Cardiomyopathy

Question 1

Cardiomyopathy is an ____ disease of the myocardium that causes hemodynamic dysfunction

Answer 1

Intrinsic

Question 2

What is the usual cause of cardiomyopathy?

Answer 2

Non-ischemic and NOT related to valve disease or HTN

Question 3

What are the types of cardiomyopathy by cause?

Answer 3

• Primary intrinsic (d/t myocardial disease - genetic)

- Secondary intrinsic (d/t systemic disease or another cause)

Question 4

What are the 3 main patterns of cardiomyopathy?

Answer 4

1. Dilated
2. Hypertrophic
3. Restrictive

Question 5

In early cardiomyopathy, all patients present with:

Answer 5

1. DOE (increased LV/LA/PA pressure)

2. Fatigue (decreased CO)

Question 6

What is the MC pattern (type) of cardiomyopathy?

Answer 6

Dilated cardiomyopathy (90% of cases)

Question 7

What is dilated cardiomyopathy?

Answer 7

Enlarged LV with decreased systolic function and EF less than 50%

• Causes 25% of HF cases
• Blacks, males, 20-50 yo

Question 8

What type of cardiomyopathy causes 25% of all HF cases?

Answer 8

Dilated cardiomyopathy

Question 9

In dilated cardiomyopathy, ____ (systolic/diastolic) failure is more pronounced

Answer 9

Systolic

Question 10

What are the causes of dilated cardiomyopathy?

Answer 10

• Genetic in 20-50% cases

- Idiopathic

Question 11

What heart sound is present in dilated cardiomyopathy?

Answer 11

S3

Question 12

Treatment of dilated cardiomyopathy

Answer 12

Standard tx for heart failure

Question 13

Describe hypertrophic cardiomyopathy (HCM)

Answer 13

• Obstructive and non obstructive
• MC seen 20-40 yo
• Increased LV hypertrophy without underlying cause
• Main dysfunction is increased diastolic filling pressure from a stiff and small LV

Question 14

What is the MC genetic cause of cardiac death in young people?

Answer 14

HCM

Question 15

What is the main dysfunction in HCM?

Answer 15

Increased diastolic filling pressure from a stiff and small chambered hypertrophied LV

Question 16

Pathophys of non-obstructive HCM

Answer 16

Increased wall thickness (hypertrophy w/o dilation) decreases wall tension, increases EF

Question 17

Pathophys of obstructive HCM

Answer 17

Asymmetric interventricular septal hypertrophy that can obstruct outflow by narrowing LV tract and decreasing EF

Question 18

What are the causes of HCM?

Answer 18

• Genetic 50-80% cases
• Idiopathic
• Infants of DM mothers

Question 19

What is the biggest difference between the pathophys of dilated and hypertrophic cardiomyopathy?

Answer 19

HCM has HYPERcontractility

Question 20

What heart sound is present with HCM?

Answer 20

Loud S4 from stiff, hypertrophic ventricle

Question 21

What is found on physical exam of HCM?

Answer 21

• Systolic ejection murmur (decreases w/squatting, increases w/standing)
• Bisferiens carotid pulse

Question 22

What is the main cause of restrictive cardiomyopathy?

Answer 22

Amyloidosis

Question 23

What population is affected by restrictive cardiomyopathy?

Answer 23

Males, 40+ yo

Question 24

What is the pathophys of restrictive cardiomyopathy?

Answer 24

• Impaired LV/RV diastolic filling
• Reasonably preserved contractility
• Decreased ventricular compliance
• R heart failure dominates over L sided heart failure

Question 25

What is the difference between restrictive and constrictive cardiomyopathy?

Answer 25

In restrictive:

• NO pulsus paradoxus
• PA pressure is elevated