SFP: cardiomyopathy and carditis

Question 1

What is the basic definition of cardiomyopathy?

Answer 1

Disease of the heart muscle

Question 2

What is the most common cardiomyopathy?

Answer 2

Dilated cardiomyopathy

Question 3

In terms of genetics, cardiomyopathies are normally ___ (inheritance pattern)?

Answer 3

Autosomal dominant

Question 4

Most genes related to cardiomyopathies are associated with…?

Answer 4

Cytoskeletal proteins

Question 5

What is dilated cardiomyopathy?

Answer 5

All 4 chambers are dilated, but not thickened. It results in impaired systolic function.

Question 6

What are symptoms of dilated cardiomyopathy?

Answer 6

Dyspnea, edema, fatigue

Question 7

What are microscopic features of dilated cardiomyopathy?

Answer 7

Nothing specific

Question 8

What are causes of dilated cardiomyopathy?

Answer 8

Idiopathic, alcohol, myocarditis, pregnancy, and obesity

Question 9

What is the outcome of dilated cardiomyopathy?

Answer 9

Heart failure/death or dysrhythmia

Question 10

What are features used to diagnose dilated cardiomyopathy?

Answer 10

Decreased EF, EKG

Question 11

What is the treatment for dilated cardiomyopathy?

Answer 11

Transplant

Question 12

What medication can cause dilated cardiomyopathy?

Answer 12

Doxorubicin

Question 13

Which condition can be hard to distinguish from dilated cardiomyopathy?

Answer 13

Congestive heart failure

Question 14

Describe arrhythmogenic RV cardiomyopathy.

Answer 14

Thinning, fatty replacement of the right ventricle.

Question 15

What are clinical presentations of arrhythmogenic RV cardiomyopathy?

Answer 15

Tachyarrhythmia, syncope, HF, sudden death

Question 16

What filament is mutated in arrhythmogenic RV cardiomyopathy?

Answer 16

Desmosomes

Question 17

How can we diagnose arrhythmogenic RV cardiomyopathy?

Answer 17

EKG, cardiac MRI, heart biopsy

Question 18

Where is the best place to take a heart biopsy?

Answer 18

Interventricular septum

Question 19

Describe hypertrophic cardiomyopathy.

Answer 19

Most concerning when it is obstructive. The septum is thickened causing decreased compliance and impaired diastole.

Question 20

What is a common presentation for hypertrophic cardiomyopathy?

Answer 20

Sudden death in young athletes during exercise

Question 21

What are some symptoms of hypertrophic cardiomyopathy?

Answer 21

Dyspnea, chest pain, syncope

Question 22

What are microscopic findings of hypertrophic cardiomyopathy?

Answer 22

Myocyte hypertrophy and disarray

Question 23

Which condition can be hard to distinguish from hypertrophic cardiomyopathy?

Answer 23

HTN

Question 24

What is the most common genetic cardiomyopathy?

Answer 24

Hypertrophic cardiomyopathy

Question 25

What is commonly mutated in hypertrophic cardiomyopathy?

Answer 25

Cardiac sarcomere (myosin heavy chain, myosin binding protein C, troponin T)

Question 26

A patient has a crescendo-decrescendo murmur that increases with Valsalva. What is the diagnosis?

Answer 26

Hypertrophic cardiomyopathy

Question 27

What are the diagnostic tools for hypertrophic cardiomyopathy?

Answer 27

EKG and biopsy

Question 28

Why do Valsalva and standing make HOCM worse?

Answer 28

They force blood out of the heart, exacerbating the murmur.

Question 29

What are treatments for hypertrophic cardiomyopathy?

Answer 29

Alcohol ablation and myomectomy

Question 30

Describe restrictive cardiomyopathy.

Answer 30

A stiff wall with normal thickness causes decreased compliance and filling.

Question 31

What are three processes that can cause restrictive cardiomyopathy?

Answer 31

Infiltrative processes, storage diseases, or endomyocardial anchoring.

Question 32

Give examples of infiltrative processes that can lead to restrictive cardiomyopathy.

Answer 32

Radiation fibrosis, sarcoid, and amyloid.

Question 33

A patient has sarcoid with giant cells. What cardiomyopathy are they at risk for?

Answer 33

Restrictive cardiomyopathy

Question 34

What are storage diseases that can lead to restrictive cardiomyopathy?

Answer 34

Hemochromatosis

Question 35

What is Loeffler endomyocarditis?

Answer 35

A thickened endocardium with hypereosinophilia that causes restrictive cardiomyopathy.

Question 36

What is myocarditis?

Answer 36

Inflammation and necrosis of heart muscle.

Question 37

What are non-viral causes of myocarditis?

Answer 37

Hypersensitivity, autoimmune transplant.

Question 38

What are outcomes of myocarditis?

Answer 38

Spontaneously resolving, chronic disease, death.

Question 39

Chagas disease is associated with…

Answer 39

Myocarditis

Question 40

Toxoplasmosis is associated with…

Answer 40

Myocarditis

Question 41

Describe pericarditis.

Answer 41

Inflammation of the pericardium.

Question 42

What are common causes of pericarditis?

Answer 42

Post MI via necrosis or Dressler syndrome weeks later, uremia, autoimmune issues.

Question 43

What is the clinical presentation of pericarditis?

Answer 43

Friction rub

Question 44

A patient has hemorrhagic pericarditis. What does this indicate about the cause?

Answer 44

It is likely metastatic or autoimmune.

Question 45

Fibrous bands are seen in…

Answer 45

Pericarditis

Question 46

Pulsus paradoxus can be indicative of…

Answer 46

Cardiac tamponade

Question 47

What is pulsus paradoxus?

Answer 47

Systolic BP drop in greater than 10 mmHg on inspiration.

Question 48

What is seen with pericardial effusion?

Answer 48

Serous fluid with heart failure and low albumin.