Cardiomyopathies

Question 1

Discuss Dilated Cardiomyopathy

Answer 1

1. EF<40%
2. Cardiomegaly is due to dilation, not hypertrophy
3. Most common cardiomyopathy
4. Absence to external pressure overload

Question 2

What causes ischemic DCM? Non-ischemic?

Answer 2

Coronary Artery Disease; Alcohol

Question 3

Symptoms of DCM

Answer 3

LHF: Orthopnea, PND
RHF: Chest pain

Question 4

Physical exam findings of DCM

Answer 4

Rales, S3, murmur of mitral insufficiency

Question 5

Laboratory exam findings of DCM

Answer 5

1. Boxcar myocytes
2. EKG: LVH, LBBB
3. X-ray: Cardiomegaly

Question 6

How is DCM diagnosed?

Answer 6

Echo

Question 7

How is DCM treated?

Answer 7

Get rid of edema
Sodium restriction, Diuretics
Increase contractility
Dopamine, dobutamine

Question 8

Discuss Restrictive Cardiomyopathy

Answer 8

Decreased compliance due to myocardial infiltration or fibrosis

Question 9

Discuss Amyloidosis

Answer 9

Amyloid deposits in interstitum seen with Congo red stain and polarized light showing apple green birefringence

Question 10

Laboratory exam findings of RCM/Amyloidosis

Answer 10

Square root sign

Question 11

How is RCM diagnosed?

Answer 11

Echo: Determines if pt has systolic or diastolic dysfunction

Question 12

What should be avoided in an amyloidosis pt?

Answer 12

Avoid digoxin because it collect in amyloid fibrils and causes serious arrhythmias.

Question 13

Discuss Hypertrophic Cardiomyopathy

Answer 13

1. Hypertrophy in the absence of an identifiable cause
2. Diastolic dysfunction
3. Asymmetrical septal hypertrophy can lead to LV outflow obstruction (HOCM)

Question 14

Etiology of HCM

Answer 14

Beta myosin heavy chain is the most common protein mutation

Question 15

Pathology of HCM

Answer 15

1. Small ventricular cavity; dilated LA

2. MYOFIBRIL DISARRAY

Question 16

EKG findings of HCM

Answer 16

Deep Q-wave

Question 17

Treatment of HCM

Answer 17

Negative ionotropes: Beta blockers and CCB