CARDIOMYOPATHIES, MYOCARDITIS, AND PERICARDIAL DISEASE

Question 1

….. is the second most common cause of sudden cardiac death in the adolescent population and the leading cause of sudden death in competitive athletes.

Answer 1

Hypertrophic cardiomyopathy (HCM)

Question 2

The Primary Cardiomyopathies

Answer 2

Genetic
  Hypertrophic cardiomyopathy
  Arrhythmogenic right ventricular cardiomyopathy/dysplasia
  Left ventricular noncompaction
  Conduction system disease
    Long-QT syndrome
    Brugada syndrome
    Catecholaminergic polymorphic ventricular tachycardia
    Short-QT syndrome
    Idiopathic ventricular fibrillation
Mixed (genetic and nongenetic)
  Dilated cardiomyopathy
  Primary restrictive nonhypertrophied cardiomyopathy
Acquired
  Myocarditis (inflammatory cardiomyopathy)
  Stress ("Takotsubo") cardiomyopathy
  Peripartum cardiomyopathy

Question 3

Common Causes of Secondary Cardiomyopathies

Answer 3

1) Toxins
  Ethanol
  Chemotherapeutic agents (doxorubicin)
  Antiretroviral agents (zidovudine, didanosine)
  Phenothiazines
  Cocaine
  Methamphetamine
2) Infiltrative diseases
  Amyloidosis
3) Storage diseases
  Hemochromatosis
4) Autoimmune disorders
  Scleroderma
  Systemic lupus erythematosus
  Rheumatoid arthritis
  Dermatomyositis
5) Metabolic
  Nutritional deficiency (thiamine, selenium)
  Endocrine (diabetes mellitus, hypothyroidism, hyperthyroidism)
  Electrolytic disturbance (hypophosphatemia, hypocalcemia)
6) Neuromuscular disorders
  Muscular dystrophy
  Friedreich ataxia

Question 4

The use of … and …, specifically…., improves survival in patients with dilated cardiomyopathy and CHF.

Answer 4

angiotensin-converting enzyme inhibitors
Beta-blockers
carvedilol

Question 5

Myocarditis is frequently accompanied by….

Answer 5

pericarditis

Question 6

Common “viral” Causes of Myocarditis (7)

Answer 6

Coxsackie B virus	
Echovirus	
Influenza virus	
Parainfluenza virus	
Epstein-Barr virus	
Hepatitis B virus	 
Human immunodeficiency virus

Question 7

Common “bacterial” Causes of Myocarditis (5)

Answer 7

Lyme disease
Beta-Hemolytic streptococci (rheumatic fever)
Mycoplasma pneumoniae 
Neisseria meningitidis 
Corynebacterium diphtheriae

Question 8

…. are common signs and symptoms of myocarditis. (4)

Answer 8

Fever,
myalgias,
headache,
sinus tachycardia usually out of proportion with fever

Question 9

In Hypertrophic Cardiomyopathy …. is the most frequent initial complaint and is due to …., which results in an …. and …..

Answer 9

Dyspnea on exertion
exercise-induced sinus tachycardia
abrupt elevated LV diastolic pressure
pulmonary venous hypertension

Question 10

Most cases of restrictive cardiomyopathy are …

Answer 10

idiopathic (sometimes Autosomal Dominant)

Question 11

Restrictive cardiomyopathy may result from systemic disorders

Answer 11

amyloidosis, 
sarcoidosis, 
hemochromatosis, 
progressive systemic sclerosis (scleroderma), 
carcinoid heart disease, 
endomyocardial fibrosis, 
hypereosinophilic syndrome

Question 12

In restrictive cardiomyopathy Cardiac conduction disturbances are common in…. and….

Answer 12

amyloidosis

sarcoidosis

Question 13

Common Causes of Acute Pericarditis (9)

Answer 13

1 Idiopathic
2 Infectious
Viral (coxsackie virus, echovirus, human immunodeficiency virus)
Bacterial [especially Staphylococcus, Streptococcus pneumoniae, beta-hemolytic streptococci (acute rheumatic fever), Mycobacterium tuberculosis]
Fungal (especially Histoplasma capsulatum)
3 Malignancy (leukemia, lymphoma, metastatic breast and lung carcinoma, melanoma)
4 Drug-induced (procainamide, hydralazine)
5 Systemic rheumatic diseases (systemic lupus erythematosus, rheumatoid arthritis, scleroderma, polyarteritis nodosa, dermatomyositis)
6 Radiation-induced
7 Postmyocardial infarction (Dressler syndrome)
8 Uremia
9 Myxedema

Question 14

In pericarditis ,Referral of pain to … is a particular distinguishing feature.

Answer 14

the left trapezial ridge (due to inflammation of the joining diaphragmatic pleura)

Question 15

Acute pericarditis ECG changes

Answer 15

PR depression (II, aVF, V4-6)
ST Elevation, especially in I, V5, and V6
T wave inversion, especially in I, V5, and V6

Question 16

If the ratio of ST amplitude (in millivolts) to T-wave amplitude (in millivolts) is …., acute pericarditis is likely, and if the ratio …., acute pericarditis is unlikely

Answer 16

> 0.25

Question 17

Indicators of a poor prognosis in pericarditis include:

Answer 17

temperature >38Β°C (100.4Β°F),
subacute onset over weeks,
immunosuppression,
history of oral anticoagulant use,
associated myocarditis (elevated cardiac biomarkers, symptoms of CHF),
large pericardial effusion (an echo-free space >20 mm)

Question 18

Common Causes of Cardiac Tamponade in Medical (Nontrauma) Patients

Answer 18

Metastatic malignancy	
Acute idiopathic pericarditis	
Uremia	
Bacterial or tubercular pericarditis	
Chronic idiopathic pericarditis	
Hemorrhage (anticoagulant)	
Other (systemic lupus erythematosus, postradiation, myxedema, etc.)