Myocarditis and Cardiomyopathies — MCQs

10 questions

Cardiomyopathy is not a feature of

Which of the following statements is false regarding restrictive cardiomyopathy?

A 16-day-old baby girl is brought to the emergency department appearing ill. On examination, she has pallor and dyspnea with a respiratory rate of 85 per minute. Her heart rate is 200 bpm, heart sounds are distant, and a gallop is heard. Chest X-ray shows cardiomegaly. Echocardiogram reveals dilated ventricles and dilation of the left atrium. ECG shows ventricular depolarization complexes with low voltage. What is the most likely underlying diagnosis?

274. A young athlete was found to have hypertrophic cardiomyopathy during testing for a competitive sport. Which of the following maneuvers will increase the murmur?

Dilated cardiomyopathy is caused by which gene alteration?

What will be the likely cause of death in a 4-year-old boy who tires easily, exhibits weakness in the pelvic and shoulder girdles, and calf muscle enlargement, with elevated serum creatine kinase levels, and a biopsy showing marked variation in muscle fiber size and shape, muscle fiber necrosis, myophagocytosis, regenerating fibers, and fibrosis?

A 9-month-old child of a diabetic mother presents with tachypnea and hepatomegaly. Echocardiography shows normal cardiac morphology with asymmetric septal hypertrophy. Which of the following medications is indicated for the management of this child's condition?

The 9-month-old child of a diabetic mother presents with tachypnea and hepatomegaly. Echocardiography of the heart showed normal cardiac morphology with asymmetric septal hypertrophy. Which of the following would you give to treat this child?

Kawasaki disease is associated with all of the following clinical features except

Q10

Which of the following are neonatal complications of maternal diabetes during pregnancy? I. Hyperbilirubinemia II. Hypocalcemia III. Cardiomyopathy IV. Hypoglycemia Select the correct answer using the code given below :

Myocarditis and Cardiomyopathies Indian Medical PG Practice Questions and MCQs

Question 1: Cardiomyopathy is not a feature of

A. Duchenne's Muscular Dystrophy
B. Friedreich's ataxia
C. Lowe's syndrome (Correct Answer)
D. Pompe disease

Explanation: ***Lowe's syndrome*** - **Lowe's syndrome** (oculocerebrorenal syndrome) is characterized by congenital cataracts, intellectual disability, and renal tubulopathy, but **not cardiomyopathy**. - The primary cardiac manifestations in Lowe's syndrome are **mitral valve prolapse** and left ventricular hypertrophy, but not a progressive cardiomyopathy as a defining feature. *Duchenne's Muscular Dystrophy* - **Dilated cardiomyopathy** is a very common and significant feature of Duchenne's Muscular Dystrophy, often leading to heart failure [1], [2]. - Cardiac involvement is a major cause of morbidity and mortality in these patients, with **fibrosis** being a common finding [1]. *Friedreich's ataxia* - **Hypertrophic cardiomyopathy** is a prominent and frequent complication of Friedreich's ataxia, affecting a majority of patients. - It can lead to heart failure, arrhythmias, and is a major cause of death in affected individuals. *Pompe disease* - Infantile-onset Pompe disease is characterized by severe **hypertrophic cardiomyopathy** due to the accumulation of glycogen in cardiac muscle. - Cardiac involvement is often life-threatening and a hallmark of the severe forms of the disease.

Question 2: Which of the following statements is false regarding restrictive cardiomyopathy?

A. Left ventricular hypertrophy is present.
B. Filling pressure is decreased. (Correct Answer)
C. In the early phase, systolic function is impaired.
D. Heart failure is predominantly right-sided.

Explanation: Filling pressure is decreased. - In restrictive cardiomyopathy, the ventricles become stiff and noncompliant, impairing filling. - This leads to increased filling pressures (e.g., elevated left and right atrial pressures) as the heart attempts to fill adequately. Left ventricular hypertrophy is present. - Left ventricular hypertrophy is common in restrictive cardiomyopathy, particularly in conditions like amyloidosis and sarcoidosis, where infiltrative processes thicken the ventricular walls. - While the chambers are not dilated, the walls can be abnormally thick due to underlying pathology. In the early phase, systolic function is impaired. - In the early stages of restrictive cardiomyopathy, systolic function is typically preserved. The primary defect is diastolic dysfunction—impaired ventricular filling. - Systolic dysfunction may develop in later stages as the underlying disease progresses or due to severe volume overload. Heart failure is predominantly right-sided. - Right-sided heart failure symptoms (e.g., peripheral edema, ascites, jugular venous distension) are often prominent in restrictive cardiomyopathy. - Due to the rigid and non-compliant ventricles inhibiting filling, both ventricles are affected, but systemic venous congestion often dominates the clinical picture.

