Cardiomyopathies

Question 1

Most Common Cardiomyopathy

Answer 1

Dilated (congestive) Cardiomyopathy (DCM)

Question 2

Findings of DCM:

Answer 2

S3, Dilated heart on ultrasound, balloon appearance on chest x-ray

Question 3

Dilation in DCM Leads to

Answer 3

• Impairment of contractility, or hypocontraction.

- Hypocontraction and stasis predispose to mural thrombi.

Question 4

Causes of DCM (Major Causes)

Answer 4

ABCCCD

• Alcohol Abuse
• wet Beriberi
• Coxsackie B virus myocarditis
• chronic Cocaine use
• Chagas’ Disease
• Doxorubicin toxicity

Question 5

Uncommon causes of DCM

Answer 5

Hemochromatosis and Peripartum Cardiomyopathy

Question 6

DCM Type of Dysfunction

Answer 6

Systolic Dysfunction

Question 7

Complication of Hypertrophic Cardiomyopathy

Answer 7

Hypertrophied interventricular septum is “too close” to the mitral valve leaflet, leading to outflow tract obstruction

Question 8

Major Cause of Hyperthrophic Cardiomyopathy and association

Answer 8

• Familial, autosomal dominant Beta-myosin heavy chain mutation that affects Sarcomere Proteins
• Friedreich’s Ataxia

Question 9

DCM Treatments

Answer 9

Sodium Restriction, ACE Inhibitors, Diuretics, Digoxin, and Heart Transplant

Question 10

Histologic Feature of Hypertrophic Cardiomyopathy

Answer 10

• Disoriented, tangled, and hypertrophied myocardial fibers

- Asymmetric ceoncentric hypertophy of myocytes (sarcomeres added in parallel)

Question 11

Mitral Valve Leaflet Outflow Obstruction Leads to

Answer 11

Systolic Murmur and Syncopal Episodes

Question 12

Hypertrophic Cardiomyopathy Findings

Answer 12

• Normal Sized Heart, S4, apical impulses, and systolic murmur
• LV “Banana-like configuration” due to bulging septum

Question 13

How does HCM affect Stroke Volume

Answer 13

• Decreased Stroke Volume and Increased Afterload due to impaired diastolic filling and LV outflow tract obstruction = Decreased Cardiac Ouput

Question 14

HCM Type of Dysfunction

Answer 14

Diastolic

Question 15

Major Causes of Restrictive Cardiomyopathy (RCM)

Answer 15

Sarcoidosis, Amyloidosis, Postradiation Fibrosis, Endocardial Fibroelastosis, Loffler’s Syndrome, and hemochromatosis

Question 16

What is found in endocardial fibroelastosis?

Answer 16

Thick Fibroelastic tissue in endocardium of young children

Question 17

What is Loffler’s Syndrome?

Answer 17

EndoMYOCARDIAL fibrosis with a prominent EOSINOPHILIC infiltrate.

Question 18

EKG Findings of RSM

Answer 18

Low voltage and Diminished QRS Amplitudes

Question 19

Fibrosis in RSM Leads to

Answer 19

Restriction of ventricular filling leading to reduced cardiac output

Question 20

Approximately 1/3 of DCM are genetic. The majority of these are due to mutations in what? and what is the inheritance?

Answer 20

• Mutations of cardiac myocyte cytoskeletal proteins (dystrophin) or mitochondrial enzymes.
• Autosomal Dominant.