2S_3_HEART FAILURE TABLES & CARDIOMYOPATHY

CLINICAL TYPES OF HEART FAILURE:

1. HF with r___ Ejection Fraction (HFrEF)

2. HF with m___e Ejection Fraction (HFmEF)

3. HF with p___d Ejection Fraction (HFpEF)

1. HF with reduced Ejection Fraction (HFrEF)

2. HF with midrange Ejection Fraction (HFmEF)

3. HF with preserved Ejection Fraction (HFpEF)

CLINICAL TYPES OF HEART FAILURE:

HF with reduced Ejection Fraction (HFrEF)

EF < 40%

CLINICAL TYPES OF HEART FAILURE:

HF with midrange Ejection Fraction (HFmEF)

EF = 40-49%

CLINICAL TYPES OF HEART FAILURE:

HF with preserved Ejection Fraction (HFpEF)

EF > 50%

STAGES OF HEART FAILURE: HOW MANY STAGES

4

STAGES OF HEART FAILURE: At high risk for HF but without structural heart disease and symptoms of HF

STAGE A

STAGES OF HEART FAILURE: With structural heart disease but without signs or symptoms of HF

STAGE B

STAGES OF HEART FAILURE: With structural heart disease and prior or current symptoms of HF

STAGE C

STAGES OF HEART FAILURE: Refractory HF

STAGE D

NEW YORK HEART ASSOCIATION CLASSIFICATION:

HOW MANY CLASSES

4

NEW YORK HEART ASSOCIATION CLASSIFICATION:

Patients with cardiac disease but without resulting limitation of physical activity.

CLASS 1

NEW YORK HEART ASSOCIATION CLASSIFICATION:

Ordinary physical activity does not cause undue fatigue, palpitations, dyspnea, or anginal pain

CLASS 1

NEW YORK HEART ASSOCIATION CLASSIFICATION:

Patients with cardiac disease resulting in slight limitation of physical activity.

CLASS 2

NEW YORK HEART ASSOCIATION CLASSIFICATION:

They are comfortable at rest.

CLASS 2 & 3

NEW YORK HEART ASSOCIATION CLASSIFICATION:

Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.

CLASS 2

NEW YORK HEART ASSOCIATION CLASSIFICATION:

Patients with cardiac disease resulting in marked limitation of physical activity.

CLASS 3

NEW YORK HEART ASSOCIATION CLASSIFICATION:

Less than ordinary activity fatigue, palpitation, dyspnea, or anginal pain

CLASS 3

NEW YORK HEART ASSOCIATION CLASSIFICATION:

Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort.

CLASS 4

NEW YORK HEART ASSOCIATION CLASSIFICATION:

Symptoms of heart failure or the anginal syndrome may be present even at rest.

CLASS 4

NEW YORK HEART ASSOCIATION CLASSIFICATION:

If any physical activity is undertaken, discomfort is increased.

CLASS 4

Diseases of heart muscle that result from a myriad of insults

CARDIOMYOPATHIES

CARDIOMYOPATHIES: result from a myriad of insults such as:

1. G___c defects

2. C___ m___e injury

3. I___n of m___al tissues

1. Genetic defects

2. Cardiac myocyte injury

3. Infiltration of myocardial tissues

CARDIOMYOPATHIES: Results from insults to:

1. C___ el___s of the h___t, notably the cardiac m___

2. Processes that are e___l to cells such as d___ of a___al substances into the e___r matrix

1. Cellular elements of the heart, notably the cardiac myocyte

2. Processes that are external to cells such as deposition of abnormal substances into the extracellular matrix

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

1. D___d Cardiomyopathy

2. H___c Cardiomyopathy

3. R___e Cardiomyopathy

4. A___c Right Ventricular Dysplasia/Cardiomyopathy

1. Dilated Cardiomyopathy

2. Hypertrophic Cardiomyopathy

3. Restrictive Cardiomyopathy

4. Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

the most common cardiomyopathy

DILATED CARDIOMYOPATHY (DCM)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

enlargement of one or both of the ventricles and systolic dysfunction

DILATED CARDIOMYOPATHY (DCM)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

not uncommon for chamber enlargement to precede signs and symptoms of congestive heart failure

