Acute Myocarditis

Question 1

What is the typical etiology of acute myocarditis?

Answer 1

Viral etiology usually associated with epidemics

cocksackie ect.

Question 2

The majority of indiv. with acute myocarditis present with:

Answer 2

– Fever
– Chest pain with ECG changes
– Arrhythmia
– Heart failure

Note: 50% have preceding respiratory or GI symptoms

Question 3

With regards to heart physiology, what does acute myocarditis cause?

Answer 3

Dilated cardiomyopathy:
Low ejection fraction (~20%) and heart failure –> (high mortality) –> can further develop a chronic dilated cardiomyopathy

–> Heart failure with a large silent heart with impaired systolic function

Question 4

Clinical manifestations of Dilated cardiomyopathy

Answer 4

1. Heart failure
2. Arrhythmia
3. Thromboembolism

Question 5

What can Arrhythmia from Dilated cardiomyopathy result in?

Answer 5

Injury,
Fibrosis,
Dilation

Question 6

What can thromboembolism from Dilated cardiomyopathy result in?

Answer 6

Dilation,
Poor contraction,
Abnormal surface

Question 7

Activation of AT1 receptors by angiotensin II can result in?

Answer 7

Vasoconstriction
Increased aldosterone release
Sodium Retention
Fibrosis
Increased Sympathetic Activity
Hypertrophy

Question 8

What would you expect BNP levels to be in patients with CHF?

Answer 8

Super elevated compared to pts w/o CHF

Question 9

Treatment of Cardiomyopathy

Answer 9

TREATMENT OF HEART FAILURE
ANTICOAGULATION
ANTI-ARRHYTHMIC AGENTS
ANTI-INFLAMMATORY / IMMUNO-SUPPRESSIVE

Question 10

Treatment of heart failure from dilated cardiomyopathy

Answer 10

Diuretics, ACE Inhibitors, Beta blockers, Aldosterone antagonists, Vasodilators, Inotropes, LVads, Transplant

Question 11

HYPERTROPHIC CARDIOMYOPATHY WITHOUT AORTIC OUTFLOW OBSTRUCTION

• what is it?
• What is a typical symptom?

Answer 11

• Diastolic dysfunction due to impaired diastolic relaxation & increased stiffness
• `Elevated LV diastolic pressure causes increased pulmonary venous & capillary pressures
• Dyspnea on exertion usual symptom

Question 12

HYPERTROPHIC / OBSTRUCTIVE CARDIOMYOPATHY

• what is it?
• what can it result in?

Answer 12

•Asymmetric myocardial hypertrophy –>
Possibly . . . Mitral valve leaflet can obstruct aortic opening during systole
(systolic anterior motion of mitral valve)

• Diastolic dysfunction
• Enhanced systolic dysfunction
• Dynamic left ventricular outflow obstruction
• Propensity for syncope & sudden death

Question 13

Vasodilator (pick one) increases/decreases ventricular volume, and (pick one) increases/decreases outflow obstruction

Answer 13

decreases

Increases

Question 14

HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

• clinical manifestations
• what are they caused by

Answer 14

Variable: Asymptomatic to severe symptoms

1. DYSPNEA
   - cause by Increased LV filling pressure
2. ANGINA
   - Hypertrophic LV
   - Increased systolic LV pressure
3. SUDDEN DEATH
   - Arrhythmia
   - (Frequent cause of sudden death in athletes)

Question 15

HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY TREATMENT

Answer 15

Avoid competitive sports and other extreme exertion
•Decrease contractility – Beta blockers/Verapamil
•Surgical myomectomy or Alcohol ablation
•Automatic Implantable Cardiac Defibrillator if they had a syncope event!!! or else they can die O.O

Question 16

Restrictive cardiomyopathy

- what is it?

Answer 16

Impaired ventricular filling due to
stiff (noncompliant) ventricles

• but note that the ventricles are usually not dilated and systolic fxn is normal