ACTIVITY DISCLAIMER

Cardiomyopathies

CPT Megan Mahowald, MD

ACTIVITY DISCLAIMER

The material presented here is being made available by the American Academy of Family Physicians for educational purposes only. Please note that medical information is constantly changing; the information contained in this activity was accurate at the time of publication. This material is not intended to represent the only, nor necessarily best, methods or procedures appropriate for the medical situations discussed. Rather, it is intended to present an approach, view, statement, or opinion of the faculty, which may be helpful to others who face similar situations. The AAFP disclaims any and all liability for injury or other damages resulting to any individual using this material and for all claims that might arise out of the use of the techniques demonstrated therein by such individuals, whether these claims shall be asserted by a physician or any other person. Physicians may care to check specific details such as drug doses and contraindications, etc., in standard sources prior to clinical application. This material might contain recommendations/guidelines developed by other organizations. Please note that although these guidelines might be included, this does not necessarily imply the endorsement by the AAFP.

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DISCLOSURE

It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. All individuals in a position to control content for this session have indicated they have no relevant financial relationships to disclose. The content of my material/presentation in this CME activity will not include discussion of unapproved or investigational uses of products or devices.

CPT Megan Mahowald, MD

Physician/Hospital Medicine Fellow, Department of Family Medicine, Womack Army Medical Center (WAMC), Fort Bragg, North Carolina Dr. Mahowald is a Captain in the U.S. Army. She earned her medical degree from the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and completed a family medicine residency at Madigan Army Medical Center in Tacoma, Washington. She is a firstyear hospital medicine fellow at WAMC. She earned a master's degree in education and continues to pursue her dual interest in medicine and education by creating, implementing, and improving the inpatient medicine curricula for the WAMC Family Medicine Residency Program and the hospital medicine fellowship program.

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Learning Objectives

1.

Suspect Hypertrophic cardiomyopathy (HCM) in patients with

certain history, physical findings, and ECG abnormalities.

2.

Screen for cardiomyopathy, in accordance with current clinical

guidelines.

3.

Include genetic counseling during evaluation of patients with

familial inheritance.

4.

Initiate appropriate medical therapy in patients with the

obstructive form of HCM.

Additional Learning Objectives:

? Understand the various methods for classification of cardiomyopathy

? Recognize, evaluate, and treat the various types of cardiomyopathy

? Initiate a work-up for underlying etiology of cardiomyopathy

? Counsel families on genetic components of cardiomyopathy, available genetic testing, and completion of surveillance

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Audience Engagement System

Step 1

Step 2

Step 3

Associated Session

? (PBL) Cardiomyopathies

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AES Question #1

Which of the following is the appropriate method for classification of cardiomyopathies?

A. The MOGE(s) nomenclature B. By the underlying cause C. By morphology and hemodynamic effect D. Whatever my cardiologist says... E. All of the above

CARDIO MYO PATHY

(heart) (muscle) (disease)

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CARDIO MYO PATHY

(heart) (muscle) (disease)

1. 1995 World Health Organization Classification 2. 2006 American College of Cardiology (ACC)/American Heart

Association (AHA) 3. 2008 European Society of Cardiology (ESC) 4. 2013 MOGE(s) Classification World Health Organization

CARDIO MYO PATHY

1995 WHO/ISFC 2006 ACC/AHA

?Dilated

?Primary

?Hypertrophic

-Genetic

?Restrictive ?Arrhythmogenic ?Unclassified

-Mixed -Acquired

?Secondary

2008 ESC

Familial vs Non-familial

?Dilated ?Hypertrophic ?Restrictive ?Arrhythmogenic RVC ?Arrhythmogenic CM ?Unclassified

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MOGE(s)

? 2013 WHO ? Based on TNM

staging system

Example:

MH OH GAD EG-MYBPC3[IVS16-1G>A] SB-II

Eloisa Arbustini et al. JACC 2014;64:304-318v

CARDIO MYO PATHY

Jorge Muniz,

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Case One: Mr. Lou E. Fraction

35 year old male who presents to the ED with 2 weeks of progressive shortness of breath with exertion and new lower extremity edema. His dad died suddenly at age 40.

Case courtesy of Dr Andrew Dixon, , rID: 10666

Dilated Cardiomyopathy

Echocardiogram courtesy of Ryan Flanagan, MD FAAP FACC

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