Clinical Approach to Cardiomyopathies

Question 1

What is the most common cause of dilated cardiomyopathy?

Answer 1

Idiopathic causes

Question 2

What valvular disorder is associated with dilated cardiomyopathy?

Answer 2

Functional mitral regurgitation - dilation of the ventricle causes the leaflets to pull away from one another

Question 3

Coxsackie B and SARS-V-2 are associated with what cardiomyopathy?

Answer 3

Dilated cardiomyopathy

Question 4

What beta blockers are proven to have mortality benefit in patients with heart failure?

Answer 4

Carvedilol, bisoprolol, metoprolol

Question 5

True/False. Pregnant patients with previously recovered peripartum dilated cardiomyopathy had a lower risk of mortality if they developed dilated cardiomyopathy in a following pregnancy.

Answer 5

True

Question 6

What are the goals of treatment of dilated cardiomyopathy?

Answer 6

Decrease preload, decrease afterload, improve oxygenation, positive inotropes

Question 7

What is the pathophysiology of stress-induced cardiomyopathy?

Answer 7

Extreme stress causing a catecholamine surge

Question 8

Cardiomyopathy prognosis depends on the etiology. What etiology carries the worst pronosis?

Answer 8

Cardiomyopathy due to HIV infection

Question 9

What will an ECG of a patient with dilated cardiomyopathy show?

Answer 9

Normal ECG - tachycardia

Question 10

Where are endomyocardial biopsies taken when diagnosing cardiomyopathy?

Answer 10

R ventricular wall

Question 11

True/False. Hypertrophic cardiomyopathy is NOT due to pressure overload.

Answer 11

True - it is not related to long-standing hypertension, aortic stenosis, etc.

Question 12

What is the inheritance pattern for familial hypertrophic cardiomyopathy?

Answer 12

Autosomal dominant - first degree relatives of anyone with FHCM should be screened with an ECG

Question 13

Explain the pathophysiology of hypertrophic cardiomyopathy.

Answer 13

Myocyte hypertrophy leads to ventricular arrhythmias and diastolic dysfunction. Obstructions in LV outflow cause increased systolic pressure, mitral regurgitation, and an inability to increase CO with exercise. Combined, these factors increase the risk of sudden death.

Question 14

What effect does the valsalva maneuver and standing have on preload and afterload?

Answer 14

Decreases preload and afterload

Question 15

What findings will be present on a heart exam of a patient with hypertrophic cardiomyopathy?

Answer 15

Double apical pulse, S4+, crescendo/decrescendo systolic ejection murmur

Question 16

Severe cases of hypertrophic cardiomyopathy require surgical intervention. What treatment is available for symptom management?

Answer 16

Beta blockers, verapamil, anti-arrhythmics

Question 17

How can hypertrophic cardiomyopathy and athlete’s heart be differentiated?

Answer 17

With athlete’s heart, the heart will decrease in size with the cessation of exercise. This will not happen with HCM

Question 18

This type of cardiomyopathy i caused by impaired ventricular filling due to an abnormally rigid ventricle.

Answer 18

Restrictive cardiomyopathy

Question 19

What non-cardiac condition is classically found with amyloid cardiomyopathy?

Answer 19

Carpal tunnel

Question 20

What changes will be seen on an ECG of a patient with amyloid cardiomyopathy?

Answer 20

Low voltage due to replacement of myocardium with amyloid

Question 21

A patient is diagnosed with fibrofatty tissue replacement of myocardium. What would you tell the patient to avoid to prevent additional fat deposition.

Answer 21

Physical activity (increased exercise increases fatty deposition)