CARDIO- CMP

Question 1

Pt has enlargement of all chambers, HTN and PMH of arrythmias. What is the DX

Answer 1

Dilated CARDIOMYOPATHY (CMP)
SYS AND DYS DFX
MC** HF-post MI/ischemia

Question 2

What is anatomic and physiologic of Dilated CMP causes?

Answer 2

○ Myocarditis (viral)
○ Alcohol
○ Chemotherapy
○ Pregnancy
○ Connective tissue disease
○ Sepsis

Question 3

On Echo the person has LV thickening, palpitation, fatigue, SOB? What are the concerns?

Answer 3

Hypertrophic CMP (HCM)
MC athletes - SCD**
S/S/CP
SOB
orthopnea
angina
fatigue
syncompe
palpitattions
S4 (ten..nese)

Question 4

Ms. Choo 65yo smoker has dyspnea and fatigue. Last echo showed cardiomegaly. What EKG finding are MC?

Answer 4

NSSTC- no specifif ST changes
AV blocks
Ventricul Ectopy

Question 5

Ms. Choo 65yo smoker has dyspnea and fatigue. Last echo showed cardiomegaly. What EHCO finding are MC?

Answer 5

Dilated LV, LOW CO
BOTH HFpEF and HFrEF
Enlarged Atria
MV regurgitation

Question 6

Ms. Choo 65yo smoker has dyspnea and fatgiue. Last echo showed cardiomegaly. What other workups labs?

Answer 6

CXR- emergent only. Pulmonary edema, cardiomegaly
Stress Echo
Angiogam
BNP enxymes-Find cause

Question 7

What is first line of TX for Ms. choo dyspnea and fatigue d/t Dilated CMP?

Answer 7

find the cause
Tx sx of HF- ACEI,ARB,
AVOID- alcohol, Na
IF severe-consider implants ICD (high risk), LVAD, surgery

Question 8

Mr. Lewis, former MLB has CP SOB, angina, syncope during exercise. What is DX?

Answer 8

HYPERTROPHIC CMP - HCM
Thick LV muscle
DEC BLOOD FLOW
CP- SOB, orthopnea, angina, fatigue, syncope, palpitation, ankle edema, S4 (ten…ne.se)

Question 9

Mr. Lewis, former MLB has CP SOB, angina, syncope during exercise. What is cardio test is next?

Answer 9

EKG
LVH
NSST
Q-waves- old MI, scar tissue

Question 10

Mr. Lewis, former MLB has CP SOB, angina, syncope during exercise. What are MC ECHO results?

Answer 10

MC-LVH
Asym septal hypertrophy
Small LV volume
DIASTOLIC DYSFX-filling defect

Question 11

Mr. Lewis, former MLB has CP SOB, angina, syncope during exercise. What are other workup?

Answer 11

NO CXR bc will not show much

Cardiac MRI ideal

Question 12

Mr. Uptight has major diastolic dsyfx on echo with rigid walls movement?

Answer 12

RESTRICTVE CMP
strained R&L wall
LC type
Worst prognosis
IMPAIRE FILLING
FH
R/t- amyloidosis, sarcoidosis, hemacrhomatosis, scleroderma

Question 13

Mr. Uptite begins to feel dyspnea, fatigue after ECHO showed major filling defect. What other maybe present

Answer 13

RESTRICTIVE CMP CP
PE- S3+S4 sounds
Mitral valve regurg
RHF- rare

Question 14

Mr. Uptite begins to feel dyspnea, fatigue after ECHO showed major filling defect. What are EKG findings?

Answer 14

LOW voltage-non specific

Question 15

Mr. Uptite begins to feel dyspnea, fatigue after ECHO showed major filling defect. What are other ECHO findings

Answer 15

LARGE RV
Stage 4 Diastolic dysfx

LASt endomysial biopsy

Question 16

IF Mr. Uptite has a filling defect, what TX is ideal?

Answer 16

Diuretics- dec work load
PAH- sildenafil, floven
Transplant

Question 17

Mr. Lewis, former MLB has CP SOB, angina, syncope/dizzy during exercise at risk for? What is best TX?

Answer 17

BB or CCB
Surgery- ablation, myoectomy
ICD- implanted defibrillator
Valve replacement

Question 18

What and why is Mr. Lewis, former MLB has CP SOB, angina, syncope/dizzy during exercise at risk for?

Answer 18

SCD- d/t ventricula tacyarrhythmi/tachycardia
LV outflow obstruction- not rare surgery helpful
Genetic**
MC of sudden death in young athletes
any age

Question 19

What is hallmark cause of syncope in athletes/ HCM r/t SCD?

Answer 19

d/t LV outflow tract obstruction leading to decreased cerebral perfusion

MC-no symptoms

Occurs in sleep to exercise
BK#1 highest risk
FB
Soccer in Eruope

Question 20

Sarah, a 13 yo swimmer has had syncope in the last race, he MOM had similar experiences? What is the DDX and who else is at risk?

Answer 20

SCD d/ HCOM
PMH of Cardiac arrest (VF-ventricular fibrillation)
○ Spontaneous sustained VT
○ FH of premature sudden death
○ Unexplained syncope
○ LV thickness ≥ 30 mm
○ Abnormal exercise BP
○ Non-sustained spontaneous VT

Question 21

What are individual risk outside FH?

Answer 21

Possible in individual patients
○ AF-Atrial fibrillation
○ Myocardial ischemia
○ LVOTO-Left ventricular outflow tract obstruction
○ High-risk mutation
○ Intense (competitive) physical exertion

Question 22

Has athlete sudden death rates DEC even

participation screening strategies?

Answer 22

NO. Evidence does not show significant changes

Screening strategy: ​family
and personal history, physical examination, and 12-lead ECG
Questions:
CP, SOB
DOE
syncope, fatigue
Marfan
QT syndrome

Question 23

Sarah received 12 ECG with postive findings of LVH, NSSTC, septal Q waves? What is next step to determine her activity

Answer 23

ECHO
Stress test
24 Holter cardia
MRI
Angio/EMB. EPS

Question 24

Mrs. Presley is in clinic w/ c/c of chest pain? Her EKG showed ST-segment elevation. What are her DDX

Answer 24

Takosubo/ Broken heart syndrome/Stress-induced cardiomyopathy

PMP Women 1-2%

Reverislbe CMP mimics acute coronary syndrome ACS
d/t emotional/physical stressors

LABS- EKG, Troponin
Echo- wall-motion abnormalities, absence of obstructive coronary lesions. ​ apical ballooning​.

TX- ​spontaneous, rapid recovery within weeks.