Nichols- Miscellaneous Heart Disease

Question 1

What are the three types of cardiomyopathies?

Answer 1

1. Dialated
2. Restrictive
3. Hypertrophic

Question 2

Dilated cardiomyopathy is the most common. Is it a disease of systolic or diastolic dysfunction?

Answer 2

Systolic

Question 3

In dilated cardiomyopathy, what happens to the heart chambers? What about the heart’s contractility?

Answer 3

In dilated cardiomyopathy, the heart chambers dilate and the contractility of the heart decreases

Question 4

In dilated cardiomyopathy, what happens to the EF, the Pulse pressure, and the size of the heart?

Answer 4

EF decreases
Pulse pressure decreases
Heart gets bigger due to dilation

Question 5

If you have a big, soft, floppy heart with atrophic myocytes. Also, symptoms and signs of heart failure what do you have?

Answer 5

Dilated cardiomyopathy

Question 6

Is hypertrophic cardiomyopathy a disease of systolic or diastolic dysfunction?

Answer 6

Diastolic- impaired compliance

Question 7

Hypertrophic cardiomyopathy is hypertrophy of ventricular wall as a compensatory response for?

Answer 7

An autosomal dominant genetic mutation that inhibits the function of contractile sarcomeres. The sarcomeres dont contract very well so they just hypertrophy

Question 8

Classical presentation for hypertrophic cardiomyopathy?

Answer 8

Young athlete passes out and dies

Question 9

The decreased compliance in hypertrophic cardiomyopathy leads to what pressure changes in the LV, LA, and pulmonary arteries?

Answer 9

Increases in pressure

Question 10

What do cardiac myocytes look like under LM in a pt with hypertrophic cardiomyopathy?

Answer 10

Disarrayed and tangled with interspersed fibrosis

Question 11

What kind of murmur would you expect to hear in a pt with hypertrophic cardiomyopathy?

Answer 11

Systolic murmur

Question 12

The systolic murmur in hypertrophic cardiomyopathy.. is it gonna get louder or quieter with Valsalva/ standing?

Answer 12

Louder.. this is the opposite of aortic stenosis where the systolic murmur will get louder when patient is in a squatting position.. think HYPER people like to STAND

Question 13

Treatment of hypertrophic cardiomyopathy?

Answer 13

Anti-arrhythmatics.. beta blocker, Ca2+ channel blocker.. Also, NO SPORTS!!

Question 14

What is the prototype restrictive cardiomyopathy?

Answer 14

Cardiac amyloidosis

Question 15

Is restrictive cardiomyopathy a dysfunction of systole or diastole?

Answer 15

Diastolic dysfunction

Question 16

Gross appearance of the heart with amyloidosis?

Answer 16

Big, firm, tan, and waxy

Question 17

You look at a LM slide and see hyaline deposits. You polarize the slide with Congo Red stain and it looks “apple green birefringence”. What is the diagnosis?

Answer 17

Restrictive cardiomyopathy due to cardiac amyloidosis

Question 18

Patient population thats gonna get cardiac amyloidosis?

Answer 18

Old, old, old people with heart failure

Question 19

A young black male presents with an arrhythmia. Radiographic findings show bilateral hilar lymphadenopathy. Whats the diagnosis?

Answer 19

Sarcoidosis

Question 20

With sarcoidosis are you gonna see granulomas and multinucleated giant cells?

Answer 20

Of course! And the giant cells are gonna have asteroid bodies

Question 21

Most common primary heart tumor?

Answer 21

Cardiac myxoma- it is rare

Question 22

LM of cardiac myxoma shows?

Answer 22

Stellate cells with scant cytoplasm

Question 23

Signs of cardiac myxoma?

Answer 23

1. Loud S1
2. Diastolic rumble
3. Diastolic tumor plop
4. Holosystolic murmur