Cardiology – Cardiomyopathies & Myocardium

Question 1

Therapy for Takotsubo’s cardiomyopathy?

Answer 1

#ACE Inhibitors
 #Beta Blockers

Question 2

Most common causes of infectious myocarditis?

Biopsy will show?

Answer 2

#Adenovirus
 #Coxsackie
 #Enterovirus

#Myocardial necrosis and/or degeneration
#Adjacent inflammatory infiltrate

Question 3

Indications for biopsy and patient with suspected infectious myocarditis?

Answer 3

#Ventricular arrhythmia
#High-grade conduction block (2nd or 3rd degree)
#Lack of response to usual heart failure therapy

Question 4

Patient with acute myocarditis – percentage of patients that eventually recover cardiac function? Often takes how long before LV recovery?

Answer 4

50%

6-12 months

Question 5

Patient under 40 presents with ventricular arrhythmias and progressive cardiac dysfunction despite medical therapy – suspected diagnosis? Treatment?

Answer 5

Giant cell myocarditis

#Aggressive immunosuppressive therapy
#Cardiac transplantation bridged with VADs

Question 6

Patient with atrial fibrillation presents with very frequent PVCs (over 10,000 per day) – at risk for developing? Management? Acquire this lab?

Answer 6

Tachycardia-related cardiomyopathy

Control HR

TSH

Question 7

2 Pathophysiologic mechanisms of hypertrophic cardiomyopathy?

Answer 7

Diastolic dysfunction (elevated filling pressures) from abnormal relaxation and poor myocardial compliance

Left ventricular outflow tract obstruction from septal hypertrophy and anterior displacement of mitral valve apparatus

Question 8

Left particular outflow obstruction in hypertrophic cardiomyopathy is exacerbated by what type of drugs?

Answer 8

#Inotropic agents 
#Digoxin

Question 9

Patient presents with rapid and bifid carotid upstroke – suspected diagnosis? Should also look for?

Answer 9

Hypertrophic cardiomyopathy

#Bifid carotid upstroke (pulsus bisferiens)
#Heightened A wave (infundibular hypertrophy)
#Sustained bifid/trifid apical impulse
#S4
#Paradoxical splitting of S2

Question 10

LVOT obstruction murmur is best heard where?

Inhalation of this may make the murmur louder? (Mechanism?)

Answer 10

Lower left sternal border

amyl nitrate (decreases afterload)

Question 11

Systolic Murmurs that get louder with increased preload?

Systolic Murmurs that come quieter?

Answer 11

Hypertrophic cardiomyopathy

Aortic stenosis, mitral regurgitation

Question 12

LVOT obstruction is considered significant when?

Answer 12

Calculated pressure gradient is 30+ at rest or 50+ with provocation

Question 13

Hypertrophic cardiomyopathy versus athlete’s heart:

1. Family history
2. EKG findings
3. Diastolic filling on ECHO
4. Extent of hypertrophy (in mm)
5. Pattern of hypertrophy
6. Left ventricular diastolic dimension
7. Gadolinium hyper-enhancement on cMRI
8. Percent predicted peak VO2
9. Change after deconditioning

Answer 13

1. Positive versus negative
2. Q waves, TWIs, conduction defects versus non-
3. Filling abnormalities versus normal filling
4. Over 15 mm versus under 12 m
5. Any pattern versus concentric
6. Under 45 mm versus over 55 mm
7. Present versus absent
8. Under 100% versus over 120% (over 50 mL/kg/min)
9. No regression versus regression over 2 mm

Question 14

44

Answer 14

44

Question 15

Cardiomyopathy caused by emotional or physiological stress? Theorized pathogenesis? Telltale ECHO finding? EKG finding?

Answer 15

Takotsubo

Sympathetic mediated myocytes injury

Hypokinetic apex but normal mid-heart contractility

#ST segment elevation
#diffuse deep T-wave inversions
#QTc prolongation