Cardiomyopathy

Question 1

Define cardiomyopathy

Answer 1

Primary disease of the myocardium. Cardiomyopathy may be:

Dilated

Hypertrophic

Restrictive

Question 2

Dilated Cardiomyopathy

Answer 2

disease of the heart muscle, usually starting in your heart’s main pumping chamber (left ventricle). The ventricle stretches and thins (dilates) and can’t pump blood as well as a healthy heart can

Question 3

Hypertrophic cardiomyopathy

Answer 3

disease in which the heart muscle becomes abnormally thick (hypertrophied). The thickened heart muscle can make it harder for the heart to pump blood.

Question 4

Restrictive Cardiomyopathy

Answer 4

Restrictive cardiomyopathy is when the walls of the lower chambers of your heart (called the ventricles) are too rigid to expand as they fill with blood. The pumping ability of the ventricles may be normal, but it’s harder for the ventricles to get enough blood. With time, the heart can’t pump properly.

Question 5

Explain the aetiology/risk factors of cardiomyopathy=

Answer 5

Idiopathic mainly

Question 6

Dilated Cardiomyopathy aetiology/risk factors

Answer 6

• Post-viral myocarditis
• Alcohol
• Drugs (e.g. doxorubicin, cocaine)
• Familial
• Thyrotoxicosis
• Haemochromatosis
• Peripartum

Question 7

Hypertrophic Cardiomyopathy aetiology/risk factors

Answer 7

Up to 50% are genetic

Question 8

Restrictive Cardiomyopathy aetiology/risk factors

Answer 8

• Amyloidosis- amyloid build up
• Sarcoidosis- abnormal masses/ inflammation
• Haemochromatosis- absorbing too much iron

Question 9

Summarise the epidemiology of cardiomyopathy

Answer 9

Prevalence of dilated and hypertrophic cardiomyopathy is 0.05-0.20%

Restrictive is even rarer

Question 10

Presenting symptoms of- Dilated

Answer 10

Symptoms of heart failure

Arrhythmias

Thromboembolism

Family history of sudden death

Question 11

Presenting symptoms of - Hypertrophic

Answer 11

Usually NO SYMPTOMS

Syncope

Angina

Arrhythmias

Family history of sudden death

Question 12

Presenting symptoms of- Restrictive

Answer 12

Dyspnoea

Fatigue

Arrhythmias

Ankle or abdominal swelling

Family history of sudden death

Question 13

Signs of cardiomyopathy on physical examination- Dilated

Answer 13

Raised JVP

Displaced apex beat

Functional mitral and tricuspid regurgitations

Third heart sound

Question 14

Signs of cardiomyopathy on physical examination- Hypertrophic-

Answer 14

Jerky carotid pulse

Double apex beat

Ejection systolic murmur

Question 15

Signs of cardiomyopathy on physical examination- Restrictive

Answer 15

Raised JVP

Kussmaul Sign - paradoxical rise in JVP on inspiration due to restricted filling of the ventricles

Palpable apex beat

Third heart sound

Ascites

Ankle oedema

Hepatomegaly

Question 16

Identify appropriate investigations for cardiomyopathy

Answer 16

CXR
ECG 
Echocardiography
Cardiac Catheterisation 
Endomyocardial Biopsy 
Pedigree or Genetic Analysis

Question 17

CXR

Answer 17

May show cardiomegaly

May show signs of heart failure

Question 18

ECG- All types

Answer 18

Non-specific ST changes

Conduction defects

Arrhythmias

Question 19

ECG- Hypertrophic

Answer 19

Left-axis deviation

Signs of left ventricular hypertrophy

Q waves in inferior and lateral leads

Question 20

ECG- Restrictive

Answer 20

Low voltage complexes

Question 21

Echocardiography-Dilated

Answer 21

Dilated ventricles with global hypokinesia

Question 22

Echocardiography- Hypertrophic

Answer 22

Ventricular hypertrophy (asymmetrical septal hypertrophy)

Question 23

Echocardiography- Restrictive

Answer 23

Non-dilated non-hypertrophied ventricles

Atrial enlargement

Preserved systolic function

Diastolic dysfunction

Granular or sparkling appearance of myocardium in amyloidosis