Cardiology Pathology

Question 1

What types of diseases are referred to as cardiomyopathy?

Answer 1

non-inflammatory diseases of the heart that are not associated withHTN, congenital heart disease, valvular dysfunction, or CAD

Question 2

Define Dilated Cardiomyopathy

Answer 2

four chamber hypertrophy, unexplained dilation, impaired systolic function of one or both ventricles

Question 3

Etiology of dilated cardiomyopathy

Answer 3

Idiopathic

Alcoholism (thiamine
deficiency)

Genetic

Myocarditis

Drugs: chemotherapy (doxorubicin), cocaine, heroin

Organic solvents (“glue sniffers”)

Peripartum (last trimester or within 6 mo postpartum)

Question 4

clinical features of dilated cardiomyopathy

Answer 4

Massive enlargement of all chambers of the heart

Mitral and tricuspid regurgitation

L + R S3 and S4

Narrow pulse pressure due to dec SV

Arrhythmias (ventricular and atrial)

Sudden death

Question 5

What causes the murmurs in dilated cardiomyopathy?

Answer 5

Block in bundle of His > atrial and ventricular arrythmias

Question 5

Work up for dilated cardiomyopathy (and their purpose/findings)

Answer 5

CBC, CMP

BNP (monitor fluid
overload)

Myocardial necrosis markers (tropnonin, CK, CKMB) may be acutely elevated with myocarditis

CXR - enlarged heart, pleural effusion

Angiography - to exclude IHD

Question 6

treatment of dilated cardiomyopathy

Answer 6

Similar to tx for CHF

Treat underlying disease (alcohol abstinence, diet change)

AGEi, ARBs, BB, aldosterone antagonists, cardiac glycosides, vasodilators, anti arrythmia

Acute + severe HF - oxygen, nitrates, furosemide en route to hospital

Question 7

definition of hypertrophic cardiomyopathy

Answer 7

Unexplained hypertrophy of the ventricles

Question 8

Etiology of hypertrophic cardiomyopathy

Answer 8

AD
Chromosome 14
Missense mutation that codes for cardiac sarcomere proteins

Question 9

pathophys of hypertrophic cardiomyopathy

Answer 9

Hypertrophy of the myocardium with greater hypertrophy of IVS than the left ventricular wall itself
(May lead to obstruction of blood flow below aortic valve)

Left ventricular outflow tract may be obstructed as the left ventricle has hypertrophied significantly combined with hypertrophy of interventricular septum

Question 10

Sx of hypertrophic cardiomyopathy

Answer 10

Palpitations

Dizziness (rapid standing, valsalva during defacation)

Angina with exercise

SOB on exertion, CHF, arrythmias

Split S2, S4, harsh systolic ejection murmur (crescendo-decrescendo) along lower left sternal border/apex

Palpable double apical impulse

Question 11

work up/findings for hypertrophic cardiomyopathy

Answer 11

ECG: abnormal and prominent Q wave, short P-R interval

2D echocardiography is diagnostic

Cardiac MRI is useful in dx and assessing severity

Question 12

Treatment of hypertrophic cardiomyopathy

Answer 12

Avoid strenuous exercise

BBs

Avoid drugs that decrease preload (diuretics) or increase force of contraction (digitalis)

Tx of ventricular arrythmias: amiodarone

Question 13

define restrictive cardiomyopathy

Answer 13

Impaired ventricular filling or decreased ventricular compliance with normal systolic function

“Stiffening” of the heart system

Question 14

etiology of restrictive cardiomyopathy

Answer 14

Amyloidosis, sarcoidosis

Myocardial fibrosis after open heart surgery

Radiation

Question 15

Sx of restrictive cardiomyopathy

Answer 15

Gradually worsening SOB

Progressive exercise intolerance/ weakness and Fatigue (due to dec SV and CO)

CHF with normal left ventricular systolic function, arrythmias

Elevated JVP

Loud early diastolic filling sound (S3)

Mitral and tricuspid regurgitation

Question 16

Work up/findings for restrictive cardiomyopathy

Answer 16

ECG: normal or nonspecific ST-T wave changes

Low QRS voltage

CXR - mild cardiac enlargement

Ventricular biopsy can determine etiology