27. Cardio Path. - 4

Question 1

A 29 year old man to the doctor complaining of fatigue and chest pain. Examination is done and is found a large infiltrate of macrophages and eosinophils in the myocardium of the heart with no giant cells. PCR is negative for viral nucleic acids. The man’s history is not significant for repeated infection and no recent travel history. What is a possible cause of this development?

A. Coxsackie A 
B.Sulfa drugs
C. Thyrotoxicosis 
D. Trypanosoma cruzi 
E. Candida Albicans 

RFA

Answer 1

B. Sulfa drugs- do to the history Sulfa drugs is the best choice since it can cause infection myocarditis Immunologically mediated other causes are

• SLE
• Polymyositis
• Methyldopa

C. Thyrotoxicosis- along with SLE is main cause of other form of Non Infectious Myocarditis, Giant Cell Myocarditis

Question 2

A 33 year old woman dies due to complications of right sided heart failure and arrhythmia. Upon examination of the heart it is found that the right ventricle has thinned due to myocytes being replaced by fatty infiltration. What is the possible defect that caused a issue in this woman?

A. Sarcomeric Proteins
B. Desmosomal Adhesion Proteins 
C. Cytoskeletal Protein 
D. Dystrophin gene 
E.  Mitochondrial proteins involved in oxidative phosphorylation 

RFA

Answer 2

Ans. B- the patient had Arrhythmogenic Right Ventricular Cardiomyopathy noted by the replacement of myocytes with fatty infiltration. This is due to a AD desmosomal adhesion protein defect. Also associated with Naxos Syndrome

A. Sarcomeric Proteins- is related to Hypertrophic cardiomyopathy, AD missense of B-myosin,protein C or cardiac Troponin T. Would be noted by enlargement of the LV myocardium and small LV chamber

C, D & E- are all genetic problems related to DCM. C is AD, D is X-linked and E is mitochondrial. The patient would have dilation of all the chamber of the heart.