Cardiomyopathy

Question 1

Types

Answer 1

Dilated Cardiomyopathy (which Takotsubo Cardiomyopathy is a type of)

Hypertrophic Cardiomyopathy

Restrictive Cardiomyopathy

Question 2

Hypertrophic Cardiomyopathy

Pathology

Genetics

Answer 2

Pathology: mainly diastolic dysfunction
- Left Ventricular Hypertrophy results less compliance and so reduced ventricular filling and so reduced cardiac output

Histopathology: myocardium in disarray

Genetics: Autosomal Dominant Condition

Question 3

Hypertrophic Cardiomyopathy

Clinical Features

Answer 3

Often Asymptomatic

Exertional SOB

Syncope (particularly after exercise)

Sudden death in the young (a risk factor for which is unexplained syncope)

Question 4

Hypertrophic Cardiomyopathy

Examination findings

Answer 4

Jerky pulse

Ejection Systolic Murmur louder on standing + queiter when sitting or squating (most commonly but can be pansystolic too)

[Pathology of ESM: asymmetrical hypertrophy results in obstruction of the aortic outflow tract so essentially aortic stenosis]

Heart sound 4 heard in the apex : due to the left atrium contacting against a thickened left ventricle
[also seens in aortic stenosis i.e. any condition that causes left ventricular hypertrophy)

Question 5

Hypertrophic Cardiomyopathy

Associations

Answer 5

Friedrich’s Ataxia (autosomal recessive, trinucleotide repeat that doesn’t show anticipation)

Question 6

Cardiomyopathy

Investigations to do

Answer 6

Bloods:
- FBC, U+Es, Cardiac markers (Trop, BNP)

Bedside:
- ECG: looking for left ventricular hypertrophy (sometimes atrial fibrillation)

Imaging:
- ECHO

Question 7

Hypertrophic Cardiomyopathy

Echo findings

Answer 7

[MR SAM ASH]

Mitral Regurgitation

Seperate Anterior Motion of the anterior mitral valve leaflet

Asymmetrical hypertrophy: due to thickening of the interventricular septum

Question 8

Hypertrophic Cardiomyopathy

Management

Contraindicated

Answer 8

[ABCDE]

Amiodarone 
Beta-blocker for symptoms 
Cardioverter Defibrillator 
Dual Chamber pacemaker OR Digoxin (in otropic) 
Endocarditis prophylaxis

Drugs that reduce the venous return/ pre load worsen HOCM as there is less blood in the ventricles stretching out the outflow tract obstruction:

• GTN
• ACE inhibitors
• Dihydroppyridine Ca2+ channel blockers e.g. amlodipine

Question 9

What is the most common type of cardiomyopathy?

Answer 9

Dilated Cardiomyopathy

Question 10

Dilated Cardiomyopathy

Pathology

Cause

Answer 10

Mainly Systolic Dysfunction

CAUSE

• Chronic Alcohol use
• Myocarditis e.g. Coxsackie B,
• Chagas disease (parasite Trypanosoma cruzi from South America - aka kissing disease)
• Malnutrition: selenium deficinecies
• Drugs: Doxorubicin, Trastuzumab

Question 11

Dilated Cardiomyopathy

Clinical Features

Answer 11

Classic symptoms of heart failure

Question 12

Dilated Cardiomyopathy

Examination findings

Answer 12

Enlargement of the ventricles with cause systolic murmurs in the form of mitral and tricuspid regurgitaiton

Heart Sound 3 due to the blood rushing and hitting the dilated ventricular wall during diastole

Question 13

What is Takotsubo Cardiomyopathy?

Answer 13

A form of dilated cardiomyopathy caused by stress

Question 14

Restrictive Cardiomyopathy

Pathology

Causes

Answer 14

Heart muscle is stiff (and dilated) resulting in diastolic dysfunction

Causes:

• Primary: endomyocardial fibrosis
• Secondary: Amyloidosis

Question 15

Restrictive Cardiomyopathy

Examination Findings

Answer 15

S3 heart sound: due to the blood rushing and hitting the dilated ventricle walls during diastole

Question 16

Restrictive Cardiomyopathy

ECG findings

Answer 16

Reduced voltage QRS complexes [The QRS complexes are RESTRICTED to flourish]