Question 3: A 16-day-old baby girl is brought to the emergency department appearing ill. On examination, she has pallor and dyspnea with a respiratory rate of 85 per minute. Her heart rate is 200 bpm, heart sounds are distant, and a gallop is heard. Chest X-ray shows cardiomegaly. Echocardiogram reveals dilated ventricles and dilation of the left atrium. ECG shows ventricular depolarization complexes with low voltage. What is the most likely underlying diagnosis?

A. Hypoplastic Left Heart Syndrome
B. Critical Aortic Stenosis
C. Total Anomalous Pulmonary Venous Return
D. Congestive Heart Failure secondary to congenital heart disease (Correct Answer)

Explanation: ***Congestive Heart Failure secondary to congenital heart disease*** - This is the **most appropriate answer** given the options, as it describes the clinical syndrome present in this neonate. - The findings of **dilated ventricles**, **dilated left atrium**, **low voltage ECG**, **distant heart sounds**, **gallop rhythm**, and **cardiomegaly** indicate severe cardiac dysfunction with heart failure. - While CHF is technically a presentation rather than an underlying structural diagnosis, the echo findings of **chamber dilation** (rather than hypoplasia or hypertrophy) distinguish this from the other structural heart diseases listed. - Clinical context: In neonates with dilated chambers and low voltage, consider **dilated cardiomyopathy** (from myocarditis, metabolic disease, or anomalous coronary origins), but among these options, CHF secondary to CHD is the encompassing diagnosis. *Hypoplastic Left Heart Syndrome* - HLHS involves **underdeveloped (hypoplastic)** left-sided structures, **not dilated ones** as seen in this case. - Echocardiogram would show **small/hypoplastic left ventricle** and **left atrium**, completely opposite to the dilated chambers described here. *Critical Aortic Stenosis* - Would typically show **left ventricular hypertrophy** (concentric or eccentric) rather than ventricular dilation with low voltage. - Presents with reduced cardiac output but **LV would be hypertrophied**, not dilated with low voltage as seen here. *Total Anomalous Pulmonary Venous Return* - Typically causes **right heart enlargement** and **pulmonary venous congestion** more prominently than left heart changes. - Would show **right atrial and right ventricular dilation**, not the prominent left-sided chamber dilation described in this case.

Question 4: 274. A young athlete was found to have hypertrophic cardiomyopathy during testing for a competitive sport. Which of the following maneuvers will increase the murmur?

A. Handgrip
B. Valsalva maneuver (Correct Answer)
C. Squatting
D. Leaning forward
E. Passive leg raise

Explanation: **Valsalva maneuver** - The **Valsalva maneuver** reduces **preload** by decreasing venous return to the heart. - A decrease in preload reduces the left ventricular chamber size, which in turn exacerbates the **left ventricular outflow tract (LVOT) obstruction** characteristic of hypertrophic cardiomyopathy (HCM), thereby **increasing the intensity of the murmur**. *Handgrip* - **Handgrip** is an isometric exercise that leads to an increase in **afterload** and **peripheral vascular resistance**. - Increased afterload causes the left ventricle to eject blood against higher pressure, which **enlarges the left ventricular chamber** and **reduces the LVOT obstruction**, thus **decreasing the intensity of the murmur** in HCM. *Squatting* - **Squatting** increases both **preload** (due to increased venous return) and **afterload** (due to increased peripheral vascular resistance). - The increased preload and afterload lead to an **increased left ventricular volume**, which **reduces the LVOT obstruction** and therefore **decreases the intensity of the murmur** in HCM. *Passive leg raise* - **Passive leg raise** increases **preload** by increasing venous return to the heart from the lower extremities. - The increased preload leads to an **increased left ventricular chamber size**, which **reduces the LVOT obstruction** and therefore **decreases the intensity of the murmur** in HCM. *Leaning forward* - Leaning forward during auscultation is typically used to better hear **aortic regurgitation murmurs**, as it brings the aorta closer to the chest wall. - This maneuver does not significantly alter **cardiac preload or afterload** in a way that would consistently increase the murmur of hypertrophic cardiomyopathy.

Question 5: Dilated cardiomyopathy is caused by which gene alteration?