DILATED CARDIOMYOPATHY (DCM)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

DILATED CARDIOMYOPATHY (DCM): Common causes:

1. I__A

2. H__

1. ISCHEMIA

2. HTN

CARDIOMYOPATHY: DILATED CARDIOMYOPATHY (DCM):

Idiopathic DCM in __%

50%

SPECIFIC DILATED CARDIOMYOPATHY:

1. T___O (S___S-I___D) CM

2. P___UM CARDIOMYOPATHY

3. TA___-INDUCED CARDIOMYOPATHY

4. A___ CARDIOMYOPATHY

5. I___C CARDIOMYOPATHY

6. V___AR CARDIOMYOPATHY

7. H___E CARDIOMYOPATHY

8. I___Y CARDIOMYOPATHY

9. M___C CARDIOMYOPATHY

10. G___L S___ DISEASE

11. MUSCULAR D___

12. N___R DISORDERS

13. SE___Y AND T___ REACTIONS

1. TAKOTSUBO (STRESS-INDUCED) CM

2. PERIPARTUM CARDIOMYOPATHY

3. TACHYCARDIA-INDUCED CARDIOMYOPATHY

4. ALCOHOLIC CARDIOMYOPATHY

5. ISCHEMIC CARDIOMYOPATHY

6. VALVULAR CARDIOMYOPATHY

7. HYPERTENSIVE CARDIOMYOPATHY

8. INFLAMMATORY CARDIOMYOPATHY

9. METABOLIC CARDIOMYOPATHY

10. GENERAL SYSTEMIC DISEASE

11. MUSCULAR DYSTROPHIES

12. NEUROMUSCULAR DISORDERS

13. SENSITIVITY AND TOXIC REACTIONS

SPECIFIC DILATED CARDIOMYOPATHY:

Broken Heart Syndrome

TAKOTSUBO (STRESS-INDUCED) CM

SPECIFIC DILATED CARDIOMYOPATHY:

Provoked by a stressful or emotional situation

TAKOTSUBO (STRESS-INDUCED) CM

SPECIFIC DILATED CARDIOMYOPATHY:

Most common among middle-aged women

TAKOTSUBO (STRESS-INDUCED) CM

SPECIFIC DILATED CARDIOMYOPATHY:

Appears to be related to catecholamine release

TAKOTSUBO (STRESS-INDUCED) CM

SPECIFIC DILATED CARDIOMYOPATHY:

Fully reversible with supportive care in most cases

TAKOTSUBO (STRESS-INDUCED) CM

SPECIFIC DILATED CARDIOMYOPATHY:

Manifests between the last month of pregnancy and 6 months postpartum

PERIPARTUM CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Etiology is unclear (inflammatory factors, lymphocytic inflammation)

PERIPARTUM CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Common in Africa but also manifests in the developed world (3rd world countries like PH)

PERIPARTUM CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Excellent long-term natural history if patients survive the initial period

PERIPARTUM CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Increased risk of recurrences c subsequent pregnancies

PERIPARTUM CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Patients may develop a DCM with CHF in the face of recurrent or persistent tachycardias

TACHYCARDIA-INDUCED CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Most common association is with atrial fibrillation or supraventricular tachycardia (SVT)

TACHYCARDIA-INDUCED CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

High rate of full recovery with control of the arrhythmia

TACHYCARDIA-INDUCED CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Patients always have a fast heart rate

TACHYCARDIA-INDUCED CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

The most common secondary CM

ALCOHOLIC CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Closely resembles idiopathic DCM

ALCOHOLIC CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Linked to ongoing excessive alcohol consumption

ALCOHOLIC CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Dose-related and responsive to cessation of alcohol exposure

ALCOHOLIC CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Alcohol exposure also increases risk for comorbidities that can contribute to cardiovascular disease, such as HTN, stroke, arrhythmias, and SCD

