Non-ischemic cardiomyopathy cases

Question 1

What is cardiomyopathy?

Answer 1

Abnormal myocardial tissues leading to structural

heart disease.

Question 2

What is heart failure?

Answer 2

Constellation of signs/symptoms related to structural heart disease. Symptoms result from an inability to contract or inability to fill.

Question 3

59 y/o male with h/o hypertension and diabetes presents with progressive shortness of breath and lower extremity swelling over the past 2 weeks. Echocardiogram shows a dilated ventricular cavity and a left ventricular ejection fraction (LVEF) of 20%. Is this pt is heart failure?

Answer 3

Yes, most likely a pumping problem.

Question 4

72 y/o male with h/o peripheral neuropathy and chronic kidney disease with progressive shortness of breath and lower extremity swelling over the past 2 weeks. Echocardiogram shows a thick-walled, small ventricular cavity and a left ventricular ejection fraction (LVEF) of 70%. Is this pt in heart failure?

Answer 4

Yes, most likely a filling problem.

Question 5

Difference between cardiomyopathy and heart failure?

Answer 5

Cardiomyopathy is structural and Heart Failure is the symptoms

Question 6

What are the symptoms of heart failure?

Answer 6

• Dyspnea on exertion
• Orthopnea- Difficulty breathing when lying flat ask “How many pillows…?”
• Paroxysmal nocturia dyspnea (PND) - Waking up at night due to shortness of breath
• Lower extremity edema/swelling
• Ascites
• Decreased appetite/anorexia
• Weakness/fatigue

Question 7

What are signs of pulmonary congestion?

Answer 7

• Rales (Crackles)

* Decreased breath sounds from pleural effusion

Question 8

When do pt get pulmonary congestion?

Answer 8

left sided heart failure

Question 9

What are signs of right sided heart failure?

Answer 9

• Systemic congestion
– Dependent (pitting) edema
– Jugular venous distension
– Hepatomegaly
– Splenomegaly
– Ascites
– Anorexia

Question 10

Myocardial pathology can cause decrease in contractility or compliance. This decreases does what to stroke volume?

Answer 10

decreases

Question 11

Decreased stroke volume can do what to filling pressure and CO?

Answer 11

increases ventricular filling pressure and decreases forward CO

Question 12

A decrease in CO results in what symptoms?

Answer 12

fatigue and weakness

Question 13

Increased ventricular filling pressure does what to the vascular system?

Answer 13

Causes pulmonary or systemic congestion

Question 14

Decreasing afterload in a pt with heart failure can help increase what?

Answer 14

Stroke volume

Question 15

What are the 3 major types of nonischemic cardiomyopathy?

Answer 15

• Dilated Cardiomyopathy (DCM)
• Restrictive Cardiomyopathy (RCM)
• Hypertrophic Cardiomyopathy (HCM)

Question 16

What is the etiology of dilated cardiomyopathy?

Answer 16

• alcohol
  – Coxsackie virus (Viral Myocarditis)
  – Idiopathic
  – Pregnancy

Question 17

What is the etiology of restrictive cardiomyopathy?

Answer 17

– Amyloidosis

– Hematochromatosis

Question 18

What is the etiology of hypertrophic cardiomyopathy?

Answer 18

myosin gene mutation

Question 19

What are the characteristics of dilated cardiomyopathy?

Answer 19

• Increased left ventricular chamber size
• Decreased left ventricular ejection fraction (LVEF)
• “Pumping problem”
• Multiple Causes
• Key physical exam findings:
– S3 gallop
– Soft S1

Question 20

Peripartum cardiomyopathy usually happens when and what is the prognosis?

Answer 20

– Must occur in the last month of pregnancy or within 5 months of delivery
– 50% improve, 25% persist, 25% get worse

Question 21

How much alcohol do you have to drink to get dilated cardiomyopathy?

Answer 21

– Related to average daily intake and duration of drinking

• 80-90 gm ethanol/day for > 5years (1 L wine, 8 beers, ½ pint hard liquor daily)

Question 22

How do you fix alcohol related cardiomyopathy?

Answer 22

Stop drinking stupid (abstinence)

Question 23

How does viral myocarditis dilated cardiomyopathy present?

Answer 23

– 2 week viral pro-drome
– Chest pain, Heart failure, Elevated markers of myocardial damage (troponin)
– Gradations in clinical presentation

Question 24

Do pt with viral myocarditis dilated cardiomyopathy completely recover?

Answer 24

– May or may not regain normal LV systolic function

• Sicker at presentation better overall prognosis

Question 25

What is restrictive cardiomyopathy?

Answer 25

• Small left ventricular chamber size, thick walls

* “Filling problem”

Question 26

What is the equation for CO?

Answer 26

CO = HR x SV

Question 27

Restrictive cardiomyopathy is usually an infiltrate process by what?

Answer 27

– Amyloid (transthyretin deposits)

– Hemachromatosis (iron deposits)

Question 28

What are key exam findings in amyloid restrictive cardiomyopathy?

Answer 28

• Systemic disease(Nerve, liver, kidney, pancreas, and skin pathology)
• Diagnostic clue: low voltage ECG

Question 29

What stain should you use to find amyloid?

Answer 29

congo red stain (polarized light)

Question 30

What happens in hypertrophic cardiomyopathy?

Answer 30

• Asymmetric left ventricular hypertrophy (wall thickness).
• Typically involves the interventricular septum.
• Can cause left ventricular outflow track obstruction

Question 31

What usually causes sudden death in young athletes?

Answer 31

hypertrophic cardiomyopathy

Question 32

Hypertrophic cardiomyopathy is what kind of inheritance?

Answer 32

a bad one… but really..

autosomal dominant

Question 33

Key exam findings with hypertrophic cardiomyopathy?

Answer 33

Harsh systolic murmur at the left sternal border that increases in intensity with Valsalva or when rising from a seated to standing position