As a Cardiology fellow, we get a lot of consults for HFpEF.
Part 2: Differential Diagnoses
*Not to use as medical advice, just tips, and always discuss with your fellow/attending*
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#MedTwitter #MedEd #Cardiotwitter #IMG
Part 2: Differential Diagnoses
*Not to use as medical advice, just tips, and always discuss with your fellow/attending*
-thread ๐งต-
#MedTwitter #MedEd #Cardiotwitter #IMG
Hypertrophic Cardiomyopathy:
- Uusually made in the presence of left ventricular hypertrophy without concomitant hypertension or aortic stenosis
- Should review family history
- Predilection for SCD, ventricular arrhythmias, and/or LVOT obstruction
- Will make separate thread!
- Uusually made in the presence of left ventricular hypertrophy without concomitant hypertension or aortic stenosis
- Should review family history
- Predilection for SCD, ventricular arrhythmias, and/or LVOT obstruction
- Will make separate thread!
Cardiac Amyloidosis:
- Amyloidosis is due to deposition of amyloid (abnormal protein) in organ tissue
- Primary amyloidosis: hematological malignancy when monoclonal plasma cells produce a light chain immunologlobulin
- Early stages with subclinical diastolic dysfunction
- Amyloidosis is due to deposition of amyloid (abnormal protein) in organ tissue
- Primary amyloidosis: hematological malignancy when monoclonal plasma cells produce a light chain immunologlobulin
- Early stages with subclinical diastolic dysfunction
Cardiac Amyloidosis:
- Later stages show a severe restrictive cardiomyopathy
- Familial amyloidosis: inheritance of a gene that produces a mutant form of transthyretin; produced in the liver and deposited in the kidneys, heart, and nerves.
- Later stages show a severe restrictive cardiomyopathy
- Familial amyloidosis: inheritance of a gene that produces a mutant form of transthyretin; produced in the liver and deposited in the kidneys, heart, and nerves.
Endomyocardial Fibrosis:
- Idiopathic restrictive CM that occurs close to the equator (Africa, South America, Asia)
- Characterized by granulation tissue, collagen, and extensive connective tissue lining the myocardium
- Associated with AF, MR, thromboembolism
- Poor prognosis
- Idiopathic restrictive CM that occurs close to the equator (Africa, South America, Asia)
- Characterized by granulation tissue, collagen, and extensive connective tissue lining the myocardium
- Associated with AF, MR, thromboembolism
- Poor prognosis
Loeffler (Eosinophilic) Endocarditis:
- Features include eosinophilia, restrictive cardiomyopathy, nervous system, and bone marrow involvement
- Can be associated with LV thrombus
- Treatment includes corticosteroids and hydroxyurea
- Features include eosinophilia, restrictive cardiomyopathy, nervous system, and bone marrow involvement
- Can be associated with LV thrombus
- Treatment includes corticosteroids and hydroxyurea
Cardiac Sarcoidosis:
- Can present with a restrictive cardiomyopathy, but more commonly produces a dilated CM phenotype
- Associated with conduction disease and ventricular tachyarrhythmia
- Can present with a restrictive cardiomyopathy, but more commonly produces a dilated CM phenotype
- Associated with conduction disease and ventricular tachyarrhythmia
Radiation Carditis:
- Affects almost all components of the heart
- Direct myocardial involvement with diastolic dysfunction; can have concomitant valvular, coronary, and/or pericardial disease
- Affects almost all components of the heart
- Direct myocardial involvement with diastolic dysfunction; can have concomitant valvular, coronary, and/or pericardial disease
Metabolic Storage Disorders:
- Characterized by intracellular deposition of substances within the myocyte, resulting in increased myocardial stiffness.
Hemochromatosis: Iron overload, can cause restrictive cardiomyopathy, usually presents with dilated cardiomyopathy
- Characterized by intracellular deposition of substances within the myocyte, resulting in increased myocardial stiffness.
Hemochromatosis: Iron overload, can cause restrictive cardiomyopathy, usually presents with dilated cardiomyopathy
Metabolic Storage Disorders:
Glycogen storage diseases: Can present w/ cardiac manifestations, asymptomatic increase in LV thickness
Gaucher's disease: deficiency in B-glucosidase w/ cerebroside deposition in multiple organs (including heart, leading to diastolic dysfunction)
Glycogen storage diseases: Can present w/ cardiac manifestations, asymptomatic increase in LV thickness
Gaucher's disease: deficiency in B-glucosidase w/ cerebroside deposition in multiple organs (including heart, leading to diastolic dysfunction)
Remember when evaluating HFpEF and diastolic dysfunction, try to determine other differential diagnoses and the underlying etiology.
Stay tuned for part 3 next: Therapy & Treatment for HFpEF. Let me know what you think! ๐
Stay tuned for part 3 next: Therapy & Treatment for HFpEF. Let me know what you think! ๐
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