Cardiomyopathies and Congestive Heart Failure

Question 1

Congestive heart failure is typically characterized by what two things?

Answer 1

Systolic failure or insufficient pumping and diminished cardiac output

Question 2

Another name for systolic failure is? Damming of blood in the venous system is called?

Answer 2

Forward failure

Diastolic failure or backwards failure

Question 3

How can the heart compensate for the diminished output?

Answer 3

Either by releasing catecholamines or undergoing hypertrophy

Question 4

On what side does CHF usually start?

Answer 4

The left side

Question 5

After compensation fails what happens to the heart?

Answer 5

Undergoes decompensation and dilatation of the ventricle. These two occurrences (along with hypertrophy) end up making the ventricle appear to be normal sized

Question 6

What happens as a result of left sided failure?

Answer 6

Ischemia of the heart
Tissue hypoxia of the organs
Mitral valve regurgitation
Hypertension
Aortic stenosis

Question 7

What are the symptoms of left sided failure?

Answer 7

Shortness of breath or dyspnea, nocturnal dyspnea, orthopnea (shortness when lying flat), hemoptysis (spitting up blood from the pulmonary system), rales or crackling sound when breathing

Question 8

What are the signs of left sided failure?

Answer 8

Hypoxic encelopathy, renal underperfusion which worsens edea, azotemia or abnormally high nitrogen compounds in the blood

Question 9

What is cor pulmonale?

Answer 9

When following a case of pulmonary edema due to right side failure, pulmonary hypertension remains even after the edema has resolved itself

Question 10

Cardiomyopathies are primary abnormalities where as congestive heart failure is?

Answer 10

An end stage abnormality, a result of several different things building up

Question 11

What are the three main patterns of cardiomyopathy?

Answer 11

Dilation, restrictive, hypertrophic

Question 12

Which pattern is the most common?

Answer 12

Dilated

Question 13

In dilated heart cardiomyopathy the heart appears?

Answer 13

With thin, flat ventricle walls. The ventricle itself in enlarged and results in poor contractility and higher than normal end diastolic and systolic volumes

Question 14

Histologically what will you see in dilated cardiomyopathy?

Answer 14

Cardiac myocyte hypertrophy and interstitial fibrosis due to an increase in connective tissue

Question 15

What percentage of hypertrophic cardiomyopathy is genetic?

Answer 15

100%, either runs in the family or due to a mutation

Question 16

What is the shape of the ventricle and why?

Answer 16

Banana shaped due to inward hypertrophy with no dilation that decreases diastolic filling

Question 17

Describe the histology of hypertrophy cardiomyopathy

Answer 17

Boxcar nuclei (seen in hypertrophic myocytes), myocytes that are in disarray and irregular, interstitial fibrosis

Question 18

What are the symptoms of hypertrophic cardiomyopathy?

Answer 18

Angina, atrial fibrillation, mitral valve endocarditis, ventricular arrhythmias, sudden death

Question 19

What happens in restrictive cardiomyopathy?

Answer 19

There is a stiffened ventricular wall and the heart cannot relax. There is poor diastolic filling which leads to dilation of the atria.

Question 20

Describe the size of the ventricles in restrictive cardiomyopathy?

Answer 20

They are normal sized and there is no affect on systolic function

Question 21

What is the cause of myocarditis?

Answer 21

Enteroviruses Coxackie A and B are most common

Question 22

Microscopically what cells will be present in this illness?

Answer 22

Lymphocytes, neutrophils if bacterial and eosinophils if immunogenic

Question 23

What two things are necessary to make a diagnosis of myocarditis?

Answer 23

Interstitial inflammatory infiltrate and focal necrosis of myocytes