354 Cardiomyopathy Flashcards
Characteristic of restrictive and dilated cardiomyopathy
Increased size of atria
Characteristic of restrictive and hypertrophic cardiomyopathy
First symptoms is exercise intolerance
Common signs and symptoms of Acute viral myocarditis
Heart failure
Common cause of parasitic myocarditis
Chaga’s disease
Alcoholic. Bipedal edema. Dyspnea. What is the diagnosis?
Cardiomyopathy
Most common toxin implicated in chronic dilated cardiomyopathy
Alcohol
Major cause of restrictive cardiomyopathy
Amyloidosis
Does not cause LV hypertrophy A. Anemia B. Systemic hypertension C. Aortic stenosis D. Mitral stenosis
Mitral stenosis
distinguish dilated and hypertrophic cardiomyopathies
LV wall thicknes and cavity dimensions
True or false. Heritability is present in 30% of dialted cardiomyopathy without other clear etiology
True.
True or false. Most familial cardiomyopathies are inherited in an autosomal dominant pattern with occasional autosomal recessive and x-linked inheritance
True.
most commmon mutations in cardiomyopathy
missense mutations with amino acid substitutions
True or false. in dilated cardiomyopathy, systolic dysfunction is more marked than diastolic dysfunction
true.
third most common parasitic infection in the world and the most common cause infective cause of cardiomyopathy
Chagas disease
causes characteristic histlogic chagnes of vacuolar degeneration and myofibrillar loss
anthracyclines
deficiency of this trace element can cause cardiomyopathy
selenium
cardiomypathy from selenium or trace mineral deficiency
Keshan’ disease
causes restrictive cardiomyopathy but the clinical presentation is often dilated cardiomyopathy
hemochromatosis
most recognizable familial cardiomyopathy syndromes with extra cardiac manifestation
muscular dystrophies
presents with apical ballooning
takotsubo cardiomyopathy
major cause of restrictive cardiomyopathy
amyloidosis
least common of the cardiomyopathies
restrictive cardiomyopathy
cardiomyopathy dominated by abnormal diastolic function with at times massively enlarged atria
restrictive cardiomyopathy
Dilated and hypertrophic cardiomyopathies can be distinguished on the basis of
left ventricular wall thickness and cavity dimension;
For all cardiomyopathies, the early symptoms often relate to
exertional intolerance with breathlessness or fatigue,
Common valvular regurgitation in cardiomyopathies
Mitral and tricuspid regurgitation
Common ejection fraction in symptomatic cardiomyopathy
Dilated: less 30% Restricted: 25-50% Hypertrophic: more than 60%
most commonly recognized genetic causes of DCM
truncating mutations of the giant protein titin, encoded by TTN
Best known sarcolemmal membrane proteins defect
dystrophin
Nuclear membrane protein defects in cardiac and skeletal muscle occur in eithe
autosomal (lamin A/C) or X-linked (emerin) patterns
What characterizes dilated cardiomyopathy
An enlarged left ventricle with reduced systolic function as measured by left ventricular ejection fraction characterizes
True or false. Systolic failure is more prominent than diastolic dysfunction in dilated cardiomyopathy
True.
Most common cause of myocarditis
infective agents that can injure the myocardium through direct invasion, production of cardiotoxic substances, or chronic inflammation with or without persistent infection
most commonly associated protozoan causing myocarditis
Trypanosoma cruzi
True or false. Acute viral myocarditis often presents with symptoms and signs of heart failure.
True.
Most common sign and symptoms of acute viral myocarditis
Heart failure
three levels of myocarditis diagnosis
Possible subclinical acute myocarditis Probable acute myocarditis Definite myocarditis
diagnosed when a typical viral syndrome occurs without cardiac symptoms, but with elevated biomarkers of cardiac injury, ECG suggestive of acute injury, reduced left ventricular ejection fraction or regional wall motion abnormality.
