Sketchy Path: Dilated and Restrictive Cardiomyopathy

Question 1

What causes dilated cardiomyopathy in most cases?

Answer 1

• Over 90% of cases are idiopathic. (Think of the “IDIOt” sign taped to the guy in the dilated heart sack.)
• Viral myocarditis –Coxsackie in particular (think of the inflamed heart sack in the back… it was set on fire by the viral lanterns).
• T. cruzi (like the sCottisH gAmeS)
• Genetic causes (like the kid with the genetic pedigree on his shirt)
• Toxins (box o rubies)
• Pregnancy (pregnant girl in sack)

Question 2

DCM leads to _____-stolic heart failure.

Answer 2

sys (like the floppy heart balloon and the systolic ejection bottle)

Question 3

Most DCM occurs on which side of the heart?

Answer 3

It’s actually most often bilateral (which is why the floppy heart balloon is symmetrically deflated).

Question 4

Genetic causes of DCM are most often through what mode of inheritance?

Answer 4

Autosomal dominant (like the kid’s DOMINant DOMINo)

Note: Duchenne’s and Becker can also cause DCM and are XLR. (like the clans Duchenne and Becker)

Question 5

Genetic defects in which proteins most often cause DCM?

Answer 5

Cytoskeletal or intercellular proteins (like the cytoskeletal pattern on his sack)

Question 6

What toxins can cause DCM?

Answer 6

• Doxorubicin / daunorubicin (like the bOX O’ RUBIes)

* Alcohol (like the kid drinking from the wine skin)

Question 7

What nutrient deficiency can cause DCM?

Answer 7

Thiamine deficiency

Wet beriberi presents with heart failure.

(Think of the cup of blue BERries.)

Question 8

How does iron affect the myocardium?

Answer 8

It can lead to either DCM or restrictive CM (like the guy in the sack that’s held down with an iron weight –it’s both dilated and restrictive)

Question 9

DCM can lead to what heart sound?

Answer 9

S3 (like the S3 slushie)

Question 10

What complication of DCM is shown on the brick wall?

Answer 10

Mural thromboemboli (like the emboli birds)

Question 11

In a nutshell, what causes restrictive cardiomyopathies?

Answer 11

Something infiltrating the heart muscles and preventing their stretching

Question 12

Restrictive cardiomyopathies lead to what kind of heart failure?

Answer 12

Diastolic (like the princess with her diastolic diamonds getting hit by the restrictive net –notice that she’s having trouble FILLING her cups, just like how restrictive CM causes filling defects)

Question 13

What heart sounds are present in restrictive CM?

Answer 13

S4 (like the stiff, 4-shaped chair by the goal)

Question 14

What sign will restrictive CM show on jugular venous pressure tracings?

Answer 14

A rapid Y descent (like the falling Y-shaped martini glass)

This occurs because the stiff myocardium springs back open and speeds ventricular relaxation which is what the Y wave represents.

Question 15

Restrictive CM, just like right-heart failure, can cause the _____________ sign.

Answer 15

Kussmaul (like the Scotsmen with the COOkie SMeLL)

Question 16

What can cause restrictive cardiomyopathy?

Answer 16

• Amyloidosis (like AMY with her beta-pleated skirt)
• Sarcoidosis (like the multinucleated soccer balls in the net)
• Hemochromatosis (guy throwing iron by net)
• Lysosomal storage disorders like Fabry and Pompe (like the guy lifting the storage trash truck)
• Scleroderma (like the scleroderma dragon)
• Radiation (like the radiation shield thrown down by Amy)
• Tropical endomyocardial fibrosis (like the tropical bamboo pole held by the dude)