Cardiomyopathy

Question 1

Cardiomyopathy

Answer 1

Any condition leading to an abnormally functional morphological abnormal myocardium

Question 2

3 Cardiomyopathies

Answer 2

Dilated
Restrictive
Hypertrophic

Question 3

How do most cardiomyopathies present?

Answer 3

Like heart failure

Question 4

Best diagnostic modality for cardiomyopathy

Answer 4

ECHO!!!

Question 5

Systolic dysfunction

Answer 5

Can’t contract the ventricles and empty them like we used to - ventricles pump harder - going to eventually have diatolic dysfunction

Question 6

Diastolic dysfunction

Answer 6

LV can’t stretch - Ventricle made of glass

Question 7

Myocarditis

Answer 7

Infectious or non-infectious process leads to necrosis. May lead to dilated cardiomyopathy

Question 8

Two main mechanisms of cardiomyopathy

Answer 8

Autoimmune or infectious

Question 9

Acute phase of myocarditis

Answer 9

Substernal, pleuritic chest pain
First 2 weeks
Fever

Question 10

Chronic phase of myocarditis

Answer 10

Autoimmune - after the first two weeks

Question 11

4 infectious causes of myocarditis

Answer 11

Adenovirus
COVID-19
Coxsackie virus
Cytomegalovirus

Question 12

3 noninfectious causes of myocarditis

Answer 12

Alcohol
Cocaine
Anthracyclines

Question 13

Myocarditis presentation

Answer 13

Acute febrile illness
SOB, Pleural chest pain, may present with HF, arrhythmias
No hx of heart problems

Question 14

Best position to hear pericardial friction rub

Answer 14

Leaning forward

Question 15

Four Initial tests for myocarditis

Answer 15

EKG - Sinus tachy, dysrhythmia, ST-T changes
Cardiac biomarkers - Elevated troponins (may have to cath)
CXR - Enlarged cardiac silloette
Increased/Reduced uptake of dye on cardiac MRI

Question 16

Only true way to diagnose myocarditis -gold standard

Answer 16

A heart biopsy - only get if it will change presentation - patient decompensating rapidly and we have no idea what is going on

Question 17

NSAIDs and IHD

Answer 17

NOT indicated

Question 18

Dilated cardiomyopathy

Answer 18

Big, dilated left ventricle with low ejection fraction, #1 reason for a heart transplant
Systolic dysfunction

Question 19

Presentation of dilated cardiomyopathy on PE

Answer 19

Valvular disorders
Arrhythmias
Pulsus alternans d/t limited emptying
S3 gallop
HF symptoms

Question 20

Etiologies of dilated cardiomyopathy

Answer 20

Pregnancy - usually go back to baseline
Lyme
Chagas
Alcohol
AF, SVT, AVNRT

Question 21

DCM etiolology mneumonic

Answer 21

Alcohol
Beri beri
Coxsackie
Cocaine
Chagas
Doxirubicin toxicity

Question 22

Diagnosis for DCM

Answer 22

Echo and BNP/pro-BMP

Question 23

Treatment for DCM

Answer 23

CHF management
Heart Transplant
Defibrillator

Question 24

Restrictive cardiomyopathy

Answer 24

Fibrosis leading to a DIASTOLIC dysfunction
Bi-atrial enlargement

Question 25

6 Etiologies of restrictive cardiomyopathy

Answer 25

Amyloidosis Sarcoidosis Hemochromatosis Fabry disease Radiation Fatty infiltration

Question 26

Diagnosis and treatment for restrictive cardiomyopathy

Answer 26

Echo or MRI, may consider Biopsy Treat HF and Underlying cause

Question 27

Hypertrophic cardiomyopathy

Answer 27

Typically a genetic issue Septal buildup of myocytes - block the aortic valve Worse with exercise, standing, valsalva DIASTOLIC dysfunction

Question 28

Presentation of hypertrophic cardiomyopathy

Answer 28

Fatigue, chest pain, aortic stenosis like murmur - worse with valsalva, better with squatting Sudden death

Question 29

Diagnostics of hypertrophic cardiomyopathy

Answer 29

LVH on EKG ECHO with LV wall over 1.5 cm thick

Question 30

Management of hypertrophic CM non invasive

Answer 30

Activity restriction BB or Verapamil Avoid diuretics or vasodilators

Question 31

Invasive management of hypertrophic cardiomyopathy

Answer 31

Septal myectomy or alcohol septal ablation

Question 32

Screening of HTCM

Answer 32

Screen first degree relatives - annual echo until 20, then Q5 years

Question 33

MCC of HF in US

Answer 33

Ischemic cardiomyopathy

Question 34

Ischemic cardiomyopathy

Answer 34

Characterized by systolic dysfunction Presentation - CHF Usually LV dysfunction Regional wall abnormality on Echo - akinetic

Question 35

Management of ischemic cardiomyopathy

Answer 35

Nuclear viability scan for hibernation Revascularization Manage CHF ICD/Wearable defibrillator

Question 36

Arrhythmogenic right ventricular cardiomyopathy

Answer 36

RV free wall myocardium is replaced by fibrous/fatty tissue Sudden death in YAs More common in europe

Question 37

Left ventricular noncompaction

Answer 37

Congenital - CHF, etc. at birth Heart wall looks like spongy bone Usually need a heart transplant

Question 38

Stress induced/Takutsobu Cardiomyopathy

Answer 38

Broken heart syndrome STEMI in the absence of CAD Due to an intense psychological stressor

Question 39

MC patient for stress induced cardiomyopathy

Answer 39

Postmenopausal women

Question 40

Diagnosis and tx for stress induced cardiomyopathy

Answer 40

LV apical ballooning!!! on echo or LV angiography Almost all patients recover in a few weeks - BB for 1 year

Question 41

Key sign for stress induced cardiomyopathy

Answer 41

LV apical ballooning