SFP: cardiomyopathy and carditis Flashcards
What is the basic definition of cardiomyopathy?
Disease of the heart muscle
What is the most common cardiomyopathy?
Dilated cardiomyopathy
In terms of genetics, cardiomyopathies are normally ___ (inheritance pattern)?
Autosomal dominant
Most genes related to cardiomyopathies are associated with…?
Cytoskeletal proteins
What is dilated cardiomyopathy?
All 4 chambers are dilated, but not thickened. It results in impaired systolic function.
What are symptoms of dilated cardiomyopathy?
Dyspnea, edema, fatigue
What are microscopic features of dilated cardiomyopathy?
Nothing specific
What are causes of dilated cardiomyopathy?
Idiopathic, alcohol, myocarditis, pregnancy, and obesity
What is the outcome of dilated cardiomyopathy?
Heart failure/death or dysrhythmia
What are features used to diagnose dilated cardiomyopathy?
Decreased EF, EKG
What is the treatment for dilated cardiomyopathy?
Transplant
What medication can cause dilated cardiomyopathy?
Doxorubicin
Which condition can be hard to distinguish from dilated cardiomyopathy?
Congestive heart failure
Describe arrhythmogenic RV cardiomyopathy.
Thinning, fatty replacement of the right ventricle.
What are clinical presentations of arrhythmogenic RV cardiomyopathy?
Tachyarrhythmia, syncope, HF, sudden death
What filament is mutated in arrhythmogenic RV cardiomyopathy?
Desmosomes
How can we diagnose arrhythmogenic RV cardiomyopathy?
EKG, cardiac MRI, heart biopsy
Where is the best place to take a heart biopsy?
Interventricular septum
Describe hypertrophic cardiomyopathy.
Most concerning when it is obstructive. The septum is thickened causing decreased compliance and impaired diastole.
What is a common presentation for hypertrophic cardiomyopathy?
Sudden death in young athletes during exercise
What are some symptoms of hypertrophic cardiomyopathy?
Dyspnea, chest pain, syncope
What are microscopic findings of hypertrophic cardiomyopathy?
Myocyte hypertrophy and disarray
Which condition can be hard to distinguish from hypertrophic cardiomyopathy?
HTN
What is the most common genetic cardiomyopathy?
Hypertrophic cardiomyopathy
What is commonly mutated in hypertrophic cardiomyopathy?
Cardiac sarcomere (myosin heavy chain, myosin binding protein C, troponin T)
A patient has a crescendo-decrescendo murmur that increases with Valsalva. What is the diagnosis?
Hypertrophic cardiomyopathy
What are the diagnostic tools for hypertrophic cardiomyopathy?
EKG and biopsy
Why do Valsalva and standing make HOCM worse?
They force blood out of the heart, exacerbating the murmur.
What are treatments for hypertrophic cardiomyopathy?
Alcohol ablation and myomectomy
Describe restrictive cardiomyopathy.
A stiff wall with normal thickness causes decreased compliance and filling.
What are three processes that can cause restrictive cardiomyopathy?
Infiltrative processes, storage diseases, or endomyocardial anchoring.
Give examples of infiltrative processes that can lead to restrictive cardiomyopathy.
Radiation fibrosis, sarcoid, and amyloid.
A patient has sarcoid with giant cells. What cardiomyopathy are they at risk for?
Restrictive cardiomyopathy
What are storage diseases that can lead to restrictive cardiomyopathy?
Hemochromatosis
What is Loeffler endomyocarditis?
A thickened endocardium with hypereosinophilia that causes restrictive cardiomyopathy.
What is myocarditis?
Inflammation and necrosis of heart muscle.
What are non-viral causes of myocarditis?
Hypersensitivity, autoimmune transplant.
What are outcomes of myocarditis?
Spontaneously resolving, chronic disease, death.
Chagas disease is associated with…
Myocarditis
Toxoplasmosis is associated with…
Myocarditis
Describe pericarditis.
Inflammation of the pericardium.
What are common causes of pericarditis?
Post MI via necrosis or Dressler syndrome weeks later, uremia, autoimmune issues.
What is the clinical presentation of pericarditis?
Friction rub
A patient has hemorrhagic pericarditis. What does this indicate about the cause?
It is likely metastatic or autoimmune.
Fibrous bands are seen in…
Pericarditis
Pulsus paradoxus can be indicative of…
Cardiac tamponade
What is pulsus paradoxus?
Systolic BP drop in greater than 10 mmHg on inspiration.
What is seen with pericardial effusion?
Serous fluid with heart failure and low albumin.
