Cardiomyopathy and Myocarditis

Question 1

clinical presentation of acute myocarditis

Answer 1

• 2 weeks after the development of a URI of flu-like syndrome with fever and chills or GI sx
• CP with pericarditis
• adult cases: HF w/ or w/o cardiogenic shock
• arrhythmias with paliptations or syncope can -> sudden death
• 3rd heart sound, pulmonary congestion, peripheral edema, mitral or tricuspid insufficiency murmurs
• inc trop
• nonspecific ECG changegs
• ECHO global or diffuse ventricular duysfunction

Question 2

possible outcomes of acute myocarditis

Answer 2

• asx cases can develop a dilated cardiomyopathy

- cases with HG may respolve, proceed rapidly downhill to death or evolve into a chronic dilated cardiomyopathy

Question 3

dilated cardiomyopathy anatomy and features

Answer 3

dilated LV with minimal hypertrophy

• HF with a large silent heart with impaired systolic fn
• usually idiopathic

Question 4

hypertrophic cardiomyopathy anatomy and features

Answer 4

• marked LV hypertrophy without dilation
• predominant diastolic dysfunction due to impaired diastolic relaxation and increased stiffness
• -> increased pulm venous and cap pressures
• dyspnea on exertion

Question 5

restrictive cardiomyopathy anatomy and features

Answer 5

• infiltrated or fibrotic LV
• most commonly infiltrative
• impaired ventricular filling due to still ventricles
• systolic fn nl and ventricles not dilated

Question 6

causes, epidemiology, anatomy and hemodynamics of hypertrophic obstructuve cardiomyopathy

Answer 6

genetic, auto dom, rare

• LV is hypertrophied but not dilated and muscle fibers and collagen matrix are disorganized
• septal thickening and a hyperdynamic contraction may cause aortic outflow tract obstruction

Question 7

clinical features and tx of hypertrophic obstructuve cardiomyopathy

Answer 7

• variable sx
• –dyspnea, angina, arrhythmia and sudden death with exertion
• diastolic dysfn
• tx: decrease contractility – Beta/Ca2+ channel blockade, surgical resection, avoid extreme exertion, ventricular pacing

Question 8

hemodynamics and clinical presentation of restrictive cardiomyopathy

Answer 8

Hemodynamics: impaired ventricular filling due to stiff ventricles
Clinical presentation: systolic fn often nl and ventricles usually not dilated
-Dx by ECHO with Doppler assessment of ventricular filling