Diseases of the Heart Muscle and Pericardium Flashcards Preview

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Flashcards in Diseases of the Heart Muscle and Pericardium Deck (56)
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1

Most common type of cardiomyopathy

Dilated Cardiomyopathy

2

Dilated Cardiomyopathy pathogenesis

An insult (ischemia, infection, alcohol, etc) --->dysfunction of LV contractility -->Dilated LV

*50% of cases are idiopathic

3

Treatment of dilated cardiomyopathy

Similar to treatment of CHF because signs and symptoms of both R and L sided failure are likely present

Digoxin
Diuretics
Vasodilators
Heart Transplant

4

What sort of prophylaxis should be considered in patients with dilated cardiomyopathy?

Anticoagulation because these patients are at increased risk of embolization

5

most cases of hypertrophic cardiomyopathy are due to....

Inheritance of an autosomal dominant trait

6

What kind of cardiac dysfunction will hypertrophic cardiomyopathy cause?

Diastolic dysfunction due to a stiff, hypertrophied ventricle with increased diastolic filling pressures that increase further with elevated heart rate and contractility (as with exercise)

7

Patients with hypertrophic cardiomyopathy may have this obstruction:

dynamic outflow obstruction due to assymmetric hypertrophy of the interventricular septum

8

young athlete experiences sudden death: may be the first manifestation of....

hypertrophic cardiomyopathy

9

Clinical signs of HCM

sustained PMI
Loud s4
systolic ejection murmur
rapidly increased carotid pulse with 2 upstrokes (bisferious pulse)

10

Systolic Ejection murmur in HCM is best heard at....

the lower left sternal border

11

standing, the valsalva maneuver, and leg raises diminish the intensity of which murmurs?

Diminish intensity of all murmurs except in Mitral Valve Prolapse and HCM

*These maneuvers decrease LV volume, thus make these two murmurs worse

12

Squatting increases the intensity of all murmurs except....

Mitral valve prolapse murmur and HCM murmur

13

Sustained hand grip decreases intensity of this murmur

HCM murmur
(Sustained hand grip increases systemic resistance)

14

All HCM patients should avoid.....

strenuous exercise including competitive sports

15

What is the initial drug used in symptomatic HCM patients? What is an alternative drug choice?

Beta blockers: decrease symptoms by improving diastolic filling via decreased HR and increasing diastole duration and decreasing contractility (and thus O2 consumption)

Calcium Channel Blockers (Verapamil) are alternatives if patient is not responding to the Beta Blockers (via similar mechanism)

16

This procedure is reserved for HCM patients with severe disease

Myomectomy: excision of part of the myocardial septum (Has high success rate for relieving symptoms)

17

Pathogenesis of Restrictive Cardiomyopathy

Infiltration of myocardium ---> impaired diastolic ventricular filling due to decreased ventricular compliance

18

Causes of RCM

Amyloidosis
Sarcoidosis
Scleroderma
Carcinoid Syndrome
Chemo/Radiation therapy
Hemochromatosis
Idiopathic

19

RCM on echocardiogram will show:

Thickened myocardium
Increased RA and LA size with normal LV and RV size

*Possible systolic ventricular dysfunction

20

Signs and Symptoms of RCM

Dyspnea
Exercise intolerance
R-sided HF signs and symptoms (due to increased filling pressures)

21

Echo findings show myocardium appearing righter than normal with a possibly speckled appearance; you should suspect....

RCM caused by amyloidosis

22

In the treatment of RCM, you must treat the underlying disorder. You can give digoxin if systolic dysfunction is present, except when....

Patient has cardiac amyloidosis because these patients have increased incidence of digoxin toxicity

23

Myocarditis Causes

Inflammation of the myocardium caused by:
virus
bacteria
SLE
medications
idopathic

24

"Classic Case" for myocarditis

Patient that is a young male

may present with fever, fatigue, chest pain, pericarditis, CHF, arrhythmia

25

Should look for these labs in myocarditis

cardiac enzymes elevated
ESR elevated

26

Cardinal manifestations of acute pericarditis

Chest pain
Pericardial friction rub
ECG changes: diffuse ST elevation and PR depression
Pericardial effusion (with or without tamponade)

27

How can you differentiate the chest pain of pericarditis from that of an MI?

Chest pain in acute pericarditis is pleuritic (associated with breathing) this is not the case in MI

28

Chest pain in acute pericarditis is aggravated by....

lying supine
coughing
swallowing
deep inspiration

29

Chest pain in acute pericarditis is relieved by....

sitting up and leaning forward

30

A pericardial friction rub is heard best under these conditions:

Heard best during expiration with patient sitting up and stethoscope placed firmly against chest