9 - Cardiomyopathies

Question 1

3 kinds of cardiomyopathy

Answer 1

dilated, hypertrophic, restrictive

Question 2

key features of dilated cardiomyopathy

Answer 2

ventricular dilation > impaired systolic function
generally progressive
arrhythmias common, sudden death can occur at any age

Question 3

what is the major disease associated with dilated cardiomyopathy?

Answer 3

congestive heart failure

Question 4

2 major reversible causes of dilated cardiomyopathy

Answer 4

alcohol, ischemia

Question 5

what happens in dilated cardiomyopathy due to ischemia and how can it be reversed?

Answer 5

chronically ischemic myocardium becomes “hibernating” myocardium
it can be revascularized to restore function

Question 6

4 irreversible causes of dilated cardiomyopathy

Answer 6

idiopathic
post MI scarring
familial
HIV

Question 7

hypertrophic cardiomyopathy - key features

Answer 7

genetic disease (AD)
thick walls and filling abnormalities
arrhythmias common
sudden death at a younger age

Question 8

which type of cardiomyopathy is associate with LV outflow track obstruction?

Answer 8

hypertrophic

Question 9

clinical manifestations of hypertrophic cardiomyopathy

Answer 9

dyspnea, chest pain, syncope, impaired filling, arrhythmias

Question 10

restrictive cardiomyopathy - key features

Answer 10

non-dilated ventricle with normal wall thickness and function and dilated atria. myocardium is rigid
diastolic dysfunction - ventricles fill at high pressures only

Question 11

causes of restrictive cardiomyopathy

Answer 11

most idiopathic

amyloidosis, sarcoidosis, hemochromatosis, radiation, etc

Question 12

clinical manifestations of restrictive cardiomyopathy

Answer 12

dyspnea and edema most common
elevated jugular venous pressure, pulm venous congestion
later - fatigue, weakness w/ low CO
mitral and tricuspid insufficiency, S3 gallop

Question 13

dilated cardiomyopathy physical findings

Answer 13

dec S1, weak pulses
S3 gallop, maybe S4 gallop
MR and TR holosystolic murmurs
pulsus alternans - every other beat SV changes

Question 14

hypertrophic cardiomyopathy physical findings

Answer 14

spike and dome / bisferiens arterial pulse - pulse shoots up quickly, then stops, then has a second wave as pressure becomes enough to overcome obstruction
triple apical impulse
prominent palpable S4
standing increases murmur, squatting decreases
paradoxical A2-P2 split - late A2

Question 15

what is the brockenbrough-morrow-braunwald phenomenon and with what condition is it observed?

Answer 15

dec pulse in beat following ectopic beat

hypertrophic cardiomyopathy

Question 16

ECG findings for 3 types of cardiomyopathy

Answer 16

congestive - LBBB, low voltage
hypertrophic - severe LVH, pathologic Q waves, WPW
restrictive - low voltage

Question 17

which type of cardiomyopathy is assoc with systolic heart failure and dec EF?

Answer 17

dilated

Question 18

which cause of dilated cardiomyopahy is not reversible?
alcohol
ischemia w/ hibernating myocardium
hypothyroidism
post MI scarring

Answer 18

post MI scarring

Question 19

Which is true about murmur of LVOT obstruction in hypertrophic cardiomyopathy?
best heard in axillary area
softer w/ valvsalva
louder w/ standing
louder w/ leg elevation

Answer 19

louder w/ standing

Question 20

which type of cardiomyopathy is suggested by normal size lv, normal wall thickness, normal systolic fn, and very large atria?

Answer 20

restrictive

Question 21

all are true about braunwald phenomenon except:
occurs in hypertrophic cardiomyopathy
dec pulse in pulse after ectopic beat
inc pulse after ectopic
related to dynamic change in LVOT

Answer 21

inc pulse after ectopic