Diastolic Dysfunction Lecture Powerpoint

Question 1

Diastolic Heart failure is also known as…

Answer 1

…heart failure with preserved ejection fraction (HFPEF)

Question 2

Diastolic dysfunction is ____ most commonly in patients

Answer 2

Asymptomatic

Question 3

Young patients are likely to experience ____ type of heart failure, while older patients are likely to experience ____

Answer 3

systolic, diastolic

Question 4

Diastolic heart failure symptoms (5)

Answer 4

• dyspnea***
• pulmonary edema
• left sided heart failure symptoms
• Elevated BNP
• Evidence of increased ventricular wall thickness on echo

Question 5

Diastolic heart failure causes (3)

Answer 5

• chronic hypertension** with LVH
• Aortic stenosis with LVH
• ischemic heart disease

Question 6

Diastolic dysfunction is a source of….

Answer 6

…..atrial fibrillation, atrial fib is poorly tolerated in diastolic heart failure (diastolic heart failure does not tolerate tachycardia well)

Question 7

Diastolic heart failure involves a ____ ventricle, and has a drop in ____ because of decreased ____

Answer 7

Stiff (noncompliant), stroke volume, end diastolic volume

Question 8

Diastolic dysfunction definition

Answer 8

Abnormal cardiac relaxation, filling, or distensibility resulting in elevating filling pressure being needed to achieve normal ventricular filling (to normal EDV), often done thru the RAAS

Question 9

Differential diagnosis of diastolic heart failure (3)

Answer 9

• obesity
• lung disease
• volume overload

Question 10

Physical exam finding of diastolic heart failure

Answer 10

S4

Question 11

Laboratory studies for diastolic heart failure (4)

Answer 11

• Echo***
• BNP
• EKG (LVH, left atrial hypertrophy)
• CXR

Question 12

1 drug treatment for hypertension

Answer 12

ACEI

Question 13

It is important not to use ____ in treating systolic heart failure, but can use them in diastolic heart failure

Answer 13

Non-hydropyridine Ca2+ channel blockers

Question 14

Cardiomyopathy definition

Answer 14

General term indicating disease of cardiac muscle resulting in abnormal function not due to hypertension, ischemic disease, or valvular disease

Question 15

Ischemic cardiomyopathy

Answer 15

A pseudocardiomyopathy that is the leading cause of heart failure in developed countries

Question 16

List the true cardiomyopathies (4)

Answer 16

• dilated (ventricular dilation)
• hypertrophic (myocardial hypertrophy)
• Restrictive (impaired filling due to fibrosis)
• Arrhythmogenic right ventricular (uhh skip this)

Question 17

Dilated cardiomyopathy

Answer 17

Most common true cardiomyopathy, characterized by dilation and impaired systolic function of right or left ventricle globally, 50% of cases unknown etiology, others include viral infection or familial inheritance

Question 18

Dilated cardiomyopathy clinical features (4)

Answer 18

• both R/L heart failure
• arrhythmia
• thrombus
• S3

Question 19

Dilated cardiomyopathy treatment options (5)

Answer 19

• B blockers
• ACEI
• Diuretics
• Cardiac resyncronization therapy
• Transplant

Question 20

Hypertrophic cardiomyopathy

Answer 20

Unexplained myocardial hypertrophy disproportional to hemodynamic load with disarray of muscle fibers, inherited in most cases, most common cardiovascular cause of death in athletes

Question 21

Hypertrophic cardiomyopathy differs from left ventricular hypertrophy in that….

Answer 21

….it is disproportional to hemodynamic load and asymmetrical

Question 22

Hypertrophic cardiomyopathy clinical features (4)

Answer 22

• dyspnea
• chest pain
• syncope
• sudden death

Question 23

Hypertrophic cardiomyopathy diagnostic studies (2)

Answer 23

• echo is diagnostic

- EKG

Question 24

Hypertrophic cardiomyopathy treatment options (3)

Answer 24

• automatic implantable cardioverter defibrillator (AICD)
• Myectomy
• Catheter directed alcohol ablation

Question 25

Restrictive cardiomyopathy

Answer 25

Restrictive ventricular filling and reduced diastolic volumes with normal or near normal wall thickness, uncommon in IS and presents with diastolic dysfunction (poor prognosis)

Question 26

Restrictive cardiomyopathy causes (3)

Answer 26

- amyloidosis - sarcoidosis - drug induced fibrosis

Question 27

Restrictive cardiomyopathy clinical presentation (3)

Answer 27

- Dyspnea - Fatigue - Elevated venous pressures (both sides of heart equally effective)

Question 28

Restrictive cardiomyopathy diagnostic studies (3)

Answer 28

- EKG low voltage - Echo - biopsy

Question 29

Restrictive cardiomyopathy may present similar to...

Answer 29

...restrictive pericarditis

Question 30

Amyloidosis and what 2 cardiomyopathies is it seen with? What characteristic feature does it present with?

Answer 30

Abnormal proteins produced by plasma cells in bone marrow, deposit in tissues and organs and cause structural and functional damage - seen with hypertrophy and restrictive cardiomyopathy - Low voltage on EKG despite hypertrophy on echo (nonconductive tissue)

Question 31

Hemochromatosis and what two cardiomyopathies is it seen with?

Answer 31

- Inherited disorder of iron metabolism causing overload and accumulation in different organs of the body - Dilated or restricted cardiomyopathy