Cardiomyopathy

Question 1

What are the 3 types of Cardiomyopathy?

Answer 1

• Dilated (congestive) > > systolic HF
• Hypertrophic > > diastolic HG
• Restrictive (complex physiology)

Question 2

S3m,n and low ejection fraction

Answer 2

think systolic cardiomyopathy (Dilated cardiomyopathy, congestive)

-walls of the heart are thinned and weakened

Question 3

What are the causes of dilated cardiomyopathy?

Answer 3

• Ischemia
  
  • CAD (MI)
  • coacaine
  • arrhythmia
• Viral
• Toxins (alcohol)
• Genetic (HOCM, Tako Tsubo)

Question 4

What is the virus that usually causes dilated cardiomyopathy?

Answer 4

-Hep C

Question 5

What toxins cause dilated cardiomyopathy?

Answer 5

• alcohol (reversible if stopped)

- chemotherapy

Question 6

What are the genetic causes of dilated cardiomyopathy?

Answer 6

• HOCM (Hypertrophic Cardiomyopathy)

- Tako Tsubo (reversible) due to a transient epinephrine release

Question 7

What is the medical tx for dilated cardiomyopathy?

Answer 7

• Beta blocker
• Loop diuretic
• ACEI

-Cardiac transplantatiton

Question 8

What patient population get hypertrophic cardiomyopathy?

Answer 8

-usually kids (AKA: Hyper Obstructive Cardiomyopathy) HOCM

Question 9

What is the pathology with hypertrophic cardiomyopathy?

Answer 9

-affects the sarcomere

Question 10

Kid comes in with angina, syncope, and heart failure. He has an apical lift, S4 gallop, and ejection murmur medial to the apex. (looks like aortic stenosis) What murmur maneuver do you perform?

Answer 10

• Valsalva or abrupt standing increases the murmur

- Squatting decreases the murmur, standing increases the murmur

Question 11

How do you tx the kid with hypertrophic cardiomyopathy?

Answer 11

• diuretic
• beta andrenergic blocker or CCB (verapamil/dilitazem)
• surgery in selected cases (open heart is more successful)

screen all 1st degree family members*

Question 12

What is the number one cause of cardiac death in an adolescent or you adult?

Answer 12

• Hypertrophic cardiomyopathy

- once diagnosed screen entire family (PE and echo yearly)

Question 13

S4 and a big stiff ventricle

Answer 13

think Restrictive cardiomyopathy (diastolic HF)

Question 14

what is the pathology with Restrictive Cardiomyopathy?

Answer 14

-deposits get in the muscle and make it difficult to squeeze
 (HX of infiltrative process)
-amyloidosis
-sardcoidosis
-Scleroderma
-Fibroses
-Hemochromatosis
-Cancer

Question 15

How do you get Constrictive Cardiomyopathy?

Answer 15

• pericardial sac is affected and constricts the heart due to scarring
• radiation, TB, infections, recurrent pericarditis

Question 16

Guy comes in with fatigue, dyspnea, body swelling. PE shows elevated JVP, ascites, peripheral edema (looks like right heart failure). He has JVD, liver swelling and leg edema. He has a Hx of radiation, or TB, or recurrent pericarditis. What it the like Dx?

Answer 16

• Constrictive Cardiomyopathy

- radiation is most common cause