A. Titin (Correct Answer)
B. Mitochondrial genes
C. Dystrophin mutations
D. Lamin A/C mutations

Explanation: ***Titin*** - **Titin** gene mutations are a well-known cause of **dilated cardiomyopathy**, affecting the structural integrity of cardiac myocytes [1]. - These mutations lead to **disruption in sarcomere architecture**, resulting in impaired cardiac function [1]. *Dystrophin* - Primarily associated with **Duchenne muscular dystrophy** and **Becker muscular dystrophy**, not directly causing dilated cardiomyopathy. - Deficiency of dystrophin typically affects skeletal muscle more than cardiac muscle. *Sarcomere* - While sarcomere protein mutations can cause cardiomyopathies, they are less specific than titin mutations for dilated cardiomyopathy. - Sarcomere mutations are often linked to **hypertrophic cardiomyopathy** rather than dilated types. *Mitochondrial genes* - Mutations in mitochondrial genes result in **metabolic disorders** like **mitochondrial myopathy** but are not a direct cause of dilated cardiomyopathy. - Mitochondrial dysfunctions typically present with multi-system involvement rather than isolated cardiac symptoms. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 574.

Question 6: What will be the likely cause of death in a 4-year-old boy who tires easily, exhibits weakness in the pelvic and shoulder girdles, and calf muscle enlargement, with elevated serum creatine kinase levels, and a biopsy showing marked variation in muscle fiber size and shape, muscle fiber necrosis, myophagocytosis, regenerating fibers, and fibrosis?

A. Respiratory failure/complications (Correct Answer)
B. Cerebrovascular complications
C. Chronic kidney disease
D. Pulmonary embolism

Explanation: ***Cardiomyopathy*** - In boys with **Duchenne muscular dystrophy (DMD)**, cardiomyopathy is a significant complication leading to **heart failure** and death. - The muscle biopsy findings support **muscular dystrophy** [1], and the patient's symptoms indicate weakening of the heart muscle over time. *End-stage renal disease* - Typically results from **chronic kidney conditions**, which are not indicated by the case presented. - The symptoms described, including **muscle weakness** and **fibrosis**, are not directly related to renal dysfunction. *Cerebrovascular disease* - Generally manifests as a sudden neurological deficit and is uncommon in **pediatric muscular conditions**. - There is no indication of **neurological symptoms** in this patient's presentation. *Pulmonary saddle embolism* - This condition typically presents with sudden **shortness of breath** or **chest pain**, neither of which is mentioned here. - The findings focus more on **muscle degeneration** rather than any acute pulmonary events. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1244-1245.

Question 7: A 9-month-old child of a diabetic mother presents with tachypnea and hepatomegaly. Echocardiography shows normal cardiac morphology with asymmetric septal hypertrophy. Which of the following medications is indicated for the management of this child's condition?

A. Digoxin
B. Frusemide
C. Propranolol (Correct Answer)
D. Isoptin

Explanation: ***Propranolol*** - **Propranolol** is a **beta-blocker** that is indicated for **hypertrophic cardiomyopathy** (HCM) in infants, especially those of diabetic mothers. - It works by reducing the **heart rate** and **myocardial contractility**, which decreases the **left ventricular outflow tract (LVOT) obstruction** caused by the hypertrophied septum. *Digoxin* - **Digoxin** is a **positive inotrope**, meaning it increases the force of myocardial contraction. - This effect would worsen the **outflow tract obstruction** in hypertrophic cardiomyopathy and is therefore contraindicated. *Frusemide* - **Frusemide** is a **diuretic** used to manage **fluid overload** and **congestive heart failure**. - While fluid management can be part of heart failure treatment, frusemide does not directly address the underlying **asymmetric septal hypertrophy** or **LVOT obstruction** in this context. *Isoptin* - **Isoptin** (verapamil) is a **non-dihydropyridine calcium channel blocker**. - While some calcium channel blockers can be used in adult hypertrophic cardiomyopathy, verapamil is generally avoided in infants with HCM due to its potential for **negative inotropic effects** and worsening hypotension, especially in the presence of outflow obstruction, and the risk of significant **bradycardia** and **atrioventricular block**.

Question 8: The 9-month-old child of a diabetic mother presents with tachypnea and hepatomegaly. Echocardiography of the heart showed normal cardiac morphology with asymmetric septal hypertrophy. Which of the following would you give to treat this child?