ALCOHOLIC CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Arise as dilatred cardiomyopathy with depressed ventricular function not explained by the extent of coronary artery obstructions or ischemic damage

ISCHEMIC CARDIOMYOPATH

SPECIFIC DILATED CARDIOMYOPATHY:

D/t chronic poor perfusion to the heart caused by plaque build up

ISCHEMIC CARDIOMYOPATH

• Heart muscle develops weakness over time, even if plaque obstruction is not big

SPECIFIC DILATED CARDIOMYOPATHY:

Arises as ventricular dysfunction that is out of proportion to the abnormal loading conditions produced by the valvular stenosis and/or regurgitation

VALVULAR CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Can be attributed to valve problems–stenosis and regurgitation, leading to loading problems (eg. more blood retained in the chambers)

VALVULAR CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Arises with left ventricular hypertrophy with features of cardiac failure related to systolic or diastolic dysfunction

HYPERTENSIVE CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Most common reason for dilated CM

HYPERTENSIVE CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Cardiac dysfunctuion as a consequence of myocarditis (if viral)

INFLAMMATORY CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Common instance in the past: COVID Myocarditis

INFLAMMATORY CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Includes a wide variety of causes, including endocrine abnormalities (such as thyroid function), glycogen storage disease, deficiencies (such as hypokalemia), and nutritional disorders

METABOLIC CARDIOMYOPATHY

SPECIFIC DILATED CARDIOMYOPATHY:

Includes connective tissue disorders and infiltrative diseases such as sarcoidosis and leukemia

GENERAL SYSTEMIC DISEASE

SPECIFIC DILATED CARDIOMYOPATHY:

Autoimmune diseases are systemic → can affect heart

GENERAL SYSTEMIC DISEASE

SPECIFIC DILATED CARDIOMYOPATHY:

MUSCULAR DYSTROPHIES: Includes:

1. D___e

2. B___-type

3. M___c dystrophies

1. Duchenne

2. Becker-type

3. myotonic dystrophies

SPECIFIC DILATED CARDIOMYOPATHY:

NEUROMUSCULAR DISORDERS: Includes:

1. F___ ataxia

2. N___n syndrome

3. L___s

1. Friedreich ataxia

2. Noonan syndrome

3. Lentiginosis

SPECIFIC DILATED CARDIOMYOPATHY:

Includes reactions to alcohol, catecholamine, anthrcyclinesm irradiation, some cance drugs (can weaken the heart) and others

SENSITIVITY AND TOXIC REACTIONS

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Most common of the genetic cardiovascular diseases

HYPERTROPHIC CARDIOMYOPATHY (HCM)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Caused by a multitude of mutations in genes encoding proteins of the cardiac sarcomere

HYPERTROPHIC CARDIOMYOPATHY (HCM)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Characterized by heterogenous clinical expression, unique pathophysiology, and a diverse clinical course, including sudden cardiac death (SCD) in the young

HYPERTROPHIC CARDIOMYOPATHY (HCM)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

May be responsible for heart failure–related disability at virtually any age

HYPERTROPHIC CARDIOMYOPATHY (HCM)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Thickened, but non-dilatred left ventricle in the absence of another cardiac or systemic condition capable of producing the magnitude of hypertrophy evident

HYPERTROPHIC CARDIOMYOPATHY (HCM)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

About 0.2% in the general population (e.g.,1:500)

HYPERTROPHIC CARDIOMYOPATHY (HCM)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Most affected individual may remain undiagnosed (Common in athletes, they collapse in-game because they were undiagnosed)

HYPERTROPHIC CARDIOMYOPATHY (HCM)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES: HYPERTROPHIC CARDIOMYOPATHY (HCM): OTHER NAMES:

1. I___ H___ c S___ c Stenosis (IHSS)

2. H___ c O___ e Cardiomyopathy (HOCM)

3. M___ r S___ c Stenosis (MSS)

1. Idiopathic Hypertrophic Subaortic Stenosis (IHSS)

2. Hypertrophic Obstructive Cardiomyopathy (HOCM)

3. Muscular Subaortic Stenosis (MSS)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Occurs with lower frequency in the developed world

