Cardiomyopathy & Myocarditis

Question 1

Clinical presentation of acute myocarditis

Answer 1

• often w/in 2 wks of URI/flu-like symptoms
• • preicarditis=chest pain
• S3 heart sound
• pulmonary contestion
• peripheral edema
• w/cardiac dilation –> mitral/tricuspid insufficiency murmurs
• non-specific ECG changes
• Echo=global ventricular dysfunction –> dx

Question 2

Outcomes of acute myocarditis

Answer 2

• can lead to cardiac dilation –> valvular insufficiency/regurgitation
• dilated cardiomyopathy may be acute (and resolve) or chronic
• adults –> present w/HF w/or w/out cardiogenic shock
• arrhythmias w/palpitations or syncope –> sudden death

Question 3

Anatomic classes of cardiomyopathies (3)

Answer 3

• dilated cardiomyopathy (most common)
• hypertrophic cardiomyopathy
• restrictive cardiomyopathy

Question 4

Features of dilated cardiomyopathy (causes, clinical present)

Answer 4

• causes: ischemic (CAD) & nonischemic (viral, familial)

- clinical manifestations: HFrEF w/ dilated ventricles, arrhythmia, thromboembolism

Question 5

Causes of hypertrophic obstructive cardiomyopathy

Answer 5

-strong genetic component

Question 6

Epidemiology of hypertrophic obstructive cardiomyopathy

Answer 6

-autosomal dominant inheritance

Question 7

Anatomic features of hypertrophic obstructive cardiomyopathy

Answer 7

• LV=hypertrophy, but no dilation
• muscle fibers/collagen matrix = disorganized, esp. @ septum
• septal thick + hyperdynamic contraction –> aortic outflow tract obstructuion

Question 8

Hemodynamic features of hypertrophic obstructive cardiomyopathy

Answer 8

• less compliant ventricles –> reduced filling

- -predominant diastolic dysfunction –> lower EDV –> lower SV

Question 9

Clinical features of hypertrophic obstructive cardiomyopathy

Answer 9

• eccentric hypertrophy of ventricle w/out dilation
• normal or enhanced systolic fxn
• predominant diastolic dysfunction (decreased ventricular filling/EDV)

Question 10

Treatment of hypertrophic obstructive cardiomyopathy

Answer 10

• decrease contractility: beta/calcium channel blockers
• surgical resection
• avoid extreme exertion
• ventricular pacing

Question 11

Hemodynamic features of restrictive cardiomyopathy

Answer 11

–impaired ventricular filling due to stiff ventricles –> lower EDV –> lower SV

Question 12

Clinical presentation of restrictive cardiomyopathy

Answer 12

• poor prognosis
• infiltrate: amyloidosis and sarcoidosis
• infiltrate –> noncompliant (but not dilated) ventricles
• impaired diastolic fxn
• normal systolic fxn
• dx via echo
• can lead to HFrEF and fatal arrhythmias

Question 13

Myocarditis definition and general characteristics

Answer 13

• inflammatory disease of heart
• in healthy adults/children=usually viral in origin
• often an autoimmune reaction (e.g. cross-rxn between viral epitopes and myocardium)

Question 14

Treatment of dilated cardiomyopathy

Answer 14

• tx of HF: diuretics, ACEi, beta-blockers, etc.
• anticoagulation
• anti-arrhythmic agents (drugs, defibrillators/pacers)
• heart transplants

Question 15

General features of hypertrophic cardiomyopathy

Answer 15

• LV is hypertrophied but not dilated

- often disproportionate hypertrophy of septum

Question 16

General features of restrictive cardiomyopathy

Answer 16

• infiltration or fibrosis of ventricles

- usually no dilation