MHD - lec # 10 - Cardiomyopathy/cmyocarditis/pericardial heart disease

Question 1

What are the main etiologies of DILATED CARDIOMYOPATHY?? (KNOW THIS)

LIST 7!

Answer 1

1. Post myocarditis (coxsackie B and enterovirus infections)
2. ALcohol
3. Doxorubicin and Daunarubicin (chemo agents)
4. Peripartum Cardiomyopathy
5. Genetic –> affecting CYTOSKELETON
6. Iron Overload
7. Idiopathic

Question 2

What is the cause of hypertrophic cardiomyopathy?

State the most common.

Answer 2

• missense mutation in SARCOMERE proteins

usually B - myosin heavy chain

Question 3

What is the most common cause of Left ventricle outflow obstruction in hypertrophic cardiomyopathy?

What can be seen histologically?

Answer 3

• systolic anterior motion of the mitral valve an mitral septal contact
• disorganized myocytes!
  = MYCOTES IN DISSARRAY & hypertrophy of myocytes

Question 4

What does IHSS often progress into?

Diastolic or systolic failure?

Answer 4

DIASTOLIC HF!

• cardiac insufficiency develops due to impaired diastolic filling & reduced compliance

DECREASED SV (EF is normal)

Question 5

The following clinical symptoms are characteristics of what disorder:

Systolic ejection murmur that increases in loudness during maneuvers the DECREASE PRELOAD (SQUATTING to STANDING position)

Explain why

Answer 5

Hypertrophic cardiomyopathy

• increase in intestine of murmur due to enhancement of obstruction with maneuvers that DECREASE PRELOAD, left ventricular volume, and therefore LV size

ex:
- upright position from squatting, sitting, or supine
- Valsalva maneuver
- and vasodilators
(all decrease preload and venous return to the heart)

• decrease murmur with sitting or squatting, handgrip, or passive elevation of legs

Question 6

What is the treatment for Hypertrophic cardiomyopathy (2)

Answer 6

drugs that increase LV relation

1. B blockers
2. non-dyhydropyridine calcium channel blockers

Question 7

What occurs in restrictive cardiomyopathy?

Answer 7

decrease in ventricular compliance and impaired ventricular filling during diastole

Question 8

What are the main etiologies of estrictive cardiomyopathy

Answer 8

• radiation fibrosis
• amyloidosis
• sarcoidosis
• metastatic tumor
• inborn errors of metabolism
• endomyocardial fibrosis
• LOEFLER ENDOMYOCARDITIS

Question 9

What are amyloids?

Answer 9

protein buildup in B pleated sheet

1. stain congo red
2. apple green under polarized light

Question 10

What bacteria can cause myocarditis (2)

Answer 10

Borrelia (lyme disease)

Corynebacterium Dipthereae

Question 11

WHat 3 viruses can cause myocarditis?

Answer 11

MOST COMMON CAUSE OF MYOCARDITIS is viral infection

1. Coxsackie A & B (other enteroviruses)
2. HIV
3. Influenza virus

Question 12

Flabby heart with mottled myocardium is characteristic of what type of heart disease?

Answer 12

MYOCARDITIS

• also see interstitial inflammatory infiltrate and focal myocyte necrosis

Question 13

The following clinical findings are associated with what disease?

• hypotension
• increased venous pressure (JVD)
• distant heart sounds
• PULSUS PARADOXUS

Answer 13

Cardiac Tamponade

Question 14

What is Dressler’s Syndrome?

What does it cause?

Answer 14

Autoimmune phenomenon resulting in pericarditis several weeks post MI

PERICARDITIS

Question 15

Acute bacterial infection would present with what type of exudate?

Answer 15

SUPPURATIVE

• frank pus with reddened granular pericardial surface

Question 16

What is the CLASSIC clinical finding on an EKG for a Pericarditis?

Answer 16

DIFFUSE St elevation

happening on all leads

Question 17

What is the genetic inheritance of hypertrophic cardiomyopathy?

Which proteins are affected

Answer 17

Autosomal Dominant

SARCOMERE
B- myosin of myosin binding protein
or Troponin T

Question 18

What is Beck’s triad?

What condition is it associated with?

Answer 18

1. Hypotension
2. Elevated JVD
3. Muffled heart sounds

Cardiac temponade