04-04-2024

Which of the following is a cause of dilated cardiomyopathy?

A. A high-cholesterol diet
B. Heavy alcohol consumption
C. Mutation in cardiac sodium channel gene
D. Obesity
E. Recreational cannabis use
Answer: B
• Cigarette smoking is a leading' cause of cardiovascular disease but its main influence
is on the genesis of atherosclerosis and coronary artery disease. Likewise, obesity is
associated with risk of hypertension and type 2· diabetes mellitus, but is not a risk
factor for cardiomyopathy. Hypercholesterolaemia may have dietary and genetic
components and is a risk factor for coronary artery disease, not cardiomyopathy.
• Dilated cardiomyopathy can be caused by genetic defects of sarcomeric proteins
such as troponins, tropomyosin, myosin heavy chain, actin and actin-binding
proteins, among many, but cardiac sodium channel gene mutations predispose to
cardiac arrhythmias by causing long OT syndrome or Brugada syndrome.
By which of the following features is hypertrophic cardiomyopathy usually characterised?

A. Asymmetric left ventricular hypertrophy with marked thickening of the interventricular septum
B. Asymmetric left ventricular hypertrophy with marked thickening of the anterior left ventricular wall
C. Hypertrophy of both atria and both ventricles
D. Hypertrophy of the left ventricle and atrophy of the right ventricle
E. Symmetrical left ventricular hypertrophy
Answer: A
• Hypertrophic cardiomyopathy is characterised by left ventricular hypertrophy.
This is often asymmetric with the interventricular septum classically affected.
There are other variants, such as apical hypertrophic cardiomyopathy.
Cardiac transplantation is considered in which group of patients with cardiomyopathy?

A. Asymptomatic patients
B. Frail elderly patients with end-stage heart failure
C. Patients who do not wish to take life-long medication
D. Patients who have poor quality of life despite optimal drug therapy
E. Patients who have symptoms but good quality of life on optimal drug therapy
Answer: D.
• Cardiac transplantation is limited by the availability of donor organs, the need for
life-long immunosuppressive therapy to prevent rejection, and the risks of surgery
and the drugs used afterwards. Therefore it is only offered to patients with cardiac
failure who remain symptomatic despite adherence with optimal pharmacological
therapy and, where appropriate, cardiac resynchronisation therapy.
A 48 year old woman with no significant previous medical history collapses while running a
marathon. Despite attempts at resuscitation, she does not survive. Postmortem examination
reveals asymmetric left ventricular hypertrophy with disproportionate thickening of the
interventricular septum. A postmortem diagnosis of hypertrophic cardiomyopathy is made.
What is the most likely cause of this patient's sudden collapse?

A. Atrial fibrillation
B. Left ventricular failure
C. Pulmonary embolism
D. Right ventricular failure
E. Ventricular arrhythmia
Answer: E.
• Hypertrophic cardiomyopathy is associated with disorganisation and fibrosis of left
ventricular myocardial tissue. This can predispose patients to sudden ventricular
arrhythmias. and these may occur without warning during intense exercise. The risk
is highest in patients with gross hypertrophy or left ventricular outflow tract
obstruction. Some genetic variants are also associated with high risk, such as tropnin
T mutations. Right ventricular failure and pulmonary embolism are not common in
patients with hypertrophic cardiomyopathy. Atrial fibrillation occurs and may cause
symptoms but is rarely life-threatening.
A 30 year old woman has recently been diagnosed with dilated cardiomyopathy. Her diagnosis
was maae with echocardiography, which showed moderate left ventricular dilatation and
impairment. She has noticed herself becoming increasingly fatigued on moderate exertion. Her
younger sister. died suddenly the previous year and she is veryworried about the risk of sudden
death. Which of the following treatments is known to reduce her risk of sudden death?

A. Aspirin
B. β-blocker (e.g. metoprolol)
C. Calcium channel blocker (e.g. verapamil)
D. Loop diuretic (e.g. furosemide)
E. Percutaneous coronary intervention (PCI)
Answer: B
• Loop diuretics have no effect on mortality in patients with cardiac failure. Rate-
limiting calcium channel blockers such as diltiazern and veraparnil are usually
avoided, as they have a negative inotropic effect, which may aggravate cardiac
failure. Aspirin and percutaneous coronary intervention are)featrnents for coronary
artery disease,. not cardiomyopathy.