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C. Year 3 Cardiology Random NOT on MLA map > Cardiomyopathies > Flashcards

Cardiomyopathies Flashcards

1
Q

Cardiomyopathy relates to disease of the myocardium of the heart. Dilated cardiomyopathy is when the chambers of the heart dilate. What is the estimated prevalence of dilated cardiomyopathy in the UK?

1 - 1/25
2 - 1/250
3 - 1/2500
4 - 1/250,000

A

3 - 1/2500

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2
Q

Cardiomyopathy relates to disease of the myocardium of the heart. Dilated cardiomyopathy is when the chambers of the heart dilate. If a patient has dilated cardiomyopathy, what can this lead to?

1 - IHD
2 - ACS
3 - HF
4 - cardiogenic shock

A

3 - HF
- walls of heart become thin and weak
- less able to pump blood efficiently

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3
Q

In dilated cardiomyopathy the myocardium of the heart has to enlarge. Is this by concentric or eccentric hypertrophy?

A
  • eccentric hypertropy
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4
Q

All of the following can cause dilated cardiomyopathy, but which is the most common cause?

1 - idiopathic
2 - infection
3 - alcoholism
4 - drugs
5 - wet beriberi (low vitamin B1)
6 - pregnancy
7 - genetics

A

1 - idiopathic

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5
Q

What % of dilated cardiomyopathy is linked with genetics?

1 - 0.25%
2 - 3.5%
3 - 35%
4 - 65%

A

3 - 35%

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6
Q

Are males of females more affected by dilated cardiomyopathies?

A
  • males
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7
Q

What age group does dilated cardiomyopathies typically occur in?

1 - 2-10 y/o
2 - 10-20y/o
3 - 20-60y/o
4 - >65y/o

A

3 - 20-60y/o
- more common in African-Americans than in Caucasians

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8
Q

All of the following are common signs of dilated cardiomyopathies, EXCEPT which one?

1 - dyspnoea
2 - weakness and fatigue
3 - oedema and pulmonary congestion
4 - raised JVP
5 - organomegaly (cardiac, liver, spleen)
6 - arthralgia
7 - loud third and/or fourth heart sound

A

6 - arthralgia

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9
Q

In a patient with dilated cardiomyopathy, all of the following could happen, EXCEPT which one?

1 - arrhythmias
2 - valvular regurgitation
3 - reduced ejection fraction
4 - all of the above

A

4 - all of the above

  • arrhythmias = conduction system of heart is irritated as it has become thinner
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10
Q

When trying to diagnose a patient with dilated cardiomyopathy, which 2 of the following are we likely to see on an X-ray?

1 - cardiomegaly
2 - enlarged hilar lymph nodes
3 - pulmonary oedema
4 - hyper-inflated lungs

A

1 - cardiomegaly
3 - pulmonary oedema

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11
Q

What might we see on an ECG in a patient with dilated cardiomyopathy?

1 - sinus tachycardia
2 - intraventricular conduction delay
3 - left bundle branch block
4 - nonspecific changes in ST and T waves
5 - all of the above

A

5 - all of the above

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12
Q

What might we see on an echocardiogram in a patient with dilated cardiomyopathy?

1 - dilation of the LV cavity
2 - reduced systolic and diastolic function
3 - valvular regurgitation
4 - all of the above

A

4 - all of the above

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13
Q

Although a full blood workup should be done, which 2 of the following would be most suggestive of dilated cardiomyopathy?

1 - brain natriuretic peptide (BNP)
2 - K+
3 - Na+
4 - troponin

A

1 - brain natriuretic peptide (BNP)
3 - Na+

  • BNP increases Na+ excretion to lower fluid levels and H2O follows
  • high BNP = poor prognosis
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14
Q

In dilated cardiomyopathy, would you avoid giving a patient with acute or chronic heart failure a beta blocker?

A
  • acute heart failure
  • can be used in well managed chronic HF
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15
Q

What medication is indicated in a patient with dilated cardiomyopathy with obvious fluid retention?

1 - Furosemide
2 - Ramipril
3 - Losartan or Candesartan
4 - Spironolactone

A

1 - Furosemide

  • loop diuretic
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16
Q

Patients with dilated cardiomyopathy can be prescribed an angiotensin II inhibitor. Which of the following drugs is an angiotensin II inhibitor?

