NURS 5461 Cardiomyopathy Latest Exam With
Accurate Solutions 100% Verified
CARDIOMYOPATHIES - ANSWER A large group of diseases of the myocardium that
result in mechanical and/or electrical pump dysfunction
DCM: INFECTIOUS-ANSWER Acute viral myocarditis Coxasackie B or echovirus
Self-limited infection in young people Mechanism?: • Myocyte cell death and fibrosis •
Immune mediated injury • BUT: • No change with immunosuppressive drugs
DCM: TOXIC-ANSWER Alcoholic cardiomyopathy Reversible with abstinence
Mechanism?: • Myocyte cell death and fibrosis
DCM: PERIPARTUM - ANSWER Diagnostic Criteria 1 mo pre, 5 mos post, Proposed
mechanisms: • Inflammatory Cytokines: • TNFa, IL6, Fas/AP01
HYPERTROPHIC
CARDIOMYOPATHY (HCM) - ANSWER Common genetic CV disease (autosomal
dominant mutation 55%). Remainder are spontaneous mutations.
HCM PATHO - ANSWER Wall of left ventricle thickens (but ventricle size remains normal)
• Can block blood flow out of left ventricle - need to distinguish between obstructive and
nonobstructive forms • Mitral regurgitation • Arrhythmias
HCM DIAGNOSIS AND DIFFERENTIAL - ANSWER • Characterized by unexplained LV
hypertrophy associated with nondilated ventricular chambers • LV wall thickness
>15mm • Cardiac imaging such as ECHO • Genetic testing • Screen all 1st degree family
members - risk of affect patient will transmit disease to offspring is 50% • Differential
diagnosis • Other cardiac conditions with LVH - hypertensive heart disease or "athlete's
hear
, TESTING RECOMMENDATIONS FOR HCM - ANSWER • 12-lead ECG • 24 hour
ambulatory Holter to detect VT (may be ICD candidates) • Transesophageal
echocardiogram • ?Stress testing • Cardiac MRI when ECHO inconclusive • Coronary
arteriography (invasive or CT imaging) for patient with chest discomfort who have
likelihood of CAD
TREATMENT FOR HCM Asymptomatic patients • - ANSWER Treat any comorbidities
(HTN, diabetes, hyperlipidemia, obesity) with existing guidelines • Low intensity aerobic
exercise • Use of B-blocker and CCB not well established • **high dose diuretics or
vasodilators should be avoided if have LVOT obstruction
TREATMENT FOR HCM Symptomatic patients • - ANSWER **B-blockers 1st line agent
(negative inotrop) • CCB - Verapamil for patients who don't respond or cannot tolerate
B-blockers • ACE or ARBs not well established with HCM with preserved systolic
function • Do *not* use dihydropyridine CCBs in HCM with LVOT obstruction •
Disopyramide can be added for patients with obstructive HCM who remain symptomatic
despite B-blockers and CCBs • No therapy has been shown to improve mortality
HCM: SURGICAL TREATMENT - ANSWER myectomy removal of small portion of upper
IV septum +/- mitral valve replacement 5 year symptomatic benefit in ~ 70% of patients
Dual Camber (DDD pacemaker) pacing decreases LVOT gradient (by~25%)
-ETOH septal ablation
-ICD to prevent sudden death
RESTRICTIVE CARDIOMYOPATHY (RCM)-ANSWER characterized by restrictive filling
and reduced diastolic volume W/ normal or near-normal systolic function and wall
thickness. •least common of the 3 clinically recognized and described
cardiomyopathies. • Its principal abnormality is diastolic dysfunction— specifically,
restricted ventricular filling. RCM accounts for approximately 5% of all cases of primary
heart muscle disease.
