Term
| cardiac enlargement is defined as a cardiac sillohuette greater than __ of the __ __. |
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Definition
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Term
| S3s are associated with a stiff ventricle |
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Definition
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Term
| 3 classifications of cardiomyopathy: |
|
Definition
1. Dilated- large globular, thin myocardium
2. Restricted- does not relax/fill well
3. Hypertrophic- big heart muscle |
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Term
| 4 most common reasons for cardiomyopathy: |
|
Definition
- Coronary Artery Disease (CAD) or ischemic heart disease
- HTN
- Diabetes
- Family History |
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Term
| Pts with dilated cardiomyopathy have __ __ __. |
|
Definition
| reduced ejection fractions |
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Term
| Dilated cardiomyopathy pts have: |
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Definition
- reduced ejection fraction
- reduced cardiac output
- high end diastolic volume/pressure
- high pulmonary capillary wedge pressure (measures left ventricular end diastolic pressure) |
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Term
| normal ejection fraction: |
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Definition
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Term
| An ejection fraction less than __ could be potential heart failure. |
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Definition
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Term
| An ejection fraction greater than 75 could be __ __. |
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Definition
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Term
| Dilated cardiomyopathy causes: |
|
Definition
- Idiopathic
- End-stage hypertrophic disease
- Multiple infarct or ischemia disease
- Toxins (EtOH)
- Infections (myocarditis)
- Endocrinopathy (DM, Thyroid)
- Connective tissue disease
- Muscular dystrophy
- Postpartum
- Infiltrative disease (sarcoid, amyloid, hemochromatosis) |
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Term
| Clinical presentation of Dilated Cardiomyopathy: |
|
Definition
- fatigue
- exertional dyspnea
- orthopnea
- LV/RV heave
- S3 common
- occasional mitral/tricuspid regurgitation
- jugular venous distention
- pulmonary rales
- peripheral edema
- EKG- low voltage, occasional arrhythmia
- CXR- signs of cardiomegaly |
|
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Term
| Dilated cariomyopathy evaluation: |
|
Definition
- thorough and detailed history
- Echo and/or Nuclear scan> EF, wall motion, chamber size
- Ischemia/arrhythmia eval
- Functional capacity via NYHA
- Lab screening: electrolytes, thyroid, glucose
- Myocardial biopsy where indicated: rarely done, usually done if infection suspected |
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Term
| A __ __ __ is important for understanding ischemia and ischemic burden. |
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Definition
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Term
| Once ejection fraction is below __, risk of sudden cardiac death greatly increases. |
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Definition
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Term
| Dilated cardiomyopathy therapy: |
|
Definition
- Salt and water restriction
- Preload reduction: diuretics, ACE-I
- Afterload reduction
- Inotrope: IV only, rarely used
- Anti-arrhythmic if needed
- Transplant/assistant device |
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|
Term
| Digoxin is weak oral inotrope but controversy about with LV dysfucntion, but we know that pple with LV dysfunction go to hospital less when on digoxin. |
|
Definition
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Term
| Dilated cardiomyopathy prognosis: |
|
Definition
Prognosis dependent on degree of LV dysfunction
Without ischemia, 3 yr. mortality about 30%
With ischemia, prognosis twice as poor
60% with myocarditis resolve completely
Onset may be acute or chronic dependent on etiology |
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Term
| Essentials of Dx of Dilated Cardiomyopathy: |
|
Definition
- signs and symptoms of heart failure
- EKG may show low QRS voltage, nonspecific repolarization abnormalities, intraventricular conduction abnormalities
- X-ray: cardiomegaly
- Echo: left ventricular dilation, thinning, global dysfunction |
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Term
| Restrictive cardiomyopathy has __ systolic contractility, __ diastolic relaxation and filling capacity, __ resting LV end diastolic filling pressure, and __ pulmonary capillary wedge pressure, especially with exercise. |
|
