Cardiomyopathy

Question 1

what are the causes of dilated cardiomyopathy

Answer 1

idiopathic 50%

genetic

alclcohol

infective

Question 2

what inheritance pattern is seen in dilated cardiomyopathy resulting from a genetic cause

Answer 2

autosomal dominant 25%

Question 3

what are the clinical features of dilated cardiomyopathy

Answer 3

asymptomatic

heart failure symptoms

arrhythmia (AF or sudden cardiac death due to VF)

thromboembolism

Question 4

what would you see on examination of a patient with dilated cardiomyopathy

Answer 4

displaced apex beat

S3 and S4 gallop

Question 5

how would you broadly manage dilated cardiomyopathhy

Answer 5

1. Manage heart failure symptoms
   - beta blockers and ACEi
   - loop and thiazide diuretics
2. Treat any identifiable cause
3. Prevent any complications
   - consider anti-arrhythmics
   - heart transplantation

Question 6

what is hypertrophic cardiomyopathy characterised by

Answer 6

asymmetrical LB hypertrophy with impaired diastolic filling

Question 7

what type of cardiomyopathy is most commonly associated with sudden cardiac death in the under 35s

Answer 7

hypertrophic cardiomyopathy

Question 8

what causes hypertrophic cardiomyopathy

Answer 8

genetics - autosomal dominant

Question 9

what are the two types of hypertrophic cardiomyopathy

Answer 9

Obstructive (hypertrophic obstructive cardiomyopathy - HOCM) - involves narrowing of the ventricular outflow tract due to a thickened interventricular septum

non obstructive

Question 10

what are the clinical features of hypertrophic cardiomyopathy

Answer 10

most asymptomatic

present similarly to aortic stenosis eg.

• angina
• dyspnoea
• pre-syncope/syncope
• sudden death

AF

Question 11

what is the most common arrhythmia seen in hypertrophic cardiomyopathy

Answer 11

AF

Question 12

what would you see on clinical examination of a patient with hypertrophic cardiomyopathy

Answer 12

• jerky pulse
• palpable LV hypertrophy
• double impulse at apex
• pansystolic murmur

Question 13

what changes on ECG would you see in hypertrophic cardiomyopathy

Answer 13

LV hypertrophy

T wave inversion

Question 14

what drug is CI in hypertrophic cardiomyopathy

Answer 14

digoxin

Question 15

how do you manage hypertrophic cardiomyopathy

Answer 15

initially use beta-blockers and rate limiting calcium channel blockers (verapamil)

surgical myectomy is the treatment of choice for those who do not respond to medical therapy

Alcohol ablation/HF treatment/heart transplant

Prevent complications - anti-arryhthmics, ICD

Question 16

describe the epidemiology of restrictive cardiomyopathy

Answer 16

common in developing countries, equal gender preponderance

Question 17

what is restrictive cardiomyopathy

Answer 17

contraction of atria against stiff non-dilated ventricles with near normal systolic function

Question 18

what are the causes of restrictive cardiomyopathy (and the most common)

Answer 18

most common - amyloidosis

sarcoidosis
metastases + radiotherapy

Question 19

how do you detect amyloidosis on microscopy

Answer 19

congo red stain

Question 20

what are the clinical features of restrictive cardiomyopathy

Answer 20

often presents with symptoms of congestive HF

Question 21

how does Takotsubos present

Answer 21

brought on by stressful situations

symptoms and signs mimic MI but patients have non-obstructive coronary artery