Cardiomyopathy Review Questions

You can see brief answers to these questions just by pointing at the keywords with your mouse. In some cases more extensive information is available by clicking on the link. Try initially to write down short answers on your own, before peeking to see whether you were right.

This disease followed a tortuous course, and the patient received an unusually large number of drugs. Click here to download a drugs summary chart in Adobe portable document format (drugs.pdf) that you can print out on a single A4 landscape sheet for easier reference. We have also prepared a black text printable version of the all the patient charts. Click here to download a copy in Adobe portable document format (charts.pdf) that you can print out as three A4 portrait sheets for easier reference.

1. Chest examination on admission suggested pulmonary oedema. Impairment of liver, kidney and heart function might be responsible for this condition. Explain the mechanisms by which each organ failure could cause oedema.
   
   




2. What diagnostic tests were carried out to distinguish between liver, kidney and heart damage in this patient, and what conclusions were reached? What further tests might have been useful?
   
   




3. How was the treatment of oedema monitored? Comment on the effectiveness of the treatment.
   
   




4. What side effect is associated with diuretic treatment? How was this monitored and controlled?
   
   




5. Look at the blood urea, bilirubin and creatinine figures on the graphs provided. Which is the more important measurement in the assessment of kidney function? Explain the reasons for this.
   
   



6. What evidence led to the consultant's diagnosis of cardiomyopathy? What tests were ordered to exclude other causes of these symptoms?
   
   

7. What causes cardiomyopathy? Is the cause established in this case? How would a clear diagnosis of cause affect the treatment offered?
   
   

8. What drugs were used to treat the cardiomyopathy? Explain how they act.
   
   

9. What evidence suggests that heart muscle is continuing to degenerate? What is the long-term prognosis in this condition? What further treatment is considered?
   
   

10. Why might cardiac failure predispose the patient to pulmonary embolism (possibly Day 11 & definitely Day 19)? What other features of the patients condition would also contribute?
    
    




11. What treatment is prescribed for the patient at this point? How were the effects of treatment monitored?
    
    




12. Use your understanding of the mechanisms of action of heparin and warfarin to explain the fact that heparin is used first, followed by warfarin. Why do you think a dose of Vitamin K is given on Day 29?
    
    




13. Why was Cefuroxim prescribed from Day 27?
    
    




14. The site of the patient's infection was localised on Day 38 in the right lung. How might this infection have arisen?
    
    

15. Explain why the infection of the mouth suffered by the patient may be regarded as a side-effect of his treatment.
    
    

16. Why was it necessary to change the antifungal medication on Day 36?
    
    

17. Throughout the course of this patient's illness, there is evidence of haemolysis, although there is no clear evidence that this symptom is related to the cardiomyopathy. Why might tests for G6PDH deficiency(Day 36) and sickle cells (Day 43) have been carried out on this patient?
    
    




18. What are reticulocytes, and why was the level monitored closely during the latter part of the patient's illness?
    
    

19. What is ventricular fibrillation (Day 48)? Why should cardiomyopathy lead to this condition and to the patient's death?
    
    

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