Myocarditis and Cardiomyopathy

Question 1

Acute myocarditis

Answer 1

• Inflammatory disease, attacks healthy child or adult
• often viral in origin (Coxsackie B has high relative incidence), within 2 weeks of upper respiratory tract infection
• adults present w/ heart failure with or without cardiogenic shock

Physical findings: S3, pulmonary congestion and edema. Global or diffuse ventricular dysfunction.

Question 2

Dilated cardiomyopathy

Answer 2

most common type of cardiomypathy

left ventricle always involved, but all chambers are dilated.

There are ischemic (due to coronary artery disease) and non-ischemic types. Manifests as heart failure, arrhythmia or thromboembolism.

Treatment: treat for heart failure, anticoagulation, perhaps anti-arrhythmic drugs or heart transplant.

Question 3

Hypertrophic cardiomyopathy

Answer 3

left ventricle is hypertrophied, not dilated -> disproportionate hypertrophy in the septum

Predominant diastolic dysfunction, normal or enhanced systolic function. Usually familial.

Muscle fibers and collaged matrix are disorganized. If obstruction is present, sudden death can occur. Most common cause of sudden death in young athletes.

Treatment: decrease inotropy w/ beta or Ca++ blockers. Surgical resection, stop sports, ventricular pacing.

Question 4

Restrictive cardiomypathy

Answer 4

infiltration or fibrosis of the ventricles usually without dilation.

Most common infiltrative: amyloidosis and sarcoidosis

Impaired ventricular filling due to stiff ventricles

Pretty dang rare, usually kind of fatal because heart failure or fatal arrhythmias may occur