1 - Furosemide
2 - Ramipril
3 - Losartan or Candesartan
4 - Spironolactone

A

2 - Ramipril

  • reduces effects of RAAS system
17
Q

Patients with dilated cardiomyopathy can be prescribed an angiotensin II receptor inhibitor. Which of the following drugs is an angiotensin II receptor inhibitor?

1 - Furosemide
2 - Ramipril
3 - Losartan or Candesartan
4 - Spironolactone

A

3 - Losartan or Candesartan

  • if unable to have ACE-II
18
Q

Patients with dilated cardiomyopathy can be prescribed an aldosterone antagonist. Which of the following drugs is an aldosterone antagonist?

1 - Furosemide
2 - Ramipril
3 - Losartan or Candesartan
4 - Spironolactone

A

4 - Spironolactone

19
Q

Patients with dilated cardiomyopathy can be prescribed a beta blocker. Which of the following drugs is a beta blocker?

1 - Furosemide
2 - Ramipril
3 - Losartan or Candesartan
4 - Spironolactone
5 - Bisoprolol

A

5 - Bisoprolol

  • reduces effects of sympathetic nervous system and arrhythmias
20
Q

Which diabetes medication has recently been shown to be affective in reducing fluid retention and reducing mortality in dilated cardiomyopathy patients?

1 - Metformin
2 - Dapagliflozin
3 - Dulaglutide
4 - Linagliptin

A

2 - Dapagliflozin

  • SGLT2 inhibitor
  • blocks the Na+/glucose transporter
  • reduces glucose absorption, producing an osmotic diuresis
21
Q

If a patient has developed dilated cardiomyopathy, they are susceptible to AF. What medication should therefore be prescribed?

1 - direct-acting oral anticoagulant (DOACs)
2 - warfarin
3 - thrombolytic agents
4 - low molecular weight heparin

A
  • direct-acting oral anticoagulant (DOACs)

-Factor Xa inhibitors = Edoxaban, Apixaba, Rivaroxaban
-Thrombin inhibitors = Dabigatran

22
Q

Which of the following are treatments that can be used in patients with severe dilated cardiomyopathies?

1 - heart transplant
2 - biventricular pacing
3 - left ventricular assist device (LVAD)
4 - all of the above

A

4 - all of the above
- dilated cardiomyopathy is most common cause of heart transplant

23
Q

Hypertrophic cardiomyopathy is when the walls of the heart become thick and hyper-contractile causing inappropriate LV hypertrophy. How common is this in the general population?

1 - 1 in 5
2 - 1 in 50
3 - 1 in 500
4 - 1 in 5000

A

4 - 1 in 5000
- 0.2% prevalence in UK

  • most common cause of sudden cardiac death in <30 y/o
24
Q

Hypertrophic cardiomyopathy is when the walls of the heart become thick and hyper-contractile causing inappropriate LV hypertrophy. Although this can be sporadic, aprox 50% can be caused by genetic mutations. How is this transmitted?

1 - autosomal recessive
2 - autosomal dominant
3 - X-linked recessive
4 - Y-linked dominant

A

2 - autosomal dominant
- typically mutations are present in

  • 35% - B-myosin heavy chain
  • 15% - Troponin T
  • tropomyosin
25
Q

Hypertrophic cardiomyopathy is when the walls of the heart become thick and hyper-contractile causing inappropriate LV hypertrophy. This can cause the LV posterior septum to enlarge significantly. What can this then cause?

1 - mitral valve stenosis due to high pressure
2 - reduced BP
3 - outflow obstruction
4 - right sided heart failure

A

3 - outflow obstruction

26
Q

Hypertrophic cardiomyopathy is when the walls of the heart become thick and hyper-contractile causing inappropriate LV hypertrophy. A patient with hypertrophic cardiomyopathy can present with all of the following EXCEPT which one?

1 - Chest pain / breathlessness
2 - palpitations / dizziness / syncope
3 - murmur (MR)
4 - raised JVP

A

4 - raised JVP

27
Q

When trying to diagnose a patient with hypertrophic cardiomyopathy, which of the following may we see on an ECG?