Definition
- normal systolic contractility
- decreased diastolic relaxation and filling
- high EDV pressure
- high pulmonary capillary wedge pressure |
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Term
| With restricted cardiomyopathy, ___ is impaired. |
|
Definition
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Term
| Causes of restrictive cardiomyopathy: |
|
Definition
- Infiltrative disease (sarcoid, amyloid, hemochromatosis_
- Tuberculosis
- Diabetes Mellitus
- Fibroelastosis |
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Term
| Restricted cardiomyopathy has a __ ejection fraction, while Dilated cardiomyopathy has a __ ejection fraction. |
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Definition
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Term
| A pt with Restrictive cardiomyopathy may have a normal chest x-ray |
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Definition
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Term
| Restrictive Cardiomyopathy symptoms: |
|
Definition
- similar symptoms to dilated cardiomyopathy
- S4 more common than S3
- Resting tachycardia
- less common valvular dysfunction
- No evidence of LV dilation |
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Term
| Main dx tool with restrictive cardiomyopathy: |
|
Definition
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Term
| Restrictive cardiomyopathy evaluation: |
|
Definition
- Dx of exclusion: CHF in presence of normal systolic function
- Echo to look at LV size and function
- Functional capacity
- Lab screen: glucose and ferritin
- PPD
- Myocardial biopsy with indication |
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Term
| CHF with normal systolic function suggests: |
|
Definition
| Restricted Cardiomyopathy |
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Term
| Restrictive Cardiomyopathy therapy: |
|
Definition
- judicious preload reduction: Nitrates, ACE-I
- direct therapy to underlying disease
- beta blocker/CCB may aid in relaxation |
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Term
| 2 tmt options that are geneerally NOT used with restrictive cardiomyopathy and why: |
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Definition
- Inotropes not used with restrictive cardiomyopathy b/c these work on systolic function
- Afterload reduction NOT treatment |
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Term
| Pts with __ cardiomyopathy live longer, but are harder to treat than pts with dilated cardiomyopathy. |
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Definition
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Term
| three year mortality rate of 20% |
|
Definition
| restrictive cardiomyopathy |
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Term
| Hypertrophic cardiomyopathy: DIFFERENT THAN LV HYPERTROPHY. |
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Definition
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Term
| Hypertrophic cardiomyopathy: |
|
Definition
- Genetic inheritance: autosomal dominant
- Myositis in disarray
- May hypertrophy assymetrically> obstructing outflow
- Outlet obstruction pulls anterior mitral leaflet out of position, causing regurgitation
- LV filling volume reduced due to diastolic stiffness
- High pulmonary capillary wedge pressure
- Pulmonary hypertension
- Normal LV contractility |
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Term
| Hypertrophic cardiomyopathy may have __ __. |
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Definition
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Term
| With hypertrophic cardiomyopathy the LV filling volume __ due to diastolic stiffness, there is a __ pulmonary capillary wedge pressure, __ hypertension, and __ LV function. |
|
Definition
- decreases
- high
- pulmonary HTN
- normal LV function |
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Term
| Hypertrophic cardiomyopathy: |
|
Definition
| MAY SHOW NORMAL EJECTION FRACTION AND SYSTOLIC MAY LOOK NORMAL> MAIN ISSUE IS DYSARRHYTMIA AND OUTLFOW TRACT OBSTRUCTION |
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Term
| Hypertrophic cardiomyopathy clinical presentation: |
|
Definition
- sudden death
- palpitations/arrhythmias
- chest pain
- dizziness/syncope
- basilar systolic murmur, worse on standing
- resting tachycardia |
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Term
| With hypertrophic heart disease, pts may have basilar systolic murmurs that get worse with __. |
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Definition
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Term
| Hypertrophic Cardiomyopathy essentials: |
|
Definition
- 2D ECHOCARDIOGRAM- MUST GET THIS
- physical exam characteristics
- family history
- EKG may show ST changes |
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Term
