Myocarditis and Cardiomyopathy

Question 1

What is acute myocarditis

Answer 1

acute inflammation of cardiac muscle usu viral etiology

Question 2

what is the typical etiology of acute myocarditis

Answer 2

viral

Question 3

myocarditis focal or diffuse

Answer 3

BOTH FOCAL AND DIFFUSE

Question 4

types of patients who can present with acute myocarditis

Answer 4

healthy young adults and children

Question 5

types of preceding symptoms in acute myocarditis

Answer 5

50% have preceding respiratory/GI symptoms within 2 weeks

Question 6

common symptoms of Acute myocarditis

Answer 6

fever
chest pain with ECG changes (due to concurrent pericarditis)
arrhythmia (w/ or w/o palp or syncope)
Heart failure (adults)

Question 7

what symptoms of acute myocaridtis can have high mortality

Answer 7

low ejection fraction
heart failure

but can recover and develop chronic dilated cardiomyopathy

Question 8

Myocarditis is often ____

Answer 8

an autoimmune reaction due to coxsackie B virus with similar immunologically to cardiac myosin

Question 9

Physcial exam in acute myocarditis

Answer 9

S3
pulm congestion/edema
mitral regurgitation

incr troponin
global ventricular dysfunction ECG

Question 10

Most common type of cardiomyopathy

Answer 10

dilated cardiomyopathy

Question 11

which chambers involved in dilated cardiomyopathy

Answer 11

LV always but usu all 4 chambers

Question 12

three types of cardiomyopathy

Answer 12

1) dilated
2) hypertrophic
3) restrictive

Question 13

part of heart affected in HCM

Answer 13

LV hypertrophied NOT DILATED
hypertrophy of IV septum

muscle fiber and collagen disorganized

Question 14

part of heart affected in restrictive cardiompathy

Answer 14

infiltration/fibrosis of ventricles NO DILATION

Question 15

PRESENTATION OF DILATED CARDIOMOPATHY

Answer 15

heart failure with

1) large silent heart
2) impaired systolic function (poor contract LV)

Question 16

etiology of dilated cardiomyopathy

Answer 16

1) usually idiopathic

2) genetic, viral, ischemic

Question 17

dilated cardiomyopathy on CXR

Answer 17

1) enlarged heart (cardiomegaly)

2) congested lung field

Question 18

dilated cardiomyopathy on ECHO

Answer 18

both ventricle dilated and more spherical

diffuse poor wall motion

low ejection fraction

Question 19

other clinical effects of dilated cardiomyopathy

Answer 19

1) arrhythmia- injury, fibrosis, dilation - atrial fibrillation, ventricular arrhythmia
2) thromboembolism from ventricle- dilation, poor contraction, abnormal surface

Question 20

effects of angiotensin II

Answer 20

1) vasoconstriction
2) incr aldosterone release
3) Na+ reabsorption
4) fibrosis
5) incr sympathetic activity
6) hypertrophy

Question 21

lab test elevated in patients with CHF but not asymptomatic LV dysfunction

Answer 21

BNP

Question 22

TREATMENT FOR DILATED CARDIOMYOPATHY

–> TREATING HEART FAILURE1

Answer 22

1) DIURETICS
2) ace inhibitors
3) beta blocker
4) aldosterone antag
5) vasodilator
6) inotrope
7) LVAD, transplant

Question 23

other treatments beside treating heart failure for dilated cardiomyopathy

Answer 23

1) anticoagulation
2) anti arrhythmic (drug, ICD)
3) anti-infalmmatory, immunosuppressive

Question 24

what is hypertrophic cardiomyopathy

Answer 24

eccentric hypertrophy involving IV septum NO DILATION

Question 25

what is dysfunctional in HCM

Answer 25

diastolic dysfunction
dynamic (aortic) outflow obstruction

NORMAL OR INCR SYSTOLIC FUNCTION

Question 26

inheritance of HCM

Answer 26

autosomal dominant

Question 27

what happens strcuturally HCM WITHOUT AORTIC OUTFLOW DYSFUNCTION

Answer 27

diastolic dysfunction due to

1) impaired diastolic relaxation
2) incr stiffness

1) incr LV diastolic pressure
- -> incr pulm venous/capillary pressure

Question 28

usual symptom of HCM WITHOUT AORTIC OUTFLOW OBSTRUCTION

Answer 28

dyspnea on exertion

not susceptible to sudden death

Question 29

WHAT HAPPENS in HCM obstructive

Answer 29

1) asymmetric myocardial hypertrophy
2) diastolic dysfunction
3) incr systolic dysfunction

4) dynamic LV outflow obstruction
MITRAL VALVE PARTIALLY BLOCKS OUTFLOW TRACT
BELOW AORTIC VALVE during mid-late systole
–> syncope/SUDDEN DEATH

Question 30

clinical manifestation of HCM obstructive

Answer 30

VARIABLE

1) dyspnea – incr LV filling P
2) angina- hypertrophic LV, incr systolic LV P
3) sudden death- arrhythmia

Question 31

why is there dyspnea in HCM obstructive

Answer 31

incr LV filling pressure

Question 32

why is there angina in HCM obstructive

Answer 32

hypertrophic LV

incr systolic LV pressure

Question 33

treatment for HCM obstrcutive

Answer 33

1) avoid sports and extreme exerton
2) decr contractility with beta blockers/verapamil (decr outflow obstruct)
3) surgical myomectomy or alcohol ablation
4) ICD - ventricular pacing

Question 34

restrictive cardiomyopathy is mostly caused by ___

Answer 34

infiltrative

amyloidosis
sarcoidosis

Question 35

what happens in restrictive cardiomyopathy

Answer 35

decr ventricular filling due to stiff ventricles (NOT DILATED)

normal systolic fxn

Question 36

how to diagnose restrictive cardiomyopathy

Answer 36

1) echo with doppler of ventricular filling

2) MRI

Question 37

how to treat acute myocarditis?

Answer 37

1) ACE inhibitor

2) beta blocker to prevent remodeling

Question 38

what age population is associated with sudden death from HCM?

what age assoc with stroke/heart failure

Answer 38

sudden death = young people up to age 40

stroke/heart failure = old people

Question 39

histology of HCM

Answer 39

1) disorganized myocytes = reentry paths
2) remodeled coronary arteriole = impair coronary perfusion
3) replacement fibrosis