1 - LV hypertrophy
2 - deep narrow Q waves
3 - ST and T wave abnormalities
4 - all of the above

A

4 - all of the above

28
Q

Which 2 of the following imaging modalities can be used to assess asymmetric LV hypertrophy, LV outflow tract gradient and systolic anterior motion of mitral valve / MR in a patient with suspected hypertrophic cardiomyopathy?

1 - echocardiogram
2 - doppler ultrasound
3 - MRI
4 - chest X-ray

A

1 - echocardiogram
3 - MRI

29
Q

Hypertrophic cardiomyopathy can cause dyspnea and chest pain. Bisoprolol (B-blocker) or Verapamil (Ca2+ channel blocker) can be given to elicit what effects?

1 - reduced chronotropic effect (HR)
2 - reduced inotropic effect (force)
3 - reduce myocardial O2 demand
4 - reduce LV outflow tract gradient
5 - all of the above

A

5 - all of the above

30
Q

Patients with hypertrophic cardiomyopathy are at an increased risk of arrhythmias as the conduction pathway of the heart is typically the cause of death. Which of the following drug classes would be prescribed to a patient with hypertrophic cardiomyopathy and AF or VT?

1 - bisoprolol
2 - amiodarone
3 - edoxaban
4 - all of the above

A

4 - all of the above

  • bisoprolol = beta blocker
  • amiodarone = K+ channel blocker
  • edoxaban = factor Xa inhibitor - ONLY FOR AF
  • ablation can also be offered where required
31
Q

If a patient has hypertrophic cardiomyopathy and is high risk, what should they be treated with?

1 - surgery to reduce heart size
2 - implantable cardioverter defibrillator (ICD)
3 - lifelong medication and monitoring
4 - all of the above

A

2 - implantable cardioverter defibrillator (ICD)

32
Q

To asses the risk in patients with hypertrophic cardiomyopathy we can use the hypertrophic cardiomyopathy risk score. What score automatically means patients qualify for an implantable cardioverter defibrillator (ICD)?

1 - mortality risk >4%
2 - mortality risk >6%
3 - mortality risk >10%
4 - mortality risk >20%

A

2 - >6%
- >4% is considered

33
Q

In addition with being given an implantable cardioverter defibrillator (ICD), high risk for mortality (>6%) patients with hypertrophic cardiomyopathy will also receive echocardiograms and ECGs. How often are these typically performed?

1 - every 12 weeks
2 - every 1 year
3 - every 2 years
4 - every 4 years

A

3 - every 2 years

34
Q

What causes Arrhythmogenic cardiomyopathy (ACM)?

1 - hyperglycaemia
2 - hypoglycaemia
3 - lipid deposits in RV
4 - MI

A

3 - lipid deposits in RV

35
Q

In arrhythmogenic cardiomyopathy (ACM) which is a build up of lipids in the heart, what happens to the RV?

1 - concentric hypertrophy and dilation
2 - concentric hypertrophy and thickening
3 - eccentric hypertrophy and dilation
4 - all of the above

A

3 - eccentric hypertrophy and dilation

36
Q

What % of arrhythmogenic cardiomyopathy (ACM) is genetic?

1 - 3-5%
2 - 30-35%
3 - 30-50%
4 - >50%

A

3 - 30-50%

37
Q

What common symptoms can a patient with arrhythmogenic cardiomyopathy (ACM) present with?

1 - dysponea
2 - LOC
3 - exertional symptoms
4 - all of the above

A

4 - all of the above

38
Q

What is the annual mortality of arrhythmogenic cardiomyopathy (ACM)?

1 - 2%
2 - 20%
3 - 40%
4 - >50%

A

1 - 2%

39
Q

Restrictive cardiomyopathy (RCM) can cause an increased myocardial stiffness that impedes diastolic ventricular filling. Which of the following can cause this?

1 - sarcoidosis
2 - amyloidosis
3 - inherited storage diseases (eg Fabry, Gaucher)
4 - all of the above

A

4 - all of the above

C. Year 3 Cardiology Random NOT on MLA map (5 decks)

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