CHAPTER 55 CMP AND PERICARDIAL DISEASE

Question 1

Diseases that solely or predominantly involve the myocardium and are usually familial in origin

Answer 1

Primary cardiomyopathies

Question 2

Include heart muscle diseases associated with specific systemic disorders

Answer 2

Secondary cardiomyopathies

Question 3

Second most common cause of sudden cardiac death in the adolescent population

Leading cause of sudden death in competitive athletes

Answer 3

Hypertrophic cardiomyopathy

Question 4

Systolic and diastolic dysfunction CMP type

Answer 4

Dilated CMP
Myocarditis

Question 5

Diastolic dysfunction CMP type

Answer 5

HCOM
Restrictive CMP

Question 6

Most commonly manifests as dilated cardiomyopathy

Answer 6

Peripartum cardiomyopathy

Question 7

It is characterized by systolic and diastolic dysfunction and diminished left ventricular (LV) and, often, right ventricular contractile force, resulting in a low cardiac output and increased end-systolic and end-diastolic ventricular volumes.

Answer 7

Dilated cardiomyopathy

Question 8

Hallmarks of DMCP

Answer 8

LV and RV dilatation + Normal LV wall thickness

Question 9

It is the inflammation of the heart muscle
Most frequently characterized pathologically by focal infiltration of the myocardium by lymphocytes, plasma cells, and histiocytes

Answer 9

Myocarditis

Question 10

Designed as a bridge to transplant in end-stage heart failure patients but offer long-term quality of life improvement for patients who are not candidates for transplant

Answer 10

Left ventricular assist devices (LVADs)

Question 11

CAN ONE PERFORM CHEST COMPRESSIONS ON AN LVAD PATIENT?

Answer 11

Avoid chest compressions if at all possible unless absolutely necessary

Chest compressions can potentially dislodge the LVAD from the heart and aorta –> left ventricular rupture, intractable hemorrhage

Question 12

What is audibly heard when auscultating the precordium in px with LVAD –> functional

Answer 12

“whirr”

Question 13

Gold standard for diagnosis of myocarditis

Answer 13

Endocardial biopsy

Question 14

Treatment for idiopathic or viral myocarditis

Answer 14

Supportive

-Antibiotics are needed for myocarditis complicating rheumatic fever, diphtheria, or meningococcemia

Question 15

“A disease state characterized by unexplained LV hypertrophy associated with NONDILATED ventricular chambers is the absence of another cardiac or systemic disease that itself would be capable of producing the magnitude of hypertrophy evident in a given patient.”

Answer 15

Hypertrophic cardiomyopathy

Question 16

Echocardiographic hallmark for HCOM

Answer 16

LV wall thickening >15 mm

Question 17

Cause of chest pain in HCOM

Answer 17

Due to an imbalance between the oxygen demand of the hypertrophied left ventricle and the available myocardial blood flow

Question 18

Interventions that DECREASE LV filling and the distending pressure in the LV outflow tract or that increase the force of myocardial contraction –> accentuate the murmur of HOCM

Answer 18

Standing
Valsalva

Upppp uhhh

Question 19

Maneuvers that INCREASE LV filling –> DECREASE murmur

Answer 19

Passive leg elevation
Squat
Hand grip

Question 20

T/F: The murmurs of hypertrophic cardiomyopathy and mitral valve prolapse, when associated with murmur, are similar

Answer 20

T

except HAND GRIP (increases in MVP)

Question 21

Hallmarks of restrictive CMP

Answer 21

(1) elevated LV and right ventricular end-diastolic pressure
(2) normal LV systolic function (ejection fraction >50%)
(3) a marked decrease followed by a rapid rise and plateau in early diastolic ventricular pressure observed during invasive hemodynamic assessment

Question 22

Amount of fluid in the space between the parietal and visceral pericardium

Answer 22

50 ml

Question 23

The most common symptom of acute pericarditis

Answer 23

sharp or stabbing precordial or retrosternal chest pain

-sudden or gradual onset; radiate to the back, neck, left shoulder, or arm; and aggravated by inspiration or movement.
-most severe when the patient is supine and is relieved when the patient sits up and leans forward.

Question 24

Distinguishing feature of acute pericarditis

Answer 24

Referral of pain to the left trapezial ridge - (due to inflammation of the joining diaphragmatic pleura)

Question 25

Most common and important physical finding in pericarditis

Answer 25

pericardial friction rub

-best heard with the diaphragm of the stethoscope at the lower left sternal border or apex when the patient is sitting and leaning forward

Question 26

Remarks on pericardial friction rub

Answer 26

TRIPHASIC

(1) systolic component due to ventricular contraction,
(2) early diastolic component during the early phase of ventricular filling,
(3) presystolic component synchronous with atrial systole

Question 27

MCC of cardiac tamponade

Answer 27

Metastatic malignancy
-lung, breast, lymphoma