Cardiomyopathy/Pericarditis

Question 1

Mycarditis - etiology

Answer 1

1) Infection - VIRUS, parasite, fungal, bacteria
2) Drug/toxin
3) Autoimmune
4) Metabolic

Question 2

Myocarditis symptoms

Answer 2

Fever, myalgia, muscle tenderness, chest pain with ECG arrhythmia, fatigue, dyspnea, CHF

Question 3

pathology of viral myocarditis

Answer 3

imflammation with lymphocytes

Question 4

Fungal myocarditis

Answer 4

more common in immunosuppressed

Question 5

Autoimmune myocarditis

Answer 5

collagen vascular or CT disease systemic, (lupus, scleroderma, RA) to affect all three layers of heart

Question 6

Adriamycin

Answer 6

chemo drug to lead to toxic accumulation and myocarditis

Question 7

What toxins cause mycarditis

Answer 7

Adriamycin, ethanol, cobalt, hemochromatosis

Question 8

Amyloidosis

Answer 8

Protein deposition (beta pleated sheets) to cause myocarditis

Question 9

Dilated Cardiomyopathy

Answer 9

systolic dysfunction

Question 10

Associated symptoms of dilated cardiomyopathy

Answer 10

normal HF, ventricular thrombus, M/T regurgitation, arrhythmia

Question 11

Increased BNP in dilated cardiomyopathy

Answer 11

worse outcome

Question 12

Hypertrophic Cardiomyopathy

Answer 12

disproportionate Septum thickening to cause diastolic dysfunction.
Myocyte dissaray and concentric hypertrophy.

Question 13

EF in dialated ver hypertrophic

Answer 13

dilated is reduced

hypertrophy - normal of hyperdynamic

Question 14

Murmur is hypertrophic cardiomypathy

Answer 14

systolic murmur that increases with standing and valsava

Question 15

SAM

Answer 15

Systolic anterior movement of mitral valve… gets stuck in outflow track to lead to mitral regurgitation murmur in systole.

Question 16

Surgical tx of hypertrophic cardiomyopathy

Answer 16

myomectomy and alcohol ablation

Question 17

Restrictive cardiomyopathy

Answer 17

diastolic dysfunction due to scar and fibrosis of heart. Most common cuases are amylodosis, sarcoidosis, hemochromatosis, raditiaion

Question 18

Arrhythmogenic Right Ventricular cardiomyopathy

Answer 18

mycardium is replaced by fibroblast –> arrhythmia prone. More prevalent in RV than LV.

Question 19

Secondary cuases of Hypertension

Answer 19

renal (diabetes, renal a. stenosis), endocrine, cardiovascualr

Question 20

ECG finding of acute pericarditis

Answer 20

diffuse ST elevation

Question 21

electrical alternans

Answer 21

alteration of QRS amplitude between beats in pericardial effusion

Question 22

Pulsus paradoxus

Answer 22

decreased systolic BP >10 mm with inspiration - in pericardial effusion and cardiac tamponade.

Question 23

ECHO in cardiac tamponade

Answer 23

effusion, RV and RA collapse, dialted IVC

Question 24

Symptoms of constrictive pericarditis

Answer 24

elevated JVP, edema, ascites, tachy, hepatomegaly, 3rd heart sound.

Question 25

Long QT1

Answer 25

Loss of function mutation in IKS - cannot hyperpolarize

Question 26

Long QT2

Answer 26

loss of function mutation in IKR

Question 27

Long QT3

Answer 27

gain of function in INa - does not inactivation

Question 28

Gain of Function in Long QT

Answer 28

I Na - no inactivation

Question 29

Timothy syndrome

Answer 29

incomplete ICa inactivation to prolong phase 2 mutation in CaV1.2 (de novo) to have also immunodeficiency and cognitive abnormalities (autism) G406R and G402S (exon 8 and 8A)

Question 30

Bruguda Syndrome

Answer 30

Sudden unexplained death syndrome that makes one prone to ventricular arrhythmias due to Na Channel mutation, ankryn mutation, and Cav1.2 to shorten QT

Question 31

Finnish Syndrome

Answer 31

Mutation in IKs so it cannot bind to Yotiao. Yotiao binds PKA to Ca and K channels. Thus a mutation in IKs means that when increased sympathetic activity, there wont be enough K channels to match increased Ca current and leads to afterpolarizations.

Question 32

how to overcome re-entry?

Answer 32

1) unidirection --> bidirectional block | 2) prolong refractory time

Question 33

how do you convert uni to bidirectional block?

Answer 33

1) slow conduction velocity so it cant propogate into depressred region 2) prolong refractory peroid

Question 34

Catecholaminergic polymorphic Ventricular Tachy (CPVT)

Answer 34

no ECG abnormality, but apparent wit exercise of catecholamines. RyR2 mutation that leads to Ca leaking from SR or increases RyR2 senstivity. OR Calsequestrin mutation so it can no longer buffer and RyR2 is no longer regulated.

Question 35

Treatment of CPVT

Answer 35

Beta blockers, Block RyR (tetracaine) or flecanidide (block Na channels).