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CARDIOMYOPATHY BY RUBEN RAJContent 1. Overview 2. The 3 types of cardiomyopathies 3.Causes 4.Heart Sounds 5.Investigations 6.ManagementOVERVIEW-What is Cardiomyopathy -Disease of the heart muscle -Affects the ability to pump blood around the bodyTypes of cardiomyopathyDILATED CARDIOMYOPATHY (DCM)DAlated CardiomyAlcohol Abuses I C Canch of stuff Chronic Cocaine useitis Cardiac I O Chagas DIlDtation Doxorubicin toxicityTypes of Dilated Cardiomyopathy -Peripartum Cardiomyopathy -Takotsubo Cardiomyopathy -Tachycardic CardiomyopathyPathophysiology Systolic dysfunction Reduced contractarctility Reduced stroke volume Reduced cardiac output Systolic Heart failureRHF -Jugular venous distension -Hepatomegaly -Pedal oedema LHF -Pulmonary oedema -Dyspnoe -Paroxysmal Nocturnal DysneaFeatures S3 Mitral and tricuspid regurgitationInvestigations ECG- Poor R wave progression Echocardiogram- globular, dilated heart with reduced ejection fractionManagement 1.Addressing the trigger. Ex, alcohol abstinence for alcohol-induced DCM 2.Medical treatment-Heart failure managementHYPERTROPHIC CARDIOMYOPATHY (HCM) Hypertrophic Cardiomyopathy-Causes Genetic: 1.Autosomal Dominant condition -Mutation in a very specific protein in our sarcomere Heavy Chain of Myosin protein Assosciation: -Fredreich Ataxia -Wolf-Parkinson WhitePathophysiology Diastolic dysfunction L Ventricle thickness Small ventricle cavity Reduced diastolic filling Reduced preloadReduced stroke volume Reduced cardiac output Diastolic Heart failure Reduced Coronary Perfusion Myocardial Ischaemia DEATHhttps://www.youtube.com/watch?app=desktop&v=t6pQyZkvmt4&ab_channel=808sandFastbreakFeatures S4 Mitral regurgitation Systolic Ejection MurmurInvestigations Genetic testing Echocardiogram- MR SAM ASH Mitral Regurgitation Systolic Anterior Motion Asymmetrical Septal Hypertrophy ECG- Deep T wave inversion & Abnormal Q wavesManagement Conservative Medical Surgery- Surgery Septal Myectomy - Alcohol Septal AblationAMIODAR ONE BETA-BLOCKERS/VERAAMIL CARDIOVERTER DEFRIBRILATOR DUAL CHAMBER PACEMAKER ENDOCARDITIS POPHYLAXISDRUGS to avoid Nitrates ACE inhibitor InotropesRESTRICTIVE CARDIOMYOPATHY (RCM)RADIATION FIBROSISmyopathy-Cause MYLOIDATIS HAEIOCHROMATOSIS IPathophysiology Diastolic dysfunction Reduced diastolic filling Reduced preload Reduced stroke volume Reduced cardiac output Diastolic Heart failureDiastolic Heart failure RHF -Jugular venous distension -Hepatomegaly -Pedal oedemaFeatures S3 Mitral and tricuspid regurgitationInvestigations Echocardiogram Cardiac MRIManagement Addressing underlying conditions. Ex- steroids for sarcoidosis Symptomatic reliefTHE ENDQUESTIONS?FEEDBACK FORMmenti.com 6892 8015QUESTION 1 You are a doctor attached to a cardiology clinic. You are about to see a 55-year-old male who has recently presented with progressive exertional dyspnoea, orthopnoea, and pitting ankle oedema. He went on to have an echocardiogram which showed dilation of all four chambers, thinning of both ventricular walls, tricuspid regurgitation, mitral regurgitation and a reduced ejection fraction. Which is the following is the most likely cause for this patient's condition?Answers A- Amyloidosis B-Chronic alcoholism C-Obesity D-Smoking E-Stress ANSWER IS BQUESTION 2 A 28-year-old man is a new patient at your surgery and attends for an initial visit. He has been in good health and has not had any hospitalizations. With regards to his family history. he reports that his father died of sudden cardiac death at age 38. A post-mortem examination revealed that his cause of death was hypertrophic cardiomyopathy. What is the probability that your patient inherited the same condition?Answers A- 25% B- 33% C- 50% D- 66% ANSWER IS C E- 75%QUESTION 3 A 57-year-old gentleman presents with shortness of breath. He does not get chest pain. On respiratory examination, he has fine bibasal crackles which clear on coughing. He informs you he drinks half a bottle of vodka every day and has done for most of his life. You arrange for him to have an echocardiogram. What is the echocardiogram likely to report?ANSWERS A-Left ventricular ejection fraction = 65%, dilated left ventricle, no wall motion abnormalities B-Left ventricular ejection fraction = 65%, ventricular hypertrophy, no wall motion abnormalities C-Left ventricular ejection fraction = 40%, dilated left ventricle, no regional wall motion abnormalities D-Left ventricular ejection fraction = 40%, ventricular hypertrophy, no regional wall motion abnormalities ANSWER IS C E-Left ventricular ejection fraction = 40%, regional wall motion abnormalities notedQUESTION 4 A 19-year-old man has a medical examination before joining the army. He denies any symptoms and has no family history of note. The ECG shows the following:ANSWERS A-Trifascicular block B-Hypertrophic obstructive cardiomyopathy C-Long QT syndrome D-Arrhythmogenic right ventricular cardiomyopathy E-Dextrocardia ANSWER IS BQUESTION 5 A 55-year-old woman presents to cardiology complaining of a 2-week history of chest pain, shortness of breath, dizziness, and infrequent syncope or pre-syncope. She mentions during the history that she's experienced profoundly low mood since the recent sudden death of her husband and redundancy from her job, but an otherwise insignificant past medical history. An ECG reveals widespread ST-elevation and ischaemic changes including T wave inversion. Blood testing shows moderately raised cardiac enzymes and coronary angiography is unremarkable. What is the most likely diagnosis?ANSWERS A-Myocarditis B-Non-ST-elevation myocardial infarction C-Pericarditis D-ST-elevation myocardial infarction E-Takotsubo cardiomyopathy ANSWER IS EQUESTION 6 A 23-year-old male is undergoing a medical review at a professional football club when an ejection systolic murmur is found. He is sent for echocardiogram and subsequently diagnosed with hypertrophic obstructive cardiomyopathy (HOCM). Electrocardiogram (ECG) is normal and pulse is regular. Which of the following complications of this condition is most likely to cause sudden death in this athlete?ANSWERS A-Myocardial infarction B-Ruptured mitral valve C-Complete heart block D-Ventricular arrhythmia E-Wolff-Parkinson White syndrome ANSWER IS DQUESTION 7 A 60-year-old man presents with increasing shortness-of-breath on exertion. During the examination a third heart sound is heard. Examination of the respiratory system is unremarkable. Which one of the following is most consistent with this finding?ANSWERS A-Dilated cardiomyopathy B-Hypertrophic obstructive cardiomyopathy C-Atrial fibrillation D-Mitral stenosis E-Normal variant ANSWER IS ATHANK YOU