myocardial and pericardial dz

Question 1

inflammation of heart muscle resulting in myocardial necrosis and degeneration

Answer 1

myocarditis

Question 2

variable clinical presentation including

• viral prodrome
• acute chest pain 1-4wks after viral or GI infection
• subacute HF sx onset
• cardiogenic shock
• abnormal vital signs

Answer 2

myocarditis

Question 3

has positive inflammatory markers, cardiac biomarkers and biopsy

Answer 3

myocarditis

Question 4

• Echo: normal to mildly reduced LV fxn to severe ventricular dysfxn
• MRI– ventricular dysfunction and signs of inflammation

Answer 4

myocarditis findings

Question 5

biopsy shows evidence of myocardial tissue necrosis and increased inflammatory cellular infiltrates

Answer 5

myocarditis biopsy findings

Question 6

when do you do biopsy with myocarditis?

Answer 6

severe or refractory cases after other causes hae been excluded

Question 7

3 tx of myocarditis

Answer 7

• rest & tx signs of HF
• avoid NSAIDs, alcohol, exercise, digoxin
• routine f/u

Question 8

name the condition

normal systolic function + diastolic dysfunction in non-dilated, rigid ventricle which impedes ventricular filling (reduced extent & rate)

Answer 8

restrictive cardiomyopathy

Question 9

3 most common causes of restrictive cardiomyopathy

Answer 9

1. Amyloidosis
2. sarcoidosis
3. hemochromatosis

all are infiltrative causes

Question 10

3 most common causes of restrictive cardiomyopathy

Answer 10

1. Amyloidosis
2. sarcoidosis
3. hemochromatosis

all are infiltrative causes

Question 11

this describes the pathophys of what condition

stiff myocardium leads to decreased compliance, increased effort to fill ventricles cause elevated ventricular filling pressures & atria dilation

Answer 11

RCMP pathophysiology

Question 12

can cause sx of L or RHF and nonspecific sx like palpitations, fatigue, malaise, weakness, anorexia, nausea, nocturia

Answer 12

RCMP

Question 13

most common sx of both RCMP & HCM is

Answer 13

dyspnea

Question 14

cardiomyopathy with kissmaul sign

Answer 14

RCMP

Question 15

describe kussmaul sign

Answer 15

increased JVP with inspiration

normal is decreased

Question 16

ventricular and atria finding on ECHO in RCM vs HCM

Answer 16

• RCM– normal ventricle thickness + bilateral atrial dilation
• HCM– asymmetric wall thickness

Question 17

has no specific treatment but heart transplant is the only definitive treatment; can also treat the underlying d/o

Answer 17

RCMP tx

Question 18

what can you do to identigy or r/o specific causes of RCMP

Answer 18

endomyocardial biopsy

Question 19

differentiate RCM from constrictive pericarditis

Answer 19

• RCM: S3, high BNP, biatrial enlargement
• CP: pericardial knock, calcifications/thickining, low BNP

Question 20

autosomal dominant; inappropriate LVH or RVH resulting in left ventricular outflow obstruction, diastolic dysfunction d/t hypercontractile ventricles and myocardial ischemia

Answer 20

HCM

Question 21

what is this called

left ventricular outflow tract (LVOT) obstructed d/t asymmetrical septal hypertrophy and systolic anterior motion (SAM) of the mitral valve

Answer 21

subaortic outflow obstruction

Question 22

what worsens subaortic outflow obstruction (2)

Answer 22

• increased contractility (exercise, digoxin)
• decreased LV volume (dehydration, maneuvers)

Question 23

most are asymptomatic but the ones w/ sx are dyspnea on exertion, palpiations, chest pain, exertional syncope

Answer 23

HCM sx

Question 24

2 tx of HCM

Answer 24

• reduce outflow gradient w/ BB, non-DHP CCBs, disopyramide
• ICD placement for secondary prevention of sudden death in hx of Vfib or sustained VT, syncope or holter monitor events

Question 25

4 things ppl w/ HCM should avoid

Answer 25

* dehydration * exertion & strenous exercise * digoxin * vasodilators, diuretics, ACE/ARB, nitrates

