252-254 Hf, Cm, Transplant

Question 1

MCC HFpEF

Answer 1

Htn 75%

Cad 60-75%

Question 2

Normal jvp height

Answer 2

8cm

Question 3

Normal pulmo artery pressure

Answer 3

15mmHg

Question 4

Dilated cardiomyopathy tx

Answer 4

• almost 1/2 shows spontaneous recovery
• bb, raas inhibitors
• cardiac resynchronization pacing: in whom lbbb precedes clinical hf by many years

Question 5

Dallas criteria for myocarditis

Answer 5

• lymphocytic infiltrate with evidence of myocarditis

Question 6

Mcc myocarditis

Answer 6

Infective

• viral
• t cruzi: most common infective caus eof ccardiomyopathy and 3rd mc parasitic infxn in the world

Question 7

Viral myocarditis

Answer 7

No effective tx

Question 8

Viral myocarditis

Answer 8

No effective tx

Question 9

Chagas disease phases, dx, tx

Answer 9

• acute: nonspecific
• chronic: progresses over 10-30yrs, gi and cardiac (conduction system abnormalities)
• dx: at least 2 serologic positive test
• tx: supportive, benznidazole/nifurtimox unclear if can prevent disease progression
• <30% 5yr survival when onset of clinical hf

Question 10

African trypanosomiasis

Answer 10

• tse tse fly
• western: t. Brucei gambiense, slow silent progression
• eastern: t. Brucei rhodesiende, rapid progression
• antiparasitic tx of limited efficacy

Question 11

Bacterial infection myocarditis

Answer 11

Diphtheria - affects 1/2 of cases and is mcc death, antitoxin priority over antibiotic
Clostridium - abscess
Strep (GAS) - rheumatic fever
Tb
Tropheryma whipplei - tx antitb meds, high recurrence
Lyme disease: resolves in 1-2 wks of tx

Question 12

Sarcoidosis

Answer 12

• right ventricular affectation
• dx: pet scan, biopsy of mediastinal ln (partchy cardiac involvement likely to be missed with cardiac biopsy)
• tx: glucocorticoids, immunosuppression

Question 13

Giant cell myocarditis

Answer 13

• granulomatous lesions surrounded by extensive inflammatory infiltrate unlikely to be missed on myocardial biopsy
• tx: glucocort + immunosuppression
• rapid detoriation

Question 14

Eosinophilic myocarditis

Answer 14

• churg strauss
• malignancy
• hypersensitivity: antibiotics, thiazides, methyldopa, anticonvulsants, indomethacin
• glucocort and withdrawal of offending agent

Question 15

Peripartum cardiomyopathy onset and risk factors

Answer 15

Last trimester and first 6mos postpartum

- age, parity, twin, mulnutrition, use of tocolytic, preecclampsia

Question 16

Mcc toxic cardiomyopathy

Answer 16

• Alcohol
• Contribute to >10% of hf
• 5-6drinks (4oz of pure alcohol) daily for 5-10yrs
• improvement in 3-6mos of cessation
• tx: neurohormonal antagonist and diuretics

Question 17

Chemotx cardiomyopathy

Answer 17

1. Anthracyclines
   - vacuolar degeneration and myofibrillar loss
   - occur late after exposure
   - tx: neurohormonal antagonist and bb
2. Trastuzumab
   - less than anthracyclines
   - reversible
3. 5fu, cisplatin, alkylators
   - coronary vasospasm
4. Carfilzumab>bortezomib
5. Ipilimumab, nivolumab - fulminant myocarditis when combined
6. Vegf inhibitors

Question 18

Beri beri

Answer 18

High output cardiac failure

Question 19

Left ventricular noncompaction findings

Answer 19

• taz gene (tafazzin)

- multiple trabeculations in the lv distal to the papillary muscles

Question 20

Left ventricular noncompaction triad

Answer 20

1. Arrhythmia
2. Heart failure
3. Emboli
   Tx: anticoag, icd, neurohormonal antagonist

Question 21

Takotsubo cardiomyopathy

Answer 21

• apical ballooning syndrome, global ventricular dilation with basal contractikn
• ecg: mimic mi
• intense sympathetic activation
• no tx supportive (bb, nitrates for pulmo edema,mgso4 for long qt arrhythmia), prognosis generally good

Question 22

Fabry disease biopsy findings

Answer 22

Diagnostic vesicles containing concentric lamellar figures

Question 23

Danon’s disease

Answer 23

Lamp2 gene: x linked

Cardiomyopathy, mental retardation, skeletal myopathy

Question 24

Restrictive carduomyopathy amyloidosis gene

Answer 24

• Transthyretin V122I chromosome 13
• 50%risk of hf
• Refractile brightness on 2d echo
• amyloid fibrils infiltrate the conduction system and coronary arteries
• if primary amyloid tx: bortezomib

Question 25

Loeflers endocarditis

Answer 25

Eosinophilic injury to the myocardium
Dense fibrotic layer obliterate the ventricular apices
Tx glucocorticoids

Question 26

Hocm 80% of mutations are due to

Answer 26

• myh7
• mybpc3: average onset 40y/o
• obstruction + in 30%, provoked by exercise in another 30%
  Tx: bb, ccb, disopyramide (antiarrhythmic with potent negative inotropic properties)

Question 27

Cardiac transplant cold ischemia time

Answer 27

4hrs

Question 28

Cardiac conditioning hormone used

Answer 28

Thyroid

Question 29

Most common heart transplant surgery

Answer 29

• bicaval orthotopic cardiac transplant

- denervated: if with bradycardia cannot be treated with atropine need to give isoproterenol

Question 30

Triple drug immunosuppresion for cardiac transplantation

Answer 30

• calcineurin inhibitor (cyclosporine, tacrolimus)
• glucocorticoids
• antiproliferative immunosuppression (azathioprine, mycophenolate mofetil, sirolimus, everolimus)

Question 31

Assist devices

Answer 31

• heart mate II:pulsatile, intrathoracic+ abdominal, no intrinsic pulse
• heart ware: continuous centrifugal flow
• heart mate III: continuous, fully intrathoracic magnetically levitated, with intrinsic pulse
  (MOMENTUM trial)
• syncardia: biventricular

Question 32

Reductions in mortality
Acei
Bb
Spironolactone

Answer 32

Ace inhibitor 23%
Beta blocker 35%
Spironolactone 30%