Flashcards in Diseases of the Heart Muscle and Pericardium Deck (56)
Most common type of cardiomyopathy
Dilated Cardiomyopathy pathogenesis
An insult (ischemia, infection, alcohol, etc) --->dysfunction of LV contractility -->Dilated LV
*50% of cases are idiopathic
Treatment of dilated cardiomyopathy
Similar to treatment of CHF because signs and symptoms of both R and L sided failure are likely present
What sort of prophylaxis should be considered in patients with dilated cardiomyopathy?
Anticoagulation because these patients are at increased risk of embolization
most cases of hypertrophic cardiomyopathy are due to....
Inheritance of an autosomal dominant trait
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)
Patients with hypertrophic cardiomyopathy may have this obstruction:
dynamic outflow obstruction due to assymmetric hypertrophy of the interventricular septum
young athlete experiences sudden death: may be the first manifestation of....
Clinical signs of HCM
systolic ejection murmur
rapidly increased carotid pulse with 2 upstrokes (bisferious pulse)
Systolic Ejection murmur in HCM is best heard at....
the lower left sternal border
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
Squatting increases the intensity of all murmurs except....
Mitral valve prolapse murmur and HCM murmur
Sustained hand grip decreases intensity of this murmur
(Sustained hand grip increases systemic resistance)
All HCM patients should avoid.....
strenuous exercise including competitive sports
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)
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)
Pathogenesis of Restrictive Cardiomyopathy
Infiltration of myocardium ---> impaired diastolic ventricular filling due to decreased ventricular compliance
Causes of RCM
RCM on echocardiogram will show:
Increased RA and LA size with normal LV and RV size
*Possible systolic ventricular dysfunction
Signs and Symptoms of RCM
R-sided HF signs and symptoms (due to increased filling pressures)
Echo findings show myocardium appearing righter than normal with a possibly speckled appearance; you should suspect....
RCM caused by amyloidosis
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
Inflammation of the myocardium caused by:
"Classic Case" for myocarditis
Patient that is a young male
may present with fever, fatigue, chest pain, pericarditis, CHF, arrhythmia
Should look for these labs in myocarditis
cardiac enzymes elevated
Cardinal manifestations of acute pericarditis
Pericardial friction rub
ECG changes: diffuse ST elevation and PR depression
Pericardial effusion (with or without tamponade)
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
Chest pain in acute pericarditis is aggravated by....
Chest pain in acute pericarditis is relieved by....
sitting up and leaning forward