Cardiomyopathies

Question 1

Etiology of CMs

Answer 1

• Idiopathic vs. secondary

- Genetic/familial

Question 2

What are the 3 categories of CMs?

Answer 2

1. Dilated (most common)
2. Hypertrophic
3. Restrictive (least common)

Question 3

What is the leading cause of CHF?

Answer 3

Idiopathic dilated CM

Question 4

What is the #1 cause of sudden death in athletes < 35 yo?

Answer 4

Hypertrophic CM

Question 5

Define: Dilated CM

Answer 5

Thin, enlarged ventricular wall

- Systolic dysfunction

Question 6

Define: Hypertrophic CM

Answer 6

Myocardial hypertrophy in absence of HTN or aortic stenosis

- Frequently involves septal wall

Question 7

Define: Restrictive CM

Answer 7

Nondilated ventricles, impaired filling, reduced diastolic fxn

Question 8

What does HF result from?

Answer 8

Cardiovascular abnormality –> supply/demand mismatch

- systemic perfusion inadequate to meet metabolic demand

Question 9

Features of L. sided HF

Answer 9

• Systolic dysfunction: inability to contract & expel blood, LV EF reduced
• Diastolic dysfunction: Inability of ventricle to relax & fill adequately, increased filling pressure

Question 10

What causes R. sided HF?

Answer 10

• MC = L. sided HF

- Pulmonary HTN

Question 11

What causes dilated CM? “ABCD PIG”

Answer 11

Alcohol 
Beriberi
Coxsackie B, Chagas 
Drugs: Adriamycin, cocaine 
Pregnancy 
Idiopathic, infection 
Genetic

Question 12

What is the MC of HF due to systolic dysfunction?

Answer 12

Ischemic CM

- Common cause of dilated CM

Question 13

What increases the risk of alcoholic CM?

Answer 13

Drinking > 90g (7-8 drinks) per day for 5 yrs

Question 14

Define: Peripartum CM

Answer 14

Development of HF late in pregnancy or within 5 mos of giving birth.

Question 15

What are risk factors for peripartum CM?

Answer 15

• Age > 30
• African
• Cocaine abuse
• Multiple fetuses
• Preclampsia/eclampsia

Question 16

Takotsubo CM

Answer 16

“Stress cardiomyopathy”

“Broken Heart Syndrome”

Question 17

Define: Hypertrophic CM

Answer 17

Genetic disease of heart muscle

- Unexplained hypertrophy w/out dilation of ventricles or a cardiovascular disease

Question 18

What are other names for Hypertrophic CM?

Answer 18

• Idiopathic Hypertrophic Subaortic Stenosis (IHSS)

- Asymmetric Septal Hypertrophy (ASH)

Question 19

Obstructive hypertrophic CM

Answer 19

Due to mid systolic obstruction of flow through LV outflow tract
- Result of systolic anterior motion of mitral valve toward septum

Question 20

What CM puts pts at risk for ventricular & supraventricular arrhythmias?

Answer 20

Hypertrophic CM

Question 21

What are risk factors for SCD?

Answer 21

• Hx of syncope or family hx
• Gene mutations
• LV wall thickness ≥ 30
• Non-sustained ventricular tachy
• Young age (<30)
• Hx of cardiac arrest

Question 22

How is restrictive CM characterized?

Answer 22

By non-dilated, non-hypertrophied ventricles w/ impaired LV filling

• LV wall thickness may be increased by infiltrative dz
• Bi-atrial enlargement

Question 23

What CM resembles constrictive pericarditis?

Answer 23

Restrictive CM

Question 24

What is the MC of restrictive CM?

Answer 24

• Worldwide = Loeffler Eosinophilic Endocardial

- U.S. = Amyloidosis

Question 25

How is cardiac amyloidosis characterized?

Answer 25

By multisystem deposition of amyloid fibrils

Question 26

Define: amyloidosis

Answer 26

A systemic disease, w/ infiltration being common

Question 27

What is commonly seen in cardiac amyloidosis?

Answer 27

- Periorbital purpura | - Cardiac cachexia

Question 28

How is myocarditis characterized?

Answer 28

By inflammation of myocardium

Question 29

Define: Dallas Criteria

Answer 29

Inflammatory infiltrate of the myocardium w/ necrosis &/or degeneration of adjacent myocytes not typical of the ischemic damage associated w/ CAD

Question 30

What is the px of myocarditis?

Answer 30

- 1/3 develop dilated CM - Most w/ mild sx will recover - Postpartum CM has mortality rates as high as 50% at 1 yr