Cardiomyopathy, Myocarditis, Pericardial Disease

Question 1

Dilated Cardiomyopathy

Non-genetic causes

Answer 1

Myocarditis
Peri partum
Toxic (alcohol)
Idiopathic

Question 2

Dilated Cardiomyopathy

Genetic Causes

Answer 2

Various cytoskeleton protein (nucleus, sarcomere, cell membrane)
Mitohondria

Question 3

Dilated Cardiomyopathy phenotype

Answer 3

Hypertrophy
Dilation
Fibrosis, intersitial
Intracardiac thrombi
Heart Failure symptoms

Question 4

Hypertrophic Cardiomyopathy

Answer 4

100% Genetic (autosomal dominant)
Sarcomeric proteins
Defect in energy transfer from mito to sarcomere, or direct sarcomeric dysfunction
IHSS or HOCM (hypertrophic obstructive cardiomyopathy)

Question 5

Hypertrophic Cardiomyopathy phenotype

Answer 5

Marked LV hypertrophy
Asymmetrical SEPTAL hypertrophy (banana shaped LV)
Myofiber disarray
Fibrosis, interstitial and replacement
LV outflow tract plaque
Thickened septal vessels

Question 6

Hypertrophic Cardiomyopathy associations

Answer 6

Diastolic heart failure
Exertional dyspnea
Harsh systolic ejection murmur
Anginal pain
Intractable heart failure
Arrhythmias
Sudden death (young athletes)

Question 7

Hypertrophic Cardiomyopathy Tx

Answer 7

Ventricular relaxation via medical therapy

Surgical excision of muscle

Question 8

Restrictive Cardiomyopathy

Answer 8

Decrease in ventricular complance
Impeded LV filling during diastole
Systolic function preserved
Leads to atrial enlargement
Symptoms from reduced myocardial compliance and stroke volume

Question 9

Restrictive Cardiomyopathy associations

Answer 9

Idiopathic
Radiation fibrosis
Amyloidosis
Sarcoidosis
Inborn errors of metabolism
Endocardial fibroelastosis
Loeffler endomyocarditis

Question 10

Amyloid

Answer 10

Misfolded protein
Deposits in ECS
B-pleated sheet
Congo red staining
Apple green under polarized light

Question 11

Myocarditis

Answer 11

Inflammatory process resulting in myocardial injury
Spectrum of symptoms from asymptomatic to nonspecific (fever, fatigue)
Acute CHF
Arrhythmias
Dilated cardiomyopathy

Question 12

Myocarditis

Nonifections causes

Answer 12

Immune mediated: hypersensitivity (from drugs), rheumatic fever
Giant cell myocarditis, sarcoidosis

Question 13

Myocarditis

Infectious causes

Answer 13

Viral: Coxsakie A and B, cytomegalovirus. HIV
Bacterial: Diptheria, lyme disease
Parasites: Chaga’s disease, trichinosis, toxoplasmosis

Question 14

Pericardial effusion

Answer 14

Clear yellow serous fluid
Blood
Pus
Global enlargement of heart on CXR
Rapid development compress atria, vena cava, ventricles, cardiac filling
Cause Cardiac Tamponade

Question 15

Pericarditis

Answer 15

Inflammation of pericardium
Usually secondary to cardiac, thoracic, or systemic process
Causes: infection, immune-mediate rxn, uremia, neoplasia, trauma

Question 16

Fibrinous Pericarditis

Answer 16

Irregular, shaggy surface
Uremia
Acute rheumatic fever (bread and butter fibrosis)
Hear pericardial friction rub

Question 17

Suppurative (fibrinopurulent) Pericarditis

Answer 17

Acute bacterial infection

Question 18

Hemmorrhagic Pericarditis

Answer 18

Tuberculosis

Malignancy

Question 19

Caseous Pericarditis

Answer 19

Tuberculosis
Thickened, yellow areas
Granulomas
Mycobacterium

Question 20

Tx of Constrictive Pericarditis

Answer 20

Pericardiectomy
Surgical removal of constricting pericardium
Usually there is fibrous tissue caked on

Question 21

Complications of Cardiac Trasplantation

Answer 21

Acute rejection
Chronic rejection
Infections
Post tansplat lymphoma (Epstein-Barr virus)
Late progressive diffuse stenosing intimal proliferation of coronary arteries