Dilated Cardiomyopathy

Question 1

dilation and reduced function of one or both ventricles manifested as HF, arrhythmias, and sudden death

Answer 1

dilated CM

Question 2

MCC of dilated CM (50%)

Answer 2

idiopathic

Question 3

differential diagnoses of dilated CM:

• a/w bacterial, viral, and parasitic infections
• a/w AI d/o’s

Answer 3

acute myocarditis

Question 4

are cardiac troponins elevated in acute myocarditis?

Answer 4

yes, usually

Question 5

what type of ventricular dysfunction does acute myocarditis cause?

Answer 5

regional or global

Question 6

can acute myocarditis cause cardiogenic shock or ventricular arrhythmias?

Answer 6

yes

Question 7

tx for acute myocarditis in acute phase

Answer 7

supportive care

Question 8

tx for acute myocarditis after acute phase

Answer 8

standard HF tx

Question 9

differential diagnoses of dilated CM:

• a/w chronic heavy EtOH ingestion

Answer 9

alcoholic CM

Question 10

what type of ventricular dysfunction does alcoholic CM cause?

Answer 10

LV (or usually both ventricles) is dilated and hypokinetic

Question 11

tx for alcoholic CM

Answer 11

standard HF tx and TOTAL abstinence from EtOH

Question 12

differential diagnoses of dilated CM:

• pathologic fibrofatty infiltration of RV (seen on bx or MRI)
• significant RV enlargement and dysfunction out of proportion to preserved LV function
• can also present as VT or sudden death

Answer 12

arrhythmogenic RV dysplasia

Question 13

differential diagnoses of dilated CM:

• illicit use of cocaine or amphetamines

Answer 13

drug-induced CM

Question 14

tx for drug-induced CM

Answer 14

standard HF tx

Question 15

in pts w/ stimulant-induced acute myocardial ischemia in drug-induced CM, which BB is preferred?

Answer 15

labetalol

Question 16

differential diagnoses of dilated CM:

• rare dz
• biventricular enlargement
• refractory ventricular arrhythmias
• rapid progression to cardiogenic shock in young to middle-aged adults
• bx shows multinucleated giant cells in myocardium

Answer 16

giant cell myocarditis

Question 17

tx for giant cell myocarditis

Answer 17

immunosuppression and/or cardiac transplant

Question 18

differential diagnoses of dilated CM:

• acute LV dysfunction in setting of intense EMOTIONAL or physiologic stress
• may mimic STEMI
• dilation and akinesis of LV APEX in ABSENCE of CAD

Answer 18

stress-induced (takotsubo) CM

Question 19

tx for stress-induced (takotsubo) CM

Answer 19

supportive care (resolves in days to weeks)

Question 20

differential diagnoses of dilated CM:

• 2/2 CHRONIC tachycardia

Answer 20

tachycardia-mediated CM

Question 21

tx for tachycardia-mediated CM

Answer 21

slow or eliminate arrhythmia

Question 22

in addition to reversing underlying cause (EtOH, drug, arrhythmia), what else is the tx for dilated CM?

Answer 22

standard HF tx