on 22-Apr-2016 (Fri)

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#nephrology

Question

Spironolactone/Eplerenone does what

Answer

Blocking action of Aldosterone

NB: spironolactone = K+ sparing diuretic

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#cardiology

Question

What is heart failure?

Answer

Heart Failure – “inability of the heart to pump blood forward at a sufficient rate to meet the metabolic demands of the body (forward failure) or is only able to do so if the cardiac filling pressures are abnormally high (backward failure)”

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Question

What are the 3 prinicpal functional classes of heart failure?

Answer

1. Heart failure with reduced ejection fraction (usually dilated heart)
2. Heart failure with preserved ejection fraction (usually stiff heart)
3. Right heart failure

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Question

[...] is often the end stage of numerous pathological processes that injure the myocardium

Answer

Heart failure is often the end stage of numerous pathological processes that injure the myocardium

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Question

Heart failure is often the [...] stage of numerous pathological processes that injure the myocardium

Answer

Heart failure is often the end stage of numerous pathological processes that injure the myocardium

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Question

Heart failure is often the end stage of numerous pathological processes that injure the [...]

Answer

myocardium

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Question

Initially, changes to the heart represent [...] and [...] alterations meant to improve cardiac performance after an insult to the heart or abnormal hemodynamics

Answer

Initially, changes to the heart represent structural and molecular alterations meant to improve cardiac performance after an insult to the heart or abnormal hemodynamics

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Question

Primary cardiomyopathies have significant potential for [...] .

Answer

heritability

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Question

What are 3 types of primary cardiomyopathies?

Answer

genetic, mixed, acquired

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Question

What are the genetic causes of primary cardiomyopathies?

Answer

• HCM, ARVD/C, LVNC, Glycogen storage. Conduction defects, mitochondrial myopathies, Ion channel disorders ( LQTS, Brugada, SQTS, CVPT, Asian SUNDS)

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Question

What are mixed causes of primary cardiomyopathies?

Answer

• DCM, restrictive (non-hypertrophied and non-dilated)

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Question

What are acquired causes of primary cardiomyopathies?

Answer

• inflammatory( myocarditis), stress-provoked (tako-tsubo), peripartum, tachycardia-induced, infants of insulin-dependent diabetic mellitus
  
  NB: young person death usually due to toxicity

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Question

What are causes of secondary cardiomyopathies?

Answer

Infiltrative (extracellular), Storage (intracellular) ,Toxic (alcohol known toxin) , Endomyocardial Fibrosis , Inflammatory, Endocrine (diabetes, thyroid). Genetic Syndromes. Neuromuscular. Nutritional (from alcohol) . Autoimmune / CVD

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Question

[What type of cardiomyopathy] is a specific type of heart muscle disease (primary cardiomyopathy) because it predominantly involves the heart only and typically has a genetic basis.

Answer

Hypertrophic cardiomyopathy

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Question

Hypertrophic cardiomyopathy is a specific type of heart muscle disease ( [primary/secondary] ) because it predominantly involves the heart only and typically has a genetic basis.

Answer

primary cardiomyopathy

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Question

What are the 3 structural patterns of heart disease?

Answer

hypertrophied/hypertrophic - enlarged heart often with an enlarged and thickened left ventricle

Dilated (most common) – primary or secondary DCM

Restrictive – idiopathic or due to some infiltrative process such as amyloidosis, sarcoidosis, systemic sclerosis, etc….

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Question

A hypertrophic pattern of heart disease includes many possible candidates – only one of which is a true [...]

Answer

“hypertrophic cardiomyopathy”

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Question

Other forms of hypertrophy that one may see is causing a hypertrophied pattern can include: (not all hypertrophied hearts are HCM)

Answer

1. Hypertensive heart disease (commonest cause of hypertrophy in our population)
2. Fabry’s disease
3. LVH in the setting of aortic valve disease (both aortic stenosis and aortic insufficiency associated with LVH)
   d. acromegaly
   

NB: These other forms may or may not have an underlying genetic basis and most are acquired forms of heart disease

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Question

In structural patterns of heart muscle disease, [...] is important

Answer

apex formation

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Question

In [...], the apex is distorted, valves don't close properly, and it may or may not show increased thickness

Answer

dilated cardiomyopathy

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Question

In dilated cardiomyopathy, the [...] is distorted, valves don't close properly, and it may or may not show increased thickness

Answer

apex

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Question

In dilated cardiomyopathy, the apex is distorted, valves [...] , and it may or may not show increased thickness

Answer

don't close properly

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Question

In dilated cardiomyopathy, the apex is distorted, valves don't close properly, and it may or may not show [...]

Answer

increased thickness

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Question

In [...] pattern cardiomyopathy, the thickness is widened, there is decreased blood, and it's less able to relax

Answer

hypertrophied

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Question

In hypertrophied pattern cardiomyopathy, the thickness is [...] , there is decreased blood, and it's less able to relax

Answer

widened

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Question

In hypertrophied pattern cardiomyopathy, the thickness is widened, there is [...] blood, and it's less able to relax

Answer

decreased

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Question

In hypertrophied pattern cardiomyopathy, the thickness is widened, there is decreased blood, and it's less able to [...]

Answer

relax

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Question

In [...] , there may or may not be hypertrophy of muscle, the composition of the wall is changed, and the normal elastic pattern isn't there anymore.

Answer

restrictive cardiomyopathy

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Question

In restrictive cardiomyopathy, there may or may not be hypertrophy of muscle, the composition of the wall is changed, and [...] isn't there anymore.

Answer

the normal elastic pattern

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Question

Dilated cardiomyopathy can possess [2 things]

Answer

remodelling and hypertrophy

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Question

Dilated cardiomyopathy typically exhibits [...] failure

Answer

‘forward’ (+/‐ ‘backward’)

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Question

What is the process of dilated cardiomyopathy?

Answer

• First stage of compensation is hypertrophy, then muscle function increase so 02 demand is high but o2 supply is the same so get damaged muscle
• When thin out, can affect corda tendon and papillary muscle
• Valve can’t close properly
• If Heart can’t function properly get stasis and get mural thrombosis

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Question

Describe the gross anatomy observed in dilated cardiomyopathy.

Answer

ventricle enlarged, atria often enlarged and the apex is rounded rather than pointed and base is blunted

• May lead to dilation of RV and then into RA at that point we call 4 chamber dilation

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Question

The most common pattern in hypertrophic cardiomyopathy is [...]

Answer

asymmetric septal hypertrophy

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Question

Very thick and reduced volume in hypertrophic cardiomyopathy => [...]

Answer

diastolic dysfunction

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Question

[...] is common in hypertrophic cardiomyopathy

Answer

Myocardial fibrosis/scar

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Question

What is SAM? In what condition do you see it?

Answer

systolic anterior motion of the mitral valve

Hypertrophic cardiomyopathy

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Question

The [...] also frequently hypertrophied in HCM

Answer

right ventricle

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Question

What makes a pt prone to sudden death in HCM?

Answer

Scarring- arrhythmogenic foci

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Question

What happens in restrictive cardiomyopathy?

Answer

Infiltration of fibrous tissue or some other substance in myocardium –very stiff ventricles

• Still has apex forming unlike dilated
• E.g. sarcoidosis which is a type of non-caseating granulomatous inflammation
• Idiopathic restrictive cardiomyopathy – fibrous tissue from unknown cause

Question

What does 'prima facie' mean?

Answer

At face value _{(only rough definition)}

adverb
1. at first appearance; at first view, before investigation.

adjective

2. plain or clear; self-evident; obvious.