Cardiology

Question 1

What is the MC type of cardiomyopathy

What is the hallmark PE finding for this condition

Answer 1

Dilated: systolic dysfunction due to decreased strength and dilation of heart chambers

S3 gallop

Question 2

What are the 6Ds for Dilated Cardiomyopathy

Answer 2

Dunno- idiopathic (MC)
Drugs
Drinking
Dz: Chagas
Deficient- B1, Thiamine
Doxorubicin

Question 3

How is Dilated Cardiomyopathy Dx

What meds are used only for Sx relief but have no effect on mortality

Answer 3

Echo- EF <40%
CXR- balloon-like heart

Furosemide, Digoxin

Question 4

What meds are used for Dilated Cardiomyopathy Tx that improve mortality?

When are LVAD/ICD considered?

Answer 4

BBs
ACEI
Spironolactone
Hydralazine Nitrate (Isosorbide Dinitrate)

EF <30, V-Fib, Cardiac arrest

Question 5

Deficiency of thiamine and what two others can lead to dilated cardiomyopathy?

What types of arrhythmias can lead to this condition?

Answer 5

Selenium, Carnitine

Prolonged tachycardia
Frequent PVCs
Frequent RV pacing

Question 6

Define Quebec beer-drinker cardiomyopathy?

What is the MCC of sudden cardiac death in young athletes in the US?

Answer 6

Dilated cardiomyopathy from cobalt exposure

HOCM

Question 7

Dilated cardiomyopathy Pts presenting w/ dyspnea need to have what lab added to their work up?

All Pts w/ dilated cardiomyopathy w/ A-fib should be treated with DOACs unless what condition is present?

Answer 7

BNP- establishes prognosis and severity

Mitral stenosis

Question 8

When would a cardiac MRI be preferred imaging over Echo?

When is a biopsy indicated and most useful?

Answer 8

RV dysplasia

Transplant rejection

Question 9

Define HOCM

What type of murmur does this cause?

Answer 9

Ventricular hypertrophy causing diastolic dysfunction

Mid-systolic crescendo-decrescendo that decreases w/ squatting and handgrips, increases w/ standing and Valsalva

Question 10

What type of genetic mutation causes HOCM?

This condition presents similar to what valvopathy?

Answer 10

Autosomal dominant sarcomere mutation- abnormal contraction ability due to mishandling of Ca by myosin heavy chains

Aortic stenosis

Question 11

HOCM presents w/ what PE finding?

What type of JVP finding may be seen?

Answer 11

S4 gallop w/ apical lift
Bisferiens pulse: two palpable beats during systole (also seen in AS/insufficiency)
Triple apical pulse

Prominent A-wave: increased resistance to right atrial emptying

Question 12

After Dx w/ Echo, what meds are used for HOCM management?

What drugs need to be avoided?

Answer 12

Metoprolol and/or Diltiazem/Verapamil: dec contractility and slows HR (decreased velocity)

Dec preload: nitrates, ACEI/ARB, diuretics
Digoxin- c/i, increased contractility which increases obstruction

Question 13

When are ICD considered for HOCM PTs?

What is the Echo criteria for making a Dx?

Answer 13

Hx of syncope or sudden cardiac arrest

LV wall >1.5cm (15mm, 13mm if +FamHx) thick

Question 14

What is a long term consequence and poor prognosis sign for Pts w/ HOCM?

How are Pts refractory to pharmaceutical therapies Tx?

Answer 14

A-fib

Myomectomy;
Alcohol septal ablation

Question 15

Define Restrictive Cardiomyopathy

What PE finding will be seen?

Answer 15

Non-compliant ventricular walls that resist diastolic filling

S4, Kussmaul sign: inc JVP w/ inspiration due to increased volume in internal jugular vein

Question 16

How is Restrictive Cardiomyopathy Dx

What is the MCC?

Answer 16

Echo and Cardiac Cath
Most definitive: biopsy; apple green birefringence w/ Congo red staining

Amyloidosis > Hemochromatosis, Sarcoidosis