Cardiomyopathies

Question 1

Types of cardiomyopathies

Answer 1

1. Dilated/congestive
2. **HOCM
3. Restrictive CM

Question 2

Dilated cardiomyopathy characteristics

Answer 2

1. Dilated ventricles
2. Muscle power lost
3. Systolic heart failure
4. Involves both ventricles
5. Mcc of heart transplants

Question 3

Etiology of Dilated cardiomyopathy

Answer 3

1. Idiopathic - mc
2. Alcohol
3. Postpartum
4. Post infection-viral/parasite/mycobacterium/rickettsia
5. Drugs: Vincristine, cyclophosphamide, Doxorubicin
6. Toxins: Lead, arsenic, cobalt
7. ↓K/Ca/Phosphate, ↑UA (uric acid)

Question 4

C/f of Dilated cardiomyopathy

Answer 4

RHF and LHF features
1. SOB, dyspnoea, orthopnoea, dry cough
2. Ankle edema
3. Abdominal discomfort - hepatomegaly, ascites
4. weak/lethargy
5. Syncope
6. Displaced apical beat - lateral to mid-clavicular line, 6th intercostal space

Systolic dysfunction - ↓ejection fraction
<35% - mortality↑ - ICD indicated (implantable cardioverter/defibrillator)

Question 5

Mx of dilated cardiomyopathy

Answer 5

Similar to systolic HF
ACEI/ARB

If edema+:
Furesemide
Add Spironolactone (aldosterone antagonist) if still +
Add B Blockers - compensated/euvolaemic pts
Add Digoxin (lot of S/E)
…
Still not controlled/Severe HF with <25% HF
ARNI - angiotensin receptor naprolysin inhibitor
1. Valsartan
2. Sacubitril

Can try - empaglifloxin (only diabetic drug which protects heart)

Can try evabradin

Question 6

**HOCM characteristics

Answer 6

Mcc- Heredity AD - chr 14
Interventricular septum (sometimes LV) hypertrophy
Blood cannot enter aorta - obstructive
DIASTOLIC HF
Higher than normal ejection fraction
Symptoms of RHF, LHF

Question 7

HOCM c/f

Answer 7

1. Dyspnea, angina, presyncope, syncope with exertion, and palpitations
2. Large jugular A wave
3. Bifid carotid pulse
4. Palpable S4 gallop
5. Systolic murmur and thrill -L4 ICS
6. Mitral regurgitation murmur
7. Sudden death can sometimes be the first manifestation.

**H/o sudden cardiac death in a young family member - clue to diagnose as it is hereditary

Question 8

HOCM diagnosis

Answer 8

**H/o sudden cardiac death in a young family member - clue to diagnose as it is hereditary

ECG - LVH (hypertrophy), pseudo Q waves

Best - ECHO (resting Echo might be normal)
Can be ppt by stress ECHO

Question 9

HOCM Mx

Answer 9

Same as diastolic HF
B blockers, CCB, Septoplasty

*Avoid Diuretics, Digitalis, Vasodilators, exercise

Question 10

Restrictive CM

Answer 10

Ventricles too stiff for systole/diastole
Systolic and diastolic HF

No rx other than transplant