Cardiomyopathies

Question 1

Types

Answer 1

Dilated
Hypertrophic
Restrictive/obliterative
CHF

Question 2

Types:

Dilated causes

Answer 2

Most common (90%)
Often idiopathic (up to 50%)

Other causes: 
chronic Alcoholic
wet Beriberi,
Coxsackie B virus myocarditis,
chronic Cocaine,
Chagas disease,
Doxorubicin,
hemochromatosis,
Peripartum cardiomyopathy

Question 3

Types:

Dilated findings

Answer 3

S3, dilated heart on ultrasound, balloon apperance on CXR

Microscope: eccentric hypertrophy (sarcomere in series) with systolic dysfunction

Question 4

Types:

Dilated treatment

Answer 4

Na+ restriction,
ACE inhibitors,
Diuretics,
Digoxin,
Heart transplant

Question 5

Types:

Hypertrophic

Answer 5

IV septum too close to mitral valve leaflet, leading to outflow tract obstruction
60-70% familial
Autosomal dominant (beta myosin heavy chain mutation)
Causes of sudden death in young athletes

Associated with Friedreich’s ataxia

Question 6

Types:

hypetrophic finding

Answer 6

Disoriented, tangled, hypertrophied myocardial fiber
Findings: normal sized heart, S4 apical pulse, systolic murmur.

Diastolic dysnfunction ensues.
Asymmetric concentric hypertrophy (sarcomere in parallel)

Question 7

Types:

hypertrophic consequence and treatment

Answer 7

Proximity of IV to mitral leaftlet obstruction outflow tract, results in systolic murmur and syncopal episodes.

Treatment: beta blocker, non dihdropyridine CCB (verapamil)

Question 8

Types:

restrictive/obliterative cardiomyopathy

Answer 8

Sarciodisis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children)

Question 9

Types:

restrictive/obliterative cardiomyopathy associated with

Answer 9

Loffler’s syndrome:
- endomyocardial fibrosis with a prominent eosinophilic infiltrate and hemochromatosis (dilated cardiomyopathy can also occur)

Question 10

Types:

CHF

Answer 10

Inherited or acquired abn of cardiac structure or function.
Dyspnea, fatigue, signs (edema and rales)

Right heart failure 2/2 to Left heart failure.
Isolated right heart failure due to cor pulmonale

Question 11

Types:

CHF treatment

Answer 11

ACEi,
beta blockers (except in acute decompensated)
ARBs
Spironolactone

Thiazide or loop for symptomatic relief.
Hydralazine with nitrate therpay improves symptom and mortality in selected pts