RESTRICTIVE AND INFILTRATIVE CARDIOMYOPATHY

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Increase in stiffness of the ventricular walls, which causes heart failure because of impaired diastolic filling of the ventricle

RESTRICTIVE AND INFILTRATIVE CARDIOMYOPATHY

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Deterioration in systolic function is usually observed as the disease progresses

RESTRICTIVE AND INFILTRATIVE CARDIOMYOPATHY

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Most often, it is invariably progressive with an accelerated mortality

RESTRICTIVE AND INFILTRATIVE CARDIOMYOPATHY

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

No specific therapy for the idiopathic form of restrictive cardiomyopathy

RESTRICTIVE AND INFILTRATIVE CARDIOMYOPATHY

RESTRICTIVE CARDIOMYOPATHY: CAUSES:

NON-INFILTRATIVE:

1. I____ CM

2. F____l CM

3. H____c CM

4. Sc____a

5. P____a e____m

6. D____ CM

1. Idiopathic CM

2. Familial CM

3. Hypertrophic CM

4. Scleroderma

5. Pseudoxanthoma elasticum

6. Diabetic CM

RESTRICTIVE CARDIOMYOPATHY: CAUSES:

INFILTRATIVE:

1. A____s

2. S____s

3. G____r disease

4. H____r disease

5. F____ infiltration

1. Amyloidosis

2. Sarcoidosis

3. Gaucher disease

4. Hurler disease

5. Fatty infiltration

RESTRICTIVE CARDIOMYOPATHY: CAUSES:

STORAGE DISEASE:

1. H____sis

2. F____ disease

3. Gl____ storage disease

1. Hemochromatosis

2. Fabry disease

3. Glycogen storage disease

RESTRICTIVE CARDIOMYOPATHY: CAUSES:

ENDOMYOCARDIAL:

1. En____l fibrosis

2. H____ic syndrome

3. C____ heart disease

4. M____c cancers

5. R____n

6. A____e

7. Drugs causing fi____ en____itis (serotonin, methysergide, ergotamine, mercurial agents, busulfan)

1. Endomyocardial fibrosis

2. Hypereosinophilic syndrome

3. Carcinoid heart disease

4. Metastatic cancers

5. Radiation

6. Anthracycline

7. Drugs causing fibrous endocarditis (serotonin, methysergide, ergotamine, mercurial agents, busulfan)

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Progressive fibrofatty replacement of the right, and to some degree left, ventricular myocardium (Fat cannot contract)

ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Familial disease is common

ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

RV failure with jugular venous distention, hepatomegaly, and edema

ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

Clinical manifestations usually develop during the second decade

ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA

CARDIOMYOPATHY: STRUCTURAL & FUNCTIONAL PHENOTYPES:

• fatal ventricular tachyarrhythmias

• varying degrees of RV failure

ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA

SYMPTOMATOLOGY:

CHF, left sided

DILATED

SYMPTOMATOLOGY:

Fatigue

DILATED, RESTRICTIVE, HYPERTROPHIC

SYMPTOMATOLOGY:

Weakness

DILATED

SYMPTOMATOLOGY:

Systemic emboli

DILATED

SYMPTOMATOLOGY:

Pulmonary emboli

DILATED

SYMPTOMATOLOGY:

Dyspnea

RESTRICTIVE, HYPERTROPHIC

SYMPTOMATOLOGY:

CHF, right sided

RESTRICTIVE

SYMPTOMATOLOGY:

Signs and symptoms of systemic disease

RESTRICTIVE

SYMPTOMATOLOGY:

Angina

HYPERTROPHIC

SYMPTOMATOLOGY:

Syncope

HYPERTROPHIC

SYMPTOMATOLOGY:

Palpitations

HYPERTROPHIC

PROGNOSIS: T OR F:

Heart failure prognosis is naturally a downhill course.

TRUE