Cardiomyopathies, Pericarditis, & Myocarditis

Question 1

What is cardiomyopathy?

Answer 1

disease of the heart muscle that causes loss of muscle contractility; can be sudden or slow, & multiple causes (BAD thing)

Question 2

What is myocarditis?

Answer 2

Infection/inflammation of heart muscle and conduction system, without evidence of MI (BAD thing)

Question 3

What is pericarditis? What two things can it cause?

Answer 3

infection/inflammation of pericardium (heart muscle is ok) that can cause inflammatory CP & possible pericardial effusion with muffled heart sounds- usually not a bad thing

Question 4

What is one major thing a cardiomyopathy can cause?

Answer 4

Sudden, severe CHF

Question 5

what is a dilated cardiomyopathy? what is its major etiology?

Answer 5

dilation of ventricles with thinning of the walls leads to blood being pumped ineffectively (decreased contractility)
50% of DCM are idiopathic

Question 6

What test can diagnosis DCM?

Answer 6

Echo, not much can be done by the time its detected though

Question 7

What is the best “treatment” we have for DCM?

Answer 7

Medical treatment only helps so much: reduce workload & increase contractility (ACEI’s, BB, diuretics)
Treat the associated heart failure and see if cardiomyopathy gets better
Heart transplant is usually only suitable Tx

Question 8

If you get heart failure with DCM, what type is it?

Answer 8

heart failure with reduced ejection fraction (HFrEF)

Question 9

What are signs/symptoms of DCM?

Answer 9

dyspnea, orthopnea, weakness, fatigue, ascites, edema, generally rapidly evolving

Question 10

What two valve problems could you see with DCM?

Answer 10

mitral and tricuspid regurgitation (expansion of valvular ring)

Question 11

What is hypertrophic obstructive cardiomyopathy? Is it genetic? What population does it usually affect?

Answer 11

its an abnormal thickening of myocardium (mostly in the septum) that affects DYASTOLIC function of left ventricle
yes, its autosomal dominant (50% chance of passing to offspring)
Affects teens/young adults/athletes the most

Question 12

What part of the heart will have increased pressure from HOCM?

Answer 12

Left ventricle outflow tract is obstructed (from hypertrophic septum) and this results in elevated left atrial pressures

Question 13

What are usual signs/symptoms for HOCM?

Answer 13

patient has positive family Hx for sudden cardiac death
afib- often related to sudden cardiac death
dyspnea, CP, exertional syncope

Question 14

What is the best test to confirm HOCM?

Answer 14

ECHO
see a thickened septum, Left ventricle hypertrophy, abnormal MV (usually mitral regurg)
Muscle fibers are disorganized compared to normal

Question 15

What is the medical and surgical treatment for HOCM?

Answer 15

BB to reduce arrhythmias & improve diastolic function
Implantable defibrillator if fatal arrhythmia should occur (STANDARD OF CARE)
myotomy/myectomy- incising or removing part of the septum

Question 16

What is a restrictive cardiomyopathy? what is a common cause of this?

Answer 16

restriction of ventricular filling because of ridged walls; impaired systolic & diastolic function, spared muscle cell function
cause: myocardium is filled with amyloid or sarcoid buildup that stiffened muscle (but DOESNT thicken it)

Question 17

What are symptoms of restrictive cardiomyopathy?

Answer 17

dyspnea, paroxysmal nocturnal dyspnea, orthopnea, peripheral edema, ascites, fatigue, and weakness

Question 18

How do you detect and diagnosis a restrictive cardiomyopathy?

Answer 18

detect by echo and diagnosis with biopsy of muscle

Question 19

What is the tx for a restrictive cardiomyopathy?

Answer 19

transplant

Question 20

What is a tako-tsubo cardiomyopathy also called?

Answer 20

neurogenic myocardial stunning; “broken heart syndrome”

Question 21

Describe T-T cardiomyopathy: what does it result from, who normally gets it, talk about LV function

Answer 21

results from high catecholamine stress
most common in postmenopausal women
LV balloons out like a tako-tsubo pot
LV function is usually spared

Question 22

what does an echo show for t-t cardiomyopathy

Answer 22

LV apical akinesis (lack of ventricular wall/distal apex motion; looks like its not contracting)

Question 23

what does T-T cardiomyopathy present like?

Answer 23

anterior wall acute MI, usually mild elevations in troponin and ST elevations on EKG

Question 24

Tx for T-T cardiomyopathy

Answer 24

supportive tx: recovery within a few weeks; occasionally fatal

Question 25

what is peripartum cardiomyopathy?

Answer 25

idiopathic dilated cardiomyopathy occurring 1 month before or 5 months after delivery

Question 26

What is the prognosis for peripartum cardiomyopathy?

Answer 26

half get better within 6 months with good prognosis; some rapid fatalities or HF, high risk with subsequent pregnancies

Question 27

What usually causes myocarditis

Answer 27

usually a viral infection

Question 28

How does myocarditis present? Name other signs and symptoms for myocarditis

Answer 28

can present as sudden severe CHF or sudden death
onset with flu like syndrome with malaise, low fever, and tachycardia (more elevated than you think); often hx of GI or GU infection

Question 29

Prognosis for myocarditis

Answer 29

50% infection lasts a short time and recovery is about a month; rest vary from sudden death to chronic CHF

Question 30

What is tx for myocarditis?

Answer 30

reduce cardiac workload with rest until infection resolves, tx CHF if it remains

Question 31

what is the etiology of pericarditis?

Answer 31

usually viral or idiopathic

small % from neoplasia, TB, or autoimmune

Question 32

what is the clinical presentation for pericarditis? What does the EKG show?

Answer 32

Chest pain: sudden onset, sharp, pleuritic, IMPROVED by sitting up & leaning forward
pericardial friction rub (along LSB)
maybe pericardial effusion
EKG shows ST elevation (signifies general inflammation) or PR depression

Question 33

What labs/imaging do you do for pericarditis?

Answer 33

not much is helpful
Echo is normal (unless effusion)
CXR is normal
Troponins might be elevated (1/3 of people)
General inflammatory labs (ESR, CRP, leukocytosis)

Question 34

what is the Tx for pericarditis?

Answer 34

usually supportive: NSAIDS, maybe steroids, consider non viral causes & their tx
may do pericardiocentesis for constant effusions (can send this fluid for culture)
course is almost always benign

Question 35

What are some types of high risk pts who might require hospitalization for pericarditis?

Answer 35

pt with significant fever
pt with tamponade/large effusion
immunosuppressed
on warfarin (bleeding can cause tamponade)
as a result of trauma
poor response to NSAID within 7 days
elevated troponins