Cardiomyopathy

Question 1

Common pathway of cardiomyopathy:

Answer 1

Arrhythmia
CHF
Death

Question 2

Pathophysiology of HCM:

Answer 2

Septal hypertrophy leading to diastolic dysfx leading to levitate ventricular outflow obstruction

Question 3

HCM pts can develop what abnormalities? (3)

Answer 3

MI
Arrhythmias
Mitral regurgitation

Question 4

HCM w/u includes:

Answer 4

• clinical suspicion
• ekg
• echo (test of choice)
• cardiac MRI
• genetic testing

Question 5

HCM sxs:

Answer 5

Syncope
SOB
CP
Turbulent murmurs: S4 and mitral regurgitation
Ventricular Arrhythmias
Sudden death

Question 6

HCM tx:

Answer 6

• BB; metoprolol (lopressor)
• restrict activity
• definitive ICD (only preventable tx)
• avoid vasodilators (DHP CCB, nitrates, hydralazine) and ionotropes (dopamine, dobutamine, digoxin, epinephrine)
• surgical septal myectomy
• alcohol septal ablation

Question 7

Arrhythmogenic right ventricular cardiomyopathy etiology:

Answer 7

Fibro-fatty infiltration of right ventricular myocardium

Question 8

Arrhythmogenic right ventricular cardiomyopathy phases:

Answer 8

Concealed: asxs
Electrical: palpitations or syncope
Diffuse: right sided HF

Question 9

Arrhythmogenic right ventricular cardiomyopathy leads to: (3)

Answer 9

Right sided HF
Vtach
Death

Question 10

Arrhythmogenic right ventricular cardiomyopathy dx:

Answer 10

• EKG
• echo (test of choice)
• cardiac MRI

Question 11

Arrhythmogenic right ventricular cardiomyopathy tx:

Answer 11

• BB- metoprolol (lopressor)
• reduce activity
• ICD- definitive and preventable tx

Question 12

Describe athletic left ventricular hypertrophy:

Answer 12

MC w/ arrhythmias but benign

LV hypertrophy: symmetric and >14 mm on echo

Question 13

Restrictive Cardiomyopathy etiology:

Answer 13

Inflammatory: post-radiation fibrosis
Infiltration: sarcoidosis or amyloidosis
- ventricular filling is restricted because of excessive rigidity of ventricular walls

Question 14

Restrictive Cardiomyopathy sxs:

Answer 14

HF w/ normal size heart; “small stiff hearts”
SOB
right sided HF s/s: JVD, peripheral edema, ascites

Question 15

Restrictive Cardiomyopathy w/u:

Answer 15

• clinical suspicion
• cardiac MRI
• ekg
• echo (test of choice)
• endomyocardial biopsy: definitive dx

Question 16

Restrictive Cardiomyopathy tx:

Answer 16

No real tx (aim at HF or arrhythmias)

Question 17

Dilated Cardiomyopathy etiology:

Answer 17

• etoh: MC cause
• genetic:
  Chronic persistent a. Fib
  SLE
  DM
  MD
• drugs:
  Chemo: doxorubicin (adriamycin)
  Anti-rheumatic: hydroxychloroquinine (plaquenil)

Question 18

Dilated Cardiomyopathy DX:

Answer 18

CXR- enlarged heart w/ fluffy infiltrates
EKG- LVH; LBBB; a.fib
Echo: key to investigation

Question 19

Dilated Cardiomyopathy tx:

Answer 19

• eliminate reversible causes (etoh)
• BB
• vasodilators (ace/nitrates)
• diuretics
• anticoagulants
• digoxin
• ICD
• consider transplant

Question 20

Dilated Cardiomyopathy sxs:

Answer 20

• HF: weakness, SOB, orthopedic, crackles, S3
• peripheral edema (leg, sacral, JVD)
• late stages: thrombus, mitral regurgitation, arrhythmias, death

Question 21

Myocarditis etiology:

Answer 21

Inflammatory process ending in necrosis

Question 22

Etiologies of myocarditis: (6)

Answer 22

1- viruses (MC)
2- fungal
3- protozoan
4- parasites
5- autoimmune conditions
6- bacterial

Question 23

Myocarditis presentation:

Answer 23

• MC asxs
• constitutional sxs
• acute onset HF sxs

Question 24

Myocarditis w/u: (6)

Answer 24

ECG
Positive cardiac enzymes
CXR w/ cardiomegaly
Echo
Cardiac MRI: MC used for dx
Endomyocardial biopsy: better for definitive dx

Question 25

Histology can hallmark of myocarditis:

Answer 25

Focal, patchy or diffuse inflammatory infiltrate w/ adjacent myocyte injury

Question 26

MC viruses in myocarditis: (6)

Answer 26

``` 1- adenoviruses 2- HSV 3- cox sackie virus B 4- parvovirus (B19) 5- Flu A 6- CMV ```

Question 27

Pericardium Cardiomyopathy risk factors

Answer 27

AA Twin gestation Preeclampsia w. Use of tocolytic agents (terbutaline) to prevent premature labor

Question 28

Pericardium Cardiomyopathy occurs (time and presentation)

Answer 28

- Last month of pregnancy or 5 months after pregnancy | - presents w/ systolic dysfx in HF

Question 29

Tx of takotsubo cardiomyopathy:

Answer 29

Benzos (Ativan/Valium)

Question 30

takotsubo cardiomyopathy cause and presentation on CXR:

Answer 30

- excessive catecholamines release secondary to emotional or psychological stress - hyperactive base w/ impaired apex or “apical ballooning” - “fishpot” resemblance on CXR