Possible subclinical acute myocarditis
accompanied by cardiac symptoms, such as shortness of breath or chest pain, which can result from pericarditis or myocarditis
Probable acute myocarditis
diagnosed when there is histologic or immunohistologic evidence of inflammation on endomyocardial biopsy
Definite myocarditis
Most often detected virus on PCR of the heart
parvovirus B19 and HHV6
True or false. There is currently no specific therapy ecommended during any stage of viral myocarditis.
True.
third most common parasitic infection in the world and the most common infective cause of cardiomyopathy.
Chagas’ disease
The protozoan T. cruzi is transmitted by
bite of the reduviid bug
The most common antiparasitic therapies
benznidazole and nifurtimox
True or false. Survival is <30% at 5 years after the onset of overt clinical heart failure in Chaga’s disease
True.
African trypanosomiasis infection results from
tsetse fly bite
The West African form of trypanosomiasis is caused by
Trypanosoma brucei gambiense
The East African form of trypanosomiasis is caused by
T. brucei rhodesiense
Trichinellosis is caused by
Trichinella spiralis larva ingested with undercooked meat.
True or false. Trichinellosis larva may occasionally invade the myocardium, clinical heart failure is rare.
True.
Bacterial infection that specifically affects the heart in almost one-half of cases, and cardiac involvement is the most common cause of death in patients with this infection.
Diphtheria
Whipple’s disease is caused by
Tropheryma whipplei
The most commonly diagnosed noninfective inflammation
granulomatous myocarditis, including both sarcoidosis and giant cell myocarditis.
True or false. Patients with pulmonary sarcoid are at high risk for cardiac involvement, but cardiac sarcoidosis also occurs without clinical lung disease
True.
Implicated in hypersensitivity myocarditis
thiazides, anticonvulsants, indomethacin, and methyldopa
When does Peripartum cardiomyopathy (PPCM) develop
last trimester or within the first 6 months after pregnancy
Risk factor for peripartum cardiomyopathy
increased maternal age, increased parity, twin pregnancy, malnutrition, use of tocolytic therapy for premature labor, and preeclampsia or toxemia of pregnancy
Implicated in the pathogenesis of peripartum cardiomyopathy
decreased angiogenic reserve
present in 15% of patients with PPCM and are associated with systolic dysfunction that persists.
mutations in TTN
most common toxin implicated in chronic DCM
Alcohol
alcohol consumption necessary to produce cardiomyopathy in an otherwise normal heart has been estimated to be
five to six drinks (about 4 ounces of pure ethanol) daily for 5–10 years
the most common drugs implicated in toxic cardiomyopathy.
Chemotherapy
cause characteristic histologic changes of vacuolar degeneration and myofibrillar loss.
Anthracyclines
True or false. Doxorubicin and trastuzumab are associated with cardiac injury
True.
True or false. The incidence of cardiotoxicity of trastuzumab is lower than for anthracyclines but enhanced by coadministration with them
True.
True or false. Hyperthyroidism should always be considered with new-onset atrial fibrillation or ventricular tachycardia or atrial fibrillation in which the rapid ventricular response is difficult to control
True.
The most common current reason for thyroid abnormalities in the cardiac population
treatment of tachyarrhythmias with amiodarone
True or false. Hyperthyroidism and heart failure create a dangerous combination that merits very close supervision, often hospitalization, during titration of antithyroid medications, during which decompensation of heart failure may occur precipitously and fatally.
True.
due to thiamine deficiency can result from poor nutrition in undernourished populations and in patients deriving most of their calories from alcohol, and has been reported in teenagers subsisting only on highly processed foods.
Beri-beri heart disease
True or false. Abnormalities in carnitine metabolism can cause dilated or restrictive cardiomyopathies, usually in children.
True.
Deficiency of trace elements such as ____ can cause cardiomyopathy
selenium
Selenium deficiency cardiomyopathy
Keshan’s disease
included among the causes of restrictive cardiomyopathy, but the clinical presentation is often that of a DCM
Hemochromatosis
