

muffled heart sounds
increasing JVD
hypotension

26
Q

Anesthesia w/ tamponade

A

GA and PPV can cause CV collapse from vasodilation and myocardial depression

Pericardiocentesis is performed under local anesthetic to temporize the insult of GA

After hemodynamics improved, then surgery can be performed

DOC is ketamine as does not decrease inotropy

Art line, CVL

  • maintain preload, afterload, contractility - ketamine
  • after tamponade is relieved, expect hypertension and have vasodilators ready
27
Q

Constrictive pericarditis

A

pericardium adheres to the heart and eliminates the pericardial space/candy caots the heart with a hard shell

S/S:
increased CVP - w/o other signs of heart disease
low Co
fatigue
JVD
ascites
edema
TEE - can dx pericardial thickening

pulm congestion absent

28
Q

anesthesia for constrictive pericarditis

A

minimize changes in HR, SVR, preload, contractility

Opioid and benzos can be used with low dose PIA

Paralytics with minimal circulatory effects

Invasive monitoring

Gas sampling