Clinical Cardiomyopathy

Question 1

What is restrictive cardiomyopathy also called?

Answer 1

restrictive infiltrative cardiomyopathy= preserved LV dysfunction (ejection fractions are normal, but they signs and symptoms are of heart failure).

Question 2

What is obstructive cardiomyopathy?

Answer 2

idiopathic hypertrophic subaortic stenosis= hyperdynamic ventricle and deal with it as a preserved form of heart failure.

Question 3

What do we have to know about TB?

Answer 3

• usually chronic process
• associated with night sweats and cough
• HIV associated in U.S.

Question 4

Does a negative PPD rule out TB pericarditis?

Answer 4

NO

Question 5

How do you treat TB pericarditis?

Answer 5

drain with consideration for biopsy. Needs a window with antiTB Rx.

Question 6

Why can hypothyroidism cause heart failure?

Answer 6

this can also occur after radiation therapy. Heart rate is too slow, you overstretch the heart, and thus your end diastolic volume is too high, meaning you’ve overstretched the starling curve (shift to the right) and can’t contract as well. This means the fluid leaks back into your lungs where the hydrostatic pressure is greater than the oncotic pressure.
This can also lead to a pericardial effusion.

Question 7

Why can hyperthyroidism cause heart failure?

Answer 7

heart rate is too FAST, meaning the heart doesn’t have enough time to fill, meaning you’re under-stretching the starling curve (shift to the left) and therefore the blood backs up into the lungs.

Question 8

What arrhythmia is associated with hyperthyroidism?

Answer 8

atrial fibrillation

Question 9

How do you treat heart failure as a result of hyperthyroidism?

Answer 9

give a beta blocker because it both slows the heart rate and slows the conversion of T4 to T3, thus reducing the elevated thyroid hormone (T3), which causes the tachycardia.

Question 10

What marks systole in the carotids?

Answer 10

the carotid upstroke

Question 11

Will you see a rapid x descent with acute pericardial effusion?

Answer 11

YES and this causes a restrictive cardiomyopathy.

Question 12

What is Kussmaul’s sign?

Answer 12

sign of right ventricular dysfunction. Neck veins fill with inspiration and stay filled through expiration.

Question 13

Next to idiopathic dilated cardiomyopathy, what is the next most common cause?

Answer 13

Chaga’s disease

Question 14

*What are the 4 controlling mechanisms of heart failure?

review question

Answer 14

1. preload
2. afterload
3. inotropism
4. HR

Question 15

What is myocarditis?

Answer 15

infection of the heart muscle usually from viral causes. This can cause a dilated cardiomyopathy, as well as a pericarditis (which can cause a restrictive cardiomyopathy).

Question 16

What are the symptoms of hypertrophic obstructive cardiomyopathy (HOCM)?

Answer 16

syncope, angina, dyspnea, sudden death.

Question 17

What is the initial therapy for HOCM?

Answer 17

negative inotropic agents (verapamil, or beta blockers)

Question 18

**What is the leading cause of heart failure?

Answer 18

ischemic cardiomyopathy (CAD).

Question 19

Can muscular dystrophy cause dilated cardiomyopathy?

Answer 19

YES

Question 20

What should make you suspicious of hemochromatosis?

Answer 20

people who have a good sun tan during the winter who haven’t traveled due to hemosiderin deposition in the skin.

Question 21

Where is sarcoidosis seen more often?

Answer 21

in black females. Forms noncaseating granulomas on the heart muscle.

Question 22

What is a big cause of toxicity leading to cardiomyopathy?

Answer 22

anthracyclines (chemo agent).

Question 23

What can lyme disease do?

Answer 23

3rd degree heart block due to effects on the AV node.

Question 24

**How do you make the diagnoses of 3rd degree heart block with neck veins?

Answer 24

cannon A waves