What is another name for hypertrophic cardiomyopathy?
Asymmetric septal cardiomyopathy (?)
What is seen in restrictive CM in terms of space between cells (packed or spread)?
Large expansion of interstitial space
Causes of DCM?
Mostly idiopathic, and then genetic
- Toxin induced (alcohol, cocaine)
- Thyroid disorders
- Ischemic (post MI)
- Post inflammatory (after MI)
Describe the cardiomyopathies in terms of what you would see on microscopy?
- Collagen (interstitial fibrosis) highlighted by Masson's trichrome stain
- interstitial deposits (e.g. amyloid deposits)
- Myocyte disarray, hypertrophy and interstitial fibrosis
- 50 yo male with increasing fatigue, SOB for 6 wks
- Tires, SOB when walking up stairs
- Wakes at night gasping for breath
- Sleeps on 2 extra pillows
- PMH: "cold" that lasted a ong time
- SH: travel to S America for business
- Remote alcohol abuse x 15 yrs
- SOB and extra pillows is indicative of heart failure; can see pulmonary edema
What is the most common type of cardiomyopathy?
What is the major dysfunction in DCM?
Systolic dysfunction and congestive heart failure
Gross features of DCM?
- 2-3 x heavier
- Large and flabby
- Dilation of all 4 chambers
- Ventricular thickness variable
- Mural thrombi common
Microscopic features of DCM?
- Variable myocyte nuclear enlargement and attenuation with irregularity
- Loss of myofibrils in myocytes
- Interstitial and subendothelial fibrosis
- Increased interstitial lymphocytes
- 22 yo basketball player
- Funny feeling in chest for 6 mo, on/off
- PE: forceful apical impulse, harsh systolic murmur at L sternal border; LVH on echo
What demographic does Hypertrophic CM typically affect?
HCM often affects younger age group
What are complications/outcomes of HCM?
Commonly causes sudden cardiac death in young asymptomatic person (arrhythmia)
- If symptoms are present, usually have diastolic dysfunction with extertional dypsnea, angina, or non-anginal chest pain, palpitations, syncope
- Harsh systolic ejection murmur
Causes of HCM?
- Genetic (involves sarcomere proteins)
- 2ndary: grossly hypertrophic but microscopically minimal change (as in HTN)
Gross features of HCM?
- Massive myocardial hypertrophy without ventricular dilation
- On cross-section,
Microscopic features of HCM?
- Extensive myocyte hypertrophy
- Haphazard disarry of bundles of myocytes or individual myoctes (myocyt
- Disarray of contractile elements in sarcomeres within cells (myofiber disarray)
- Interstitial fibrosis
- 65 yo female with mild, intermittent chest pain
- SOB, tired no other problems
- PE: pitting edema of legs, hepatomegaly
- ECG: non-specific ST-T changes and low voltage
- Echo: reduced LV function, large atria
Characteristics of Restrictive CM?
- Reduced ventricular compliance an diastolic dysfunction
- Dyspnea, edema, fatigue
- Congestive hepatomegaly, elevated JVP, systolic murmurs from mitral/tricuspid regurgitation
What causes RCM?
- Deposition (amyloidosis, hemosiderin in hemochromatosis, etc.)
- Scar formation (radiation, endmyocardial fibrosis)
- Infiltrative (sarcoidosis, hypereosinophilic syndrome)
What is seen microscopically in RCM?
- Variable myocardial fibrosis
- Specific findings
What are some other cardiomyopathies?
- Arrhythmogenic right ventricular cardiomyopathy
- Noncompaction cardiomyopathy
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