L33

Question 1

What is cardiomyopathy

Answer 1

Dysfxn of myocardium

Question 2

5 types of cardiomyopathies

Answer 2

1. Dilated
2. Hypertrophic
3. Restrictive

Question 3

What does dilated CM look like

Answer 3

Dilated LA & LV
Thickness can be normal - cavity larger
Dilation causes

Question 4

Is dilated CM systolic or diastolic pathology

Answer 4

Systolic

Dilated means don’t get the same contraction

Question 5

Causes of dilated CM

Answer 5

Genetics
Post-myocarditis 
Alcohol
Pregnancy 
Hemochromatosis (iron overload)

Question 6

What disease results from dilated CM?

Answer 6

CHF

Question 7

What drug could give you dilated CM

Answer 7

Doxorubicin (chemo)

Question 8

2ary findings/concerns/patho for dilated CM

Answer 8

1. Tricuspid and mitral regurg due to ventricular dilation

2. Thrombi

Question 9

What histo changes do you see with arrhythmogenic RV CM?

Answer 9

Fibrofatty

Question 10

What genetic mutation is common for hypertrophic CM

Answer 10

B myosin heavy chain

Question 11

Is hypertrophic CM a disease of systole or diastole

Answer 11

Diastole - duh, hypertrophic ventricle so doesn’t relax - doesn’t fill correctly

Question 12

What does hypertrophic CM look like?

Answer 12

Thick LV
Dilated LA
+/- outflow obstruction

Question 13

Treat hypertrophic CM

Answer 13

BBs

Ca CBs

Question 14

Hypertrophic CM histo

Answer 14

Myofiber disarray

Question 15

3 causes of restrictive CM

Answer 15

Idiopathic
Amyloid
Endocardial fibrosis

Question 16

What does restrictive CM look like?

Answer 16

Ventricles normal

Both atrial dilated

Question 17

Is restricted CM a disease of systole or diastole

Answer 17

Stiff ventricle - no change in size of gross appearance
Restricted motion - can’t relax fully - impaired filling
DIASTOLIC problem

Question 18

What are the 3 types of amyloid that could cause restrictive CM

Answer 18

AL - light chain amyloids
AA
AS - transthyretin

Question 19

What do you see grossly with amyloid restrictive CM

Answer 19

Waxy lining of endocardium (inner most layer)

Esp at atrium

Question 20

Can you ID cardiac amyloid histo?

Answer 20

GO LOOK IT UP

Test Q

Question 21

Normal or reduced EF & CO for dilated, hypertrophy and restrictive CM

Answer 21

ALL low CO = CM
Dialted = low EF
Hyper & restrictive = normal EF

Question 22

What is Loffler endocarditis? What CM can it cause?

Answer 22

Eosinophil infiltrate –> thrombosis –> scar –> restricted CM

Question 23

Treat Loffler endocarditis restricted CM

Answer 23

Steroids

Question 24

Most common cause of myocarditis

Answer 24

VIRAL

• Cox B
• Adeno

Question 25

What pts get viral myocarditis? What does the heart look like?

Answer 25

Kids and teens
Flabby, DILATED heart w/ T cell infiltrate on histo
Aka LYMPHOCYTE infiltrate

Question 26

Pathogensis for viral myocarditis - what type of CM can result (treat)

Answer 26

Viral infection - virus particles attach to heart receptors 
Infection cleared
Immune attacks viral particles on heart 
Recover totally - or DILATED CM
Treat like dilated CM
- ACE I 
- BBs

Question 27

What does HST myocarditis look like on histo?

Answer 27

EOSINOPHILIC infiltrate

- 2 lobes, bright RED granules

Question 28

What should you look for on histo for giant cell myocarditis

Answer 28

Giant cell = macrophage w/ multiple nuclei