RCM Causes - ANSWER Amyloid, sarcoidosis, fibrosis (Endemic in parts of Africa, India,
South and Central America, Asia 15-25% of cardiac deaths in equatorial Africa
hypereosinophilic syndrome (Loffler's endocarditis)
Accurate Solutions 100% Verified
CARDIOMYOPATHIES - ANSWER A large group of diseases of the myocardium that
result in mechanical and/or electrical pump dysfunction
DCM: INFECTIOUS-ANSWER Acute viral myocarditis Coxasackie B or echovirus
Self-limited infection in young people Mechanism?: • Myocyte cell death and fibrosis •
Immune mediated injury • BUT: • No change with immunosuppressive drugs
DCM: TOXIC-ANSWER Alcoholic cardiomyopathy Reversible with abstinence
Mechanism?: • Myocyte cell death and fibrosis
DCM: PERIPARTUM - ANSWER Diagnostic Criteria 1 mo pre, 5 mos post, Proposed
mechanisms: • Inflammatory Cytokines: • TNFa, IL6, Fas/AP01
HYPERTROPHIC
CARDIOMYOPATHY (HCM) - ANSWER Common genetic CV disease (autosomal
dominant mutation 55%). Remainder are spontaneous mutations.
HCM PATHO - ANSWER Wall of left ventricle thickens (but ventricle size remains normal)
• Can block blood flow out of left ventricle - need to distinguish between obstructive and
nonobstructive forms • Mitral regurgitation • Arrhythmias
HCM DIAGNOSIS AND DIFFERENTIAL - ANSWER • Characterized by unexplained LV
hypertrophy associated with nondilated ventricular chambers • LV wall thickness
>15mm • Cardiac imaging such as ECHO • Genetic testing • Screen all 1st degree family
members - risk of affect patient will transmit disease to offspring is 50% • Differential
diagnosis • Other cardiac conditions with LVH - hypertensive heart disease or "athlete's
hear
, TESTING RECOMMENDATIONS FOR HCM - ANSWER • 12-lead ECG • 24 hour
ambulatory Holter to detect VT (may be ICD candidates) • Transesophageal
echocardiogram • ?Stress testing • Cardiac MRI when ECHO inconclusive • Coronary
arteriography (invasive or CT imaging) for patient with chest discomfort who have
likelihood of CAD
TREATMENT FOR HCM Asymptomatic patients • - ANSWER Treat any comorbidities
(HTN, diabetes, hyperlipidemia, obesity) with existing guidelines • Low intensity aerobic
exercise • Use of B-blocker and CCB not well established • **high dose diuretics or
vasodilators should be avoided if have LVOT obstruction
TREATMENT FOR HCM Symptomatic patients • - ANSWER **B-blockers 1st line agent
(negative inotrop) • CCB - Verapamil for patients who don't respond or cannot tolerate
B-blockers • ACE or ARBs not well established with HCM with preserved systolic
function • Do *not* use dihydropyridine CCBs in HCM with LVOT obstruction •
Disopyramide can be added for patients with obstructive HCM who remain symptomatic
despite B-blockers and CCBs • No therapy has been shown to improve mortality
HCM: SURGICAL TREATMENT - ANSWER myectomy removal of small portion of upper
IV septum +/- mitral valve replacement 5 year symptomatic benefit in ~ 70% of patients
Dual Camber (DDD pacemaker) pacing decreases LVOT gradient (by~25%)
-ETOH septal ablation
-ICD to prevent sudden death
RESTRICTIVE CARDIOMYOPATHY (RCM)-ANSWER characterized by restrictive filling
and reduced diastolic volume W/ normal or near-normal systolic function and wall
thickness. •least common of the 3 clinically recognized and described
cardiomyopathies. • Its principal abnormality is diastolic dysfunction— specifically,
restricted ventricular filling. RCM accounts for approximately 5% of all cases of primary
heart muscle disease.
RCM Causes - ANSWER Amyloid, sarcoidosis, fibrosis (Endemic in parts of Africa, India,
South and Central America, Asia 15-25% of cardiac deaths in equatorial Africa
hypereosinophilic syndrome (Loffler's endocarditis)
