271.2 📚 國考版

271.2.0.1 必背 — Cardiomyopathy Classification

  • DCM (dilated, HFrEF)
  • HCM (hypertrophic — sarcomere mutations)
  • RCM (restrictive — amyloid + sarcoid + iron + Fabry)
  • ARVC (RV fibrofatty replacement, desmosome mutations)
  • Takotsubo (stress-induced, reversible)
  • Peripartum (pregnancy/postpartum)

271.2.0.2 必背 — DCM Etiologies

  • Idiopathic + familial/genetic (titin, lamin)
  • Inflammatory (viral myocarditis, autoimmune)
  • Toxic (alcohol, cocaine, anthracycline, ICI)
  • Tachycardia-induced
  • Peripartum

271.2.0.3 必背 — HCM

  • Asymmetric septal hypertrophy + LVOT obstruction (HOCM)
  • Sarcomere mutations (MYH7, MYBPC3, TNNT2)
  • 1 in 500 prevalence
  • Risk of SCD (especially during exertion)
  • Mavacamten (FDA 2022) for obstructive HCM
  • ICD for high-risk SCD features
  • Family screening (autosomal dominant)

271.2.0.4 必背 — RCM + Cardiac Amyloidosis

  • HFpEF phenotype
  • AL amyloidosis: plasma cell dyscrasia; daratumumab + CyBorD
  • ATTR amyloidosis: TTR misfolding; tafamidis (FDA 2019); patisiran (TTR silencer)
  • Sarcoidosis: corticosteroids + methotrexate
  • Fabry: enzyme replacement (agalsidase)
  • Hemochromatosis: phlebotomy
  • Apical sparing on strain + subendocardial LGE + PYP scan → amyloidosis

271.2.0.5 必背 — ARVC

  • RV fibrofatty replacement
  • Desmosome mutations (plakophilin-2, etc.)
  • VT with LBBB morphology
  • Epsilon wave on ECG
  • ICD + exercise restriction
  • Family screening

271.2.0.6 必背 — Takotsubo

  • Stress-induced; postmenopausal women
  • Apical ballooning + basal hyperkinesis
  • Normal coronary angiography
  • Resolves over weeks-months
  • Supportive treatment

271.2.0.7 必背 — Peripartum Cardiomyopathy

  • Pregnancy / postpartum (6 months)
  • Exclude other causes
  • 30-50% recover EF
  • Standard HFrEF therapy (avoid ACEi/ARB in pregnancy; OK post-partum)

271.2.0.8 必背 — Myocarditis Etiologies

  • Viral (Coxsackie B + adenovirus + parvovirus + COVID-19)
  • Bacterial (Lyme, Chagas, diphtheria)
  • Immune-mediated (SLE, sarcoid, eosinophilic, giant cell, ICI)
  • Drug-induced (ICI, anthracyclines, cocaine, clozapine)

271.2.0.9 必背 — Myocarditis Diagnosis

  • Cardiac MRI Lake Louise criteria (T1/T2 + LGE + edema)
  • Elevated troponin + BNP
  • Echo + ECG
  • Endomyocardial biopsy (rare)
  • Viral PCR / autoimmune workup as indicated

271.2.0.10 必背 — Specific Myocarditis Treatment

  • Giant cell myocarditis: cyclosporine + corticosteroids
  • Eosinophilic myocarditis: corticosteroids
  • Sarcoidosis: corticosteroids + methotrexate
  • ICI myocarditis: high-dose corticosteroids + stop ICI
  • Lyme: doxycycline / ceftriaxone
  • Chagas: standard HFrEF + benznidazole (early)

271.2.0.11 必背 — Mavacamten

  • Selective myosin inhibitor
  • FDA 2022 for symptomatic obstructive HCM
  • EXPLORER-HCM trial
  • Reduces LVOT obstruction + symptoms
  • Reduces need for septal reduction therapy

271.2.0.12 必背 — Cardiac Amyloidosis Workup

  1. Suspect (HFpEF + LVH + bilateral CTS + low voltage ECG + apical sparing)
  2. Free light chains + SPEP/UPEP
  3. Echo + CMR (subendocardial circumferential LGE + apical sparing strain)
  4. PYP scan for ATTR
  5. Biopsy for AL
  6. Subtype determination (ATTR vs AL) for treatment