Cardiomyopathies

Question 1

Myocarditis causes

Answer 1

50% idiopathic
Infective
Drugs (cyclophosphamide, penicillin, sulfonamides)
Cocaine, alcohol, lead, arsenic
Immunological

Question 2

Myocarditis presentation

Answer 2

ACS-like symptoms
HF symptoms

Palpitations
Tachycardia

Soft S1, S4 gallop

Question 3

Myocarditis tests

Answer 3

CRP, ESR + troponin may be raised

ECG shows ST changes, T wave inversion and conduction abnormalities
Echo shows diastolic dysfunction + regional abnormalities
Cardiac MR if stable

Endomyocardial biopsy is gold standard

Question 4

Myocarditis management

Answer 4

Supportive
Treat underlying cause
Avoid exercise as can precipitate arrythmias

Question 5

Myocarditis prognosis

Answer 5

50% recover within 4wks

12-25% develop DCM + severe HF, can be years after apparent recovery

Question 6

What is DCM

Answer 6

Dilated cardiomyopathy, dilated flabby heart of unknown cause

Question 7

DCM presentation

Answer 7

Fatigue
Dyspnoea
Pulmonary oedema
RVF
Emboli
AF/VT

Question 8

DCM signs

Answer 8

S3 gallop
Mitral/triscupid regurgitation
Hepatomegaly ± ascites

Question 9

DCM investigations

Answer 9

BNP raised
Dec Na shows poorer prognosis

CXR shows cardiomegaly, pulmonary oedema
ECG shows tachy and non-specific T-wave changes
Echo shows globally dilated hypokinetic heart

Question 10

DCM management

Answer 10

Bed rest

Diuretics
Beta-blockers
ACE-i

Anticoagulation

Biventricular pacing
ICDs + LVADs
Transplantation

Question 11

DCM mortality

Answer 11

Variable, 40% in 2yrs

Question 12

What is HCM

Answer 12

LV outflow tract obstruction from asymmetric septal hypertrophy
Leading cause of sudden cardiac death in young

Question 13

HCM presentation

Answer 13

Sudden death
Angina
Dyspnoea
Syncope

Question 14

HCM signs

Answer 14

Jerky pulse
a wave in JVP
Systolic thrill at lower left sternal edge
Harsh ejection systolic murmur

Question 15

HCM investigations

Answer 15

ECG shows LVH, progressive T-wave inversions and deep Q-waves on inferior + lateral leads
Echo shows asymmetrical septal hypertrophy, small LV cavity
Cardiac catheterisation to assess severity of gradient
Exercise test ± Holter to test risk

Question 16

HCM management

Answer 16

B-blockers/ verapamil for symptoms
Amiodarone for arrhythmias
Anticoagulate for paroxysmal AF

Septal myomectomy (surgical or using alcohol) for severe
Implantable defib depending on risk of sudden cardiac death

Question 17

HCM prognosis

Answer 17

5. 9%/yr if <14
6. 5% if >14

Syncope at presentation + family hx are poor prognostic factors

Question 18

Restrictive cardiomyopathy causes

Answer 18

Idiopathic

HH

Sarcoidosis
Amyloidosis
Scleroderma

Question 19

Restrictive cardiomyopathy presentation

Answer 19

Similar to constrictive pericarditis

RVF features predominate

Question 20

Restrictive cardiomyopathy diagnosis

Answer 20

Echo
MRI
Cardiac catheterisation

Question 21

Restrictive cardiomyopathy treatment

Answer 21

Treat cause

Question 22

What is cardiac myxoma

Answer 22

Rare benign cardiac tumour
May mimic IE or mitral stenosis
Tumour plop may be heard

Question 23

Cardiac myxoma tests

Answer 23

Echo

Shows pedunculated heterogeneous mass if in atrial wall

Question 24

Cardiac myxoma management

Answer 24

Excision