Myocarditis and Cardiomyopathy (complete)

Question 1

Discuss the clinical presentation of acute myocarditis

Answer 1

• Acute inflammation of cardiac muscle (using from a virus)
• Often seen in young adults and children => 50% have respiratory/GI symptoms

Common presentations:

• Fever
• Chest pain w/ ECG changes
• Arrhythmia
• HF

Question 2

Describe the possible outcomes of acute myocarditis

Answer 2

Low EF and HF => high mortality

Some recover but others develop a chronic dilated cardiomyopathy

Question 3

What are the difference classes of cardiomyopathies? What are their distinct features?

Answer 3

1) Dilated => dilated LV w/ minimal hypertrophy
2) Hypertrophic => marked LV hypertrophy
3) Restrictive => Infiltrated or fibrotic LV

Question 4

Describe the presentation of dilated cardiomyopathy

Answer 4

• HF w/ large silent heart
• Both ventricles dilated, more spherical
• low EF
• Impaired systolic function (poor contraction)
• Arrhythmia (injury, fibrosis, dilation)
• Thromboemboli

Question 5

What are the causes of dilated cardiomyopathy?

Answer 5

• Usually idiopathic
• Genetic
• Viral
• Ischemic
• Muscular dystrophies
• Alcohol
• Hemochromatosis

Question 6

Descibe what you would see on a chest xray of a person w/ dilated cardiomyopathy

Answer 6

• Enlarged heart

- Congested lungs

Question 7

Describe the treatment of dilated cardiomyopathy

Answer 7

• Treat the HF (diuretics, ACEI, BBs, AldAntag, etc.)
• Anticoagulation
• Anti-arrhythmic agents (drugs, ICD)
• Anti-inflammatory/immuno-suppressive

Question 8

Describe hypertrophic cardiomyopathy without aortic outflow obstruction

Answer 8

• Diastolic dysfunction (b/c of impaired diastolic relaxation/^ stiffness)
• ^ LV diastolic pressure => ^ pulmonary venous and capillary pressures
• Dyspnea on exertion

Question 9

Describe hypertrophic obstructive cardiomyopathy

Answer 9

• Asymmetric myocardial hypertrophy
• Diastolic dysfunction
• Normal or enhanced systolic function
• Dynamic LV outflow obstruction
• Increased risk for syncope and sudden death

Question 10

Why is there a LV outflow obstruction?

Answer 10

• Mitral valve partially blocks outflow track below aortic valve
• Leads to decreased EF b/c of ejection disruption

Question 11

Describe the clinical manifestations of hypertrophic obstructive cardiomyopathy

Answer 11

• Variable: asymptomatic to severe symptoms
• Dyspnea (^ LV filling pressure)
• Angina (hypertropic LV and ^ systolic LV pressure)
• Sudden death (arrhythmia) => cause for this in athletes

Question 12

Describe the treatment options of hypertrophic obstructive cardiomyopathy

Answer 12

• Avoid competitive spores/extreme exertion
• Decrease contractility (BBs, verapamil)
• Surgical myomectomy or alcohol ablation
• ICD

Question 13

Describe restrictive cardiomyopathy

Answer 13

• Mostly infiltrative: amyloidosis/sarcoidosis
• Impaired ventricular filling b/c of stiff ventricles
• Systolic function is normal
• Ventricle not usually dilated
• Diagnosed by echo w/ doppler assessment of ventricular filling