Cardiomyopathies II: Nonischemic and Peripartum - Akshay Desai, MD, MPH, FHFSA 

Please complete this brief Pre-Test to give a baseline for learning .

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* 1. A 50-year-old man with prior history of hypertension and hyperlipidemia presenting with 3 month history of progressive exertional dyspnea. He has no prior history of MI and denies chest pain.
He takes only atenolol 25 mg once daily and simvastatin 20 mg once daily. He drinks one glass of wine with dinner each night and denies use of tobacco or illicit drugs. His family history is notable for a paternal uncle who died suddenly in his 50s.
PE: BP 170/80 mm Hg, P 80 bpm, JVP 12 cm H20, clear lungs to auscultation, and mild peripheral edema. Paradoxically split S2, soft S3 gallop, grade 2/6 apical holosystolic murmur.
ECG: SR with LBBB
Echocardiogram: dilated LV with global hypokinesis, and an EF of 25%.

Which of the following factors is LEAST likely to be responsible for his HF?

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* 2. 25-year-old male presents in transfer with EF 10%, intubated, and with balloon pump
Was completely healthy until 4 days prior when he developed a flu like syndrome. In fact, ran a marathon 2 weeks ago.
History is notable for growing up in Guyana, moved to Connecticut 2 years ago, may have had a tick bite. Otherwise healthy.

Which of the following is the most likely etiology of his cardiomyopathy?

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* 3. A 40-year-old man is referred for evaluation of exertional chest pain and shortness of breath. His past medical history is notable for hypercholesterolemia, for which he takes rosuvastatin 20 mg qhs. He is a lifetime nonsmoker and does not drink alcohol. The family history is notable for his maternal grandfather and his brother having developed HF in their 50s.

His exam is notable for a blood pressure of 110/70 mm Hg, a heart rate of 80 bpm, jugular venous distention at 16 cm H20, clear lungs to auscultation, an S4 gallop, and mild peripheral edema. ECG reveals sinus rhythm, with generally low QRS voltage and no evidence of prior MI. His echocardiogram shows mild concentric LV hypertrophy, and EF is 60% with no valvular abnormalities. Initial laboratories are notable for a sodium level of 132 mEq/L, serum creatinine of 1.8 mg/dl, and a N-terminal portion of probrain natriuretic peptide (NT-proBNP) of 1800 pg/ml.

Which of the following is the most reasonable unifying diagnosis for this patient with HF and preserved EF?

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* 4. 74 yo woman presents with chest pain shortly after hearing of death of spouse
ECG: Anterior precordial T wave inversions
Labs: Troponin 0.45
Coronary Angiography: No CAD
Ventriculogram:

Q8

Which of the following is the most likely diagnosis?

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* 5. Please provide your first and last name.
Pre-test questions will not be scored, your name is required solely to confirm completion.

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