| Exaggerated amplitudes on an EKG suggest __ __. |
|
Definition
| hypertrophic cardiomyopathy |
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Term
| Hypertrophic cardiomyopathy therapy: |
|
Definition
- avoid vigorous physical activity
- avoid preload and afterload reducing agent
- myomectomy
- septal ablation with catheters
- Beta blocker/CCB to aid in slowing heart
- Maintain sinus rhythm
- Electronic pacing |
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Term
| Hypertrophic cardiomyopathy essentials of Dx: |
|
Definition
- May present with dyspnea, chest pain, syncope
- Examination shows apical impulse, S4, systolic ejection murmur
- EKG shows LV hypertrophy possibly with septal Q waves in absence of infarction
- Echo shows hypertrophy, which may be assymetric, usually shows normal/enhanced contractily and signs of dynamic obstruction |
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Term
| PE of a pt with hypertrophic cardiomyopathy may show a __ __ __, __, and a __ ___ __. |
|
Definition
- sustained apical impulse
- S4
- systolic ejection murmur |
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Term
| Primary pulmonary HTN is elevation of the __ __ __ and elevation of __ __ __ in the absence of other heart and lung diseases. |
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Definition
- pulmonary vascular pressures
- pulmonary vascular resistance |
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Term
|
Definition
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Term
| There can be secondary causes of pulmonary hypertension and is most common presentation (Groups 2-5) |
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Definition
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Term
| Characteristics of primary pulmonary HTN: |
|
Definition
- Young female > male
- Right ventricular failure presentation
- Increased JVD
- Edema
- Liver enlargement
- CXR- RVH and enlarged pulmonary vasculature
- EKG- RVH
high morbidity and mortality |
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Term
| WHO grouped pulmonary HTN into _ categories. |
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Definition
|
|
Term
|
Definition
- idiopathic causes
- infection causes
- connective tissue disorders
- congenital heart disease
this group needs more aggressive tmt |
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Term
| Group 2 Pulmonary HTN is caused by __ __ __ __. |
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Definition
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Term
| Group 3 pulmonary HTN is caused by __ __. |
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Definition
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Term
| Group 4 pulmonary HTN is caused by __ __ and __ __. |
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Definition
- pulmonary embolus
- pulmonary thrombosis |
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Term
| Group 5 pulmonary HTN is caused by miscellaneous causes that do not fit the other categories. |
|
Definition
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|
Term
|
Definition
Treatment Difficult
Common Med Options - Calcium Channel Blockers (CCB), Digoxin, Diuretics, Oxygen, Warfarin
Endothelin Receptor Antagonists (ERAs) help prevent blood vessels from narrowing.
Phosphodiesterase Inhibitors (PDE 5 Inhibitors) allow the lungs to produce more of its own natural vasodilators.
Inhaled Treatment Options, such as Prostacyclins, relieve shortness of breath.
Intravenous Treatment Options open up the blood vessels and help ease symptoms of PH, including chest pain and shortness of breath.
Subcutaneous Treatment Options are delivered through a portable infusion pump to open up the blood vessels and ease the symptoms of PH.
Lung Transplantation might be appropriate for some patients. Read more from PHA’s Scientific Leadership Council.
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Term
| Cor pulmonale is the pathological effect of _ __on the __ chambers of the heart. |
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Definition
- lung dysfunction
- right chambers
can be acute or chronic |
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|
Term
Cor pulmonale etiology:
KNOW THIS |
|
Definition
- Primary Pulmonary HTN
- Obesity/Hypoventilation Syndrome
- Sleep Apnea (obstructive or central)
- Multiple Pulmonary Emboli Syndrome
- Congenital Heart Disease
- Chronic Interstitial Lung Disease
- Chronic Obstructive Lung Disease
- High Altitude |
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|
Term
| Pathophysiology of cor pulmonale: |
|
Definition
Pulmonary Vascular Bed
Normally compliant with flow reserve
Vascular obliteration 25-50% required to raise pulmonary pressure
Primary result of hypoxia is vascular construction
Acidemia also creates vasoconstriction |
