Cardiomyopathy

Question 1

Primary vs secondary cardiomyopathy

Answer 1

Primary - of heart muscle itself, genetic or aquired
Secondary - due to systemic disease incl infiltrative/inflammatory eg sarcoidosis, haemochromatosis, fabrys, endocrine etc

Question 1

What is hypertrophic cardiomyopathy

Answer 1

Abnormal growth of myocardium >15mm LV and atrial septum

Question 2

What is pathology of hypertrophic CM

Answer 2

• Thickened walls
  → reduced CO
• Ejection fraction often preserved - total volume and output reduced equally so ratio is the same
• Less ventricular filling

Question 3

Presentation of HCM

Answer 3

Often asymptomatic
OR
Exertional SOB
Anginal chest pain
Palpitations
Light headedness

Question 4

Hypertrophic CM examination signs

Answer 4

Systolic ejection murmur worsened by valsalva manouvure
S4 heart sound
Atrial gallop
Forceful apex beat +/- double impulse

Question 5

What can HCM cause

Answer 5

HF, arrhythmias, sudden death

Question 6

Genetic inheritance of HCM

Answer 6

Genes -> cardiac sarcomere protein coding
60% single autosomal dominant mutation
Can be spontaneous

Question 7

What murmur does a LV outflow tract obstruction cause

Answer 7

Mitral valve regurgitation
Asymmetrical septum growth - obstruct blood flow through aortic valve

Question 8

When do you screen for HOCM and how

Answer 8

Strong FH >1 direct member or severe disease eg sudden cardiac death
Check for known fenes
If none ECG and ECHO regularly

Question 9

Structural cahnges in dilated cardiomyopathy

Answer 9

Dilated and thin walls
Less contractility
Cardiomegaly but walls thinner and weaker -> HF

Question 10

Causes of dilated cardiomyopathy

Answer 10

Idiopathic
Genetics
Alcohol
Chemotherapies
Viral myocarditis
AI disease
Pregnancy - peripartum CM

Question 11

How to diagnose dilated CM

Answer 11

HF incidental often finsing
ECG, 48 hrs
Cardiac MRI

Question 12

Treatment dilated CM

Answer 12

HF symptomatic treatment
Pacemaker/ICD if highrisk for arrythmias
Avoid risk factors

Question 13

Structural chagnes in restrictive CM

Answer 13

Stiff walls
Less ventricular filling
Atria enlarged from abnormal protein infiltration or scarring
-> HF, angina, arrhtyhmias

Question 14

Which CM is least common

Answer 14

Dilated

Question 15

Causes of restrictive CM

Answer 15

Idiopathic
Amyloidosis
Sarcoidosis
Haemachromatosis

Question 16

What is arrhythmogenic RV

Answer 16

Replacement of normal myocardium with fibrous fatty tissue w poor electrical condiction
-> life threatening arrhtyhmias

Question 17

What are problems and management of arrhythmogenic R CM

Answer 17

Sudden cardiac death and HF later in life
Genetic caise often
Radio ablation can reduce number of VTs

Question 18

Red flags for CM

Answer 18

Poor cardiac output symptoms - dyspnoea, angina, syncope (without warning)
Arrhtyhmias symptoms - palpitations
FH sudden cardiac death, unexplained HF, transplants or implants

Question 19

Hypertrophic CM on ECG

Answer 19

LVH and deep narrow Q waves

Question 20

Initial investigations for CM

Answer 20

ECG, BP
bloods - FBC, u+es, LFTs, TFTs, HbA1c, pro-BNP
Imaging - ECHO

Question 21

Specialist investigations CM

Answer 21

Ambulatory ECG for arrhythmias
Exercise stress testing ECG
Cardiac MRI
Genetic testing

Question 22

Complications of CM

Answer 22

Cardiac failure - Reduced CO
AF - 1/5
Arrhythmias - non sustained VT w risk of VF
Sudden cardiac death

Question 23

What treat symptomatic LV tract obstruction with

Answer 23

Beta blockers

Question 24

Treatment for arrhthmias

Answer 24

Beta blockers and CCBs eg verapamil
ICDs