A. Isoptin
B. Propranolol (Correct Answer)
C. Furosemide
D. Digoxin

Explanation: ***Propranolol*** - **Propranolol**, a non-selective beta-blocker, is the first-line treatment for **hypertrophic cardiomyopathy (HCM)** in infants of diabetic mothers, as it reduces dynamic outflow obstruction and improves left ventricular filling. - Beta-blockers decrease heart rate and contractility, thereby reducing the severity of outflow tract obstruction caused by **asymmetric septal hypertrophy**. *Isoptin* - **Isoptin (verapamil)** is a calcium channel blocker that can worsen outflow tract obstruction in HCM by reducing afterload, leading to increased pressure gradients. - While it can be used in some forms of HCM in older children or adults, it is generally contraindicated in infants due to the risk of severe hypotension and myocardial depression. *Furosemide* - **Furosemide** is a loop diuretic that reduces preload by promoting fluid excretion, which can worsen outflow tract obstruction in HCM by decreasing ventricular volume. - It is used for fluid overload, but in HCM, reducing preload can exacerbate symptoms and is generally not recommended as a primary treatment. *Digoxin* - **Digoxin** is a cardiac glycoside that increases myocardial contractility, which would worsen the outflow tract obstruction in HCM by increasing the force of ventricular contraction. - It is generally contraindicated in HCM for this reason, as it can exacerbate symptoms and dynamic obstruction.

Question 9: Kawasaki disease is associated with all of the following clinical features except

A. Thrombocytopenia (Correct Answer)
B. Pericarditis
C. Posterior cervical lymphadenopathy
D. Truncal rash

Explanation: ***Thrombocytopenia*** - While **thrombocytosis** (elevated platelet count) is a characteristic feature of Kawasaki disease, especially in the subacute phase, **thrombocytopenia** (low platelet count) is not typically observed and would make the diagnosis less likely. - Initial presentation may show normal or slightly elevated platelet counts, but a significant drop is not a hallmark. *Pericarditis* - **Pericarditis** is a recognized cardiac manifestation of Kawasaki disease, occurring due to the systemic inflammatory response. - Other cardiac complications include myocarditis, valvulitis, and coronary artery aneurysms. *Posterior cervical lymphadenopathy* - **Cervical lymphadenopathy** is a common diagnostic criterion for Kawasaki disease, typically involving a single lymph node greater than 1.5 cm in diameter. - This lymphadenopathy is often **unilateral** and commonly affects the anterior cervical chain, but can occur in posterior regions as well. *Truncal rash* - Kawasaki disease often presents with a **polymorphous rash**, which can be macular, papular, or scarlatiniform, and commonly affects the **trunk** and extremities. - Other mucocutaneous manifestations include bilateral conjunctival injection, oral changes (strawberry tongue, red cracked lips), and extremity changes (redness and swelling of hands/feet).

Question 10: Which of the following are neonatal complications of maternal diabetes during pregnancy? I. Hyperbilirubinemia II. Hypocalcemia III. Cardiomyopathy IV. Hypoglycemia Select the correct answer using the code given below :

A. I, II and III
B. I, II and IV (Correct Answer)
C. II, III and IV
D. I, III and IV

Explanation: ***I, II and IV*** - This correctly identifies the three **most common and clinically significant neonatal complications** of maternal diabetes: **hyperbilirubinemia**, **hypocalcemia**, and **hypoglycemia**. - **Hypoglycemia** is the **most frequent complication** (25-50% of infants), occurring due to fetal hyperinsulinemia that persists after birth when maternal glucose supply is cut off. - **Hypocalcemia** occurs in 20-50% of cases due to impaired parathyroid hormone response, hypomagnesemia, and altered calcium-phosphorus metabolism. - **Hyperbilirubinemia** results from polycythemia (due to chronic intrauterine hypoxia), increased RBC breakdown, and impaired hepatic conjugation. *I, II and III* - While this includes **hyperbilirubinemia**, **hypocalcemia**, and **cardiomyopathy**, it inappropriately excludes **hypoglycemia**, which is the **most common and most critical** neonatal complication requiring immediate monitoring and management. - Omitting hypoglycemia makes this option medically incorrect as a primary answer. *II, III and IV* - This option excludes **hyperbilirubinemia**, which is a very common finding (occurs in up to 25% of infants of diabetic mothers) due to increased erythropoiesis and RBC destruction. - Fetal hyperinsulinemia drives increased oxygen consumption, leading to relative hypoxia and compensatory polycythemia. *I, III and IV* - This option misses **hypocalcemia**, which is one of the **classic metabolic complications** seen in 20-50% of infants of diabetic mothers. - Hypocalcemia typically presents in the first 24-72 hours of life and is exacerbated by concurrent **magnesium deficiency**, which impairs PTH secretion and action. **Note:** All four listed complications (I, II, III, and IV) are recognized complications of maternal diabetes. Hypertrophic cardiomyopathy occurs in 10-20% of cases but is generally less common than the metabolic triad of hypoglycemia, hypocalcemia, and hyperbilirubinemia, which require routine screening in all infants of diabetic mothers.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free