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Term
| Secondary Pulmonary HTN results from: |
|
Definition
- Increased Right Ventricular Output
- Erythrocytosis (Hct>55)
- LV failure
- Mitral regurgitaton |
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Term
| Cor pulmonale right and left ventricular response: |
|
Definition
Right Ventricular Response
RV tolerates volume load better than pressure load
Pulmonary hypertension leads to failure
Acuteness and severity of hypertension determines dilation vs. hypertrophy
Left Ventricular Response
Pulmonary hypertension generally spores the LV
Concomitant LV dysfunction severely worsens pulmonary hypertension
Distention of RV may impede filling of the LV |
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Term
| Cor pulmonale clinical presentation: |
|
Definition
- symptoms usually related to underlying pulmonary d/o
- dyspnea on exertion
- dry cough/wheezing
- atypical chest pain
- leg edema
- abdominal pain/bloating
- anorexia |
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|
Term
|
Definition
- DISTENDED NECK VEINS
- HEPATOMEGALY
- ABDOMINAL ASCITES
- CYANOSIS
- CLUBBING
- Accentuated pulmonic S2
- RV parasternal left
- RV S3 gallop
- Tricuspid regurg murmur
- Cardiac enlargement |
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Term
|
Definition
Signs of RVH
Right atrial enlargement (peaked P waves)
Right bundle branch block
May be normal
Atrial tachy dysrhythmias |
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Term
| Chest x-ray of cor pulmonale: |
|
Definition
Enlargement of RV - “globular heart”
Distention of pulmonary arteries
Peripheral vascular “pruning” |
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Term
| Globular heart refers to enlarged __ __. |
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Definition
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|
Term
| Peaked P waves= cor pulmonale: due to elevated pressure on right side and enlargment of right atrium. |
|
Definition
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|
Term
| An Echo of Cor Pulmonale pt will show __ __ and __ __ __. |
|
Definition
- RV dilation
- paradoxic septal motion |
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|
Term
| Right heart catheterizaton of pt with cor pulmonale will show __ __ __ __ and __ __ __ __. |
|
Definition
- elevated pulmonary artery pressure
- normal capillary wedge pressure |
|
|
Term
|
Definition
Survival up to 8 years after diagnosis has been reported
Appropriate therapy may temporize effects of pulmonary hypertension
Chronic bronchitis patients have poor prognosis
Morbidity variable, but usually high |
|
|
Term
|
Definition
- oxygen reduces pulmonary vasoconstriction
- Dihydropyridine CCB - high doses effective in some
- Intermittent infusion of Prostacyclin helpful in primary pulmonary HTN |
|
|
Term
| drug infusion helpful in primary pulmonary HTN; |
|
Definition
|
|
Term
| Cor Pulmonale essentials of Dx: |
|
Definition
- Symptoms and signs of chronic bronchitis and pulmonary emphysema.
- Elevated jugular venous pressure, parasternal lift, edema, hepatomegaly, ascites.
- ECG shows tall, peaked P waves (P pulmonale), right axis deviation, and right ventricular hypertrophy.
- Chest x-ray: Enlarged right ventricle and pulmonary artery.
- Echocardiogram or radionuclide angiography excludes primary left ventricular dysfunction. |
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|
Term
| Neoplastic disease of the heart: |
|
Definition
Primary tumors rare and constitute
Metastases from malignant tumors elsewhere are more frequent.
Bronchogenic carcinoma
Breast Cancer
Melanoma
Lymphomas
Renal cell carcinoma
Kaposi's sarcoma. |
|
|
Term
| Neoplastic disease of the heart: |
|
Definition
| These are often clinically silent but may lead to pericardial tamponade, arrhythmias and conduction disturbances, heart failure, and peripheral emboli. The diagnosis is often made by echocardiography, but MRI and CT scanning are also helpful. Electrocardiography may reveal regional Q waves. The prognosis is dismal; effective treatment is not available. |
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|
Term
| Primary tumors of the heart: |
|
Definition
- Myxomas (MOST COMMON AND BENIGN)
- Rhabdomyomas
- Fibrous histicytomas
- Hemangiomas
- Sarcomas |
|
|
Term
| MYXOMAS ARE MOST COMMON AND BENIGH TUMORS OF HEART: EASILY TREATED WITH SURGERY BUT SOMETIMES DON’T HAVE TO TREAT. THIS IS MOST COMMON PRIMARY TUMOR SEEN IN HEART (KNOW THIS TEST) |
|
Definition
|
|
Term
| Neoplastic Disease of Heart presentation; |
|
Definition
Outflow obstruction
Cardiac function impediment
Systemic febrile illness
Peripheral emboli
Pulmonary edema
Flow murmurs |
|
|
Term
| Dx of neoplastic disease of heart: |
|
Definition
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|
