Cardiomyopathy

Question 1

What are the types of Cardiomyopathies?

Answer 1

Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Restrictive

Question 2

What is Dilated Cardiomyopathy?

Answer 2

Dilation and weakening of the Left ventricle (contractile dysfunction)
Most common

Question 3

What is Hypertrophic Cardiomyopathy?

Answer 3

Hypertrophy left ventricular dysfunction and arrhythmias (bad systole)
familial

Question 4

What is Restrictive Cardiomyopathy?

Answer 4

Excessive myocardial stiffening with resultant ventricular dysfunction (bad diastolic filling)

Question 5

What are the etiologies of Dilated Cardiomyopathies?

Answer 5

Idiopathic 
Ischemic (CAD)
Hypertensive 
Alcoholic
Infectious- Chagas
Metabolic`

Question 6

What is normal ejection fraction?

Answer 6

65%

Question 7

How does the heart compensate for a pathologic low ejection fraction?

Answer 7

Increases Heart Rate

Question 8

What are the symptoms of LV Failure?

Answer 8

Fatigue, weakness
Dyspnia
-exertional 
-orthopnea (cant lie flat)
-PND
Pallor (poor perfusion), tachycardia

Question 9

What are the signs of LV Failure?

Answer 9

Pale dyspnic
Vital signs vary, Tachy
Cardiac apex displaced left and down
Apical lift or thrill often present
S1-2 normal. P2 varies
S3 always present
Murmurs (many possible)

Question 10

What is the most common cause of RV failure?

Answer 10

Right ventricular failure!

Question 11

What are the symptoms of RV Failure?

Answer 11

Similar to LVF dyspnia improves as LV fails

Question 12

What are the signs of RV Failure?

Answer 12

JV pulses elevates
Cardiomegaly, RV lift
P2 varies
RV and LV S3 are universal
various murmurs
pulsus alternans
hepato/splenomegaly
ascites
peripheral edema
evidence of poor nutrition (protein calorie malnutrition)

Question 13

What is the therapy of Dialated Cardiomyopathy?

Answer 13

.

Question 14

What is Alcoholic (dilated) cardiomyopathy?

Answer 14

major, Non-ischemic cardiomyopathy Direct alcohol myotoxicity
Cardiodepression even without toxicity
A-Fib very common
Same physical findings as other dilated cardiomyopathies
Labs similar
ECGs often show arrhythmia

Question 15

What is the treatment of Alcoholic Cardiomyopathy?

Answer 15

Treat the same as other dilated cardiomyopathy
MUST STOP DRINKING!!!
Thiamine Supp

Question 16

What are the types of Hypertrophic Cardiomyopathy?

Answer 16

IHSS:
HOCM:hypertrophic, obstructive
HCM: obstructive or non obs.
Aymmetric septal Hypertrophy

Question 17

What are the findings of hypertrohic Cardiomyopathy?

Answer 17

Macroscopic:
Increased Myo Mass
Asymmetric Septal Hyp
Concentric Hyp
Apical Hyp (rare)
Microscopic:
Myofibrillary Dysarray-Whorls of Deformed myocyttes
Fibrosis
Abn. intramural Coronaries

Question 18

What are the Signs and Symptoms of Hyp Cardiomyopathy?

Answer 18

Symptoms: Young
Sudden death
dyspnia
angina pectoris
fatigue, syncope
Signs:
Displaced bifid LV impulse
bisfiriens carotid pulse
S4 common
systolic murmur

Question 19

ECG findings For HCM

Answer 19

.

Question 20

How is HCM diagnosed?

Answer 20

Echocardiogram

Question 21

What anatomical changes are seen in HCM?

Answer 21

LV Hypertrophy
-symmetric
-asymmetric septal hypertrophy
-systolic antrior motion of MV
LV normal in size and normal contractility

Question 22

What is seen in Restrictive Cardiomyopathy?

Answer 22

Rare in western countries
DIASTOLIC Dysfunction
Caused by:
amyloidosis
hemochromatosis
sarcoidosis
Loeffler's 
fibrosis