Question 26

inflammation of the pericardium

Answer 26

pericarditis

Question 27

dresslers syndrome

Answer 27

post MI pericarditis + fever

Question 28

5 (technically 4) Ps of pericarditis

Answer 28

* Pleuritic pain (sharp pain worse w/ inspiration) * Postural (worse supine) * Persistent chest Pain * Pericardial friction rub

Question 29

* diffuse ST elevations (concave up) + PR depressions in precordial leads * ST depression & PR elevation in avR

Answer 29

pericarditis ECG findings

Question 30

normal echo but still done to r/o effusion and look for associated myocarditis

Answer 30

ECHO findings in pericarditis

Question 31

1st, 2nd, 3rd line tx of pericarditis

Answer 31

1. NSAIDs or aspirin 2. colchicine 3. steroids if refractory (sx >48hrs)

Question 32

loss of ventricular elasticity (fibrosis, calcification) leading to restriction of diastolic filling; caused by acute pericarditis and chronic inflammation

Answer 32

constrictive pericarditis

Question 33

# these are symptoms of? * dyspnea is main sx * R sided heart failure sx * Pericardial knock

Answer 33

constrictive pericarditis

Question 34

what is high pitched 3rd heart sound from sudden cessation of ventricular filling & what condition is it associated with

Answer 34

pericardial knock associated with constrictive pericarditis

Question 35

which two **pericardial diseases** have both pulsus paradoxus and kussmauls sign

Answer 35

* pericardial tamponade * constrictive pericarditis

Question 36

which pericardial dz would show diastolic collapse of cardiac chambers, hemodynamic compromise on an echo?

Answer 36

pericardial tamponade

Question 37

which pericardial dz would show pericardial thickening and calcification on an echo?

Answer 37

constrictive pericarditis

Question 38

which surgical procedure is done to definitively treat constrictive pericarditis?

Answer 38

pericardiectomy

Question 39

which procedure is done to treat pericardial tamponade?

Answer 39

pericardiocentesis

Question 40

# name the condition increased fluid in the pericardial space

Answer 40

pericardial effusion

Question 41

t/f, pericardial effusion shares the same etiologies as acute pericarditis

Answer 41

true

Question 42

sx of pericarditis + **distant/muffled heart sounds** is associated with which two pericardial dz?

Answer 42

pericardial effusion pericardial tamponade

Question 43

# these diagnostic test results is associated with which condition * ECG: **low QRS complex, electrical alternans** * Echo: increased pericardial fluid with NO hemodynamic compromise

Answer 43

pericardial effusion

Question 44

# name the condition pericardial effusion causing pressure on heart which limits ventricular diastolic filling

Answer 44

pericardial tamponade

Question 45

sx include: becks triad, pulsus paradoxus, kussmauls sign

Answer 45

pericardial tamponade

Question 46

# name the phenomenon pulses disappear or SBP drops more than 10 w/ inspiration

Answer 46

pulsus paradoxus

Question 47

what is becks traid (list the 3 things)

Answer 47

* distant heart sounds * increased JVP * systemic HYPOtension

Question 48

definitive management for recurrent pericardial tamponade is ___

Answer 48

pericardial window

Question 49

# name the condition **systolic** dysfunction causing ventricular dilation; decreased LVEF < 40%

Answer 49

dilated cardiomyopathy * mostly in 20-60 yo males

Question 50

can be caused by infectious, infiltrative dz, pregnancy, alcohol abuse, etc but the most common cause is idiopathic; makes up majority of all cardiomyopathies

Answer 50

dilated cardiomyopathy

Question 51

# which cardiomyopathy has these clinical findings * S3 gallop * lateral PMI displacement * other heart failure signs

Answer 51

dilated cardiomyopathy

Question 52

# which cardiomyopathy fits this finding * Echo: **LV dilation, reduced EF**, LV hypokineses * CXR shows cardiomegaly, pulmonary edema

Answer 52

dilated cardiomyopathy

Question 53

T or F: you treat dilated cardiomyopathy the same way you treat HFrEF

Answer 53

true