Cardiomyopathy

Question 1

What are the 3 types of cardiomyopathy?

Answer 1

Restrictive - Stiffening of Myocardium
Hypertrophic - hypertrophy of myocardium
Dilated - Dilation of ventricles

Question 2

What causes DCM?

Answer 2

• Genetics e.g. Muscular Dystrophy
• Drugs/alcohol/chemicals
• Endocrine disorders
• Inflammation
• Injury
• Idiopathic

Question 3

How does DCM present?

Answer 3

Fatigue - Dyspnoea/Orthopnea/PND - Oedema - Cough

Weak Pulses - Raised JVP - Tachycardia - Audible S3

Question 4

How is DCM tested for?

Answer 4

CXR - Pulm congestion + Cardiomegaly
MRI
Biopsy - Visibally stretched fibres
ECG
Echo - Dilated ventricles
ESR + FBC - Polycythaemia

Question 5

How do we treat DCM?

Answer 5

Reduce Strain - Diuretic + ACEI + Spironlactone
Increase COntractility - Digoxin
Prevent Vfib - ICD
Warfarin -> Reduce Thrombus risk
Treat Cause
Heart Transplant

Question 6

What causes RCM?

Answer 6

Amyloidosis
Sarcoidosis
Haemochromatosis
Fibrosis - MI, drugs, radiation, idiopathic
Genetics
Diabetes

Question 7

How does RCM present?

Answer 7

Cough - Chest Pain - Dyspnoea/Orthopnea - Oedema - Ascites - Fatigue
Hepatomegaly
Raised JVP - Tachycardia - Audible S3/4

Question 8

How do we test for RCM?

Answer 8

Serum Fe - Haemochromatosis
Biopsy - Visible sarcoid/amyloidosis
ECHO - biatrial enlargement and patchy fibrosis from infiltrative disease
MRI
CXR - Pulm congestion + normal heart size
Biopsy - Visible amyloid and sarcoid
ECG

Question 9

How do we treat RCM?

Answer 9

Treat the cause
ICD
Heart Transplant
Warfarin -> Prevent Thrombus
B-blockers - ACEI - Diuretic -> Reduce strain on heart

Question 10

What causes HCM?

Answer 10

Purely genetic in origin
Comes with growth of interventricular septum to occlude aortic valve

Question 11

How does HCM present?

Answer 11

Asymptomatic until the valve is occluded or the heart cant pump enough blood anymore:
Fatigue - Chest Pain - Dyspnoea - Palpitations - Tachycardia - Presyncope - Exertional Arrythmias

Notched Pulse - Raised JVP - Audible S4 - Systolic ejection murmur worse on valsalva

Question 12

How do we test for HCM?

Answer 12

ECG
ECHO - Visible hypertrophy and smaller chambers
MRI
Biopsy - myocyte dissaray
CXR - Cardiomegaly + Pulm congestion
Genetic Testing

Question 13

How do we treat HCM?

Answer 13

Heart Transplant
Warfarin
Beta blockers + reduce exercise/stress
ICD
Surgical mitral repair
Surgical removal (myomectomy) or repair of outgrowing section of IV septum (percutaneous septal ablation)