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2. Cardiovascular System > 31. Cardiomyopathy, Myocarditis and Pericarditis > Flashcards

31. Cardiomyopathy, Myocarditis and Pericarditis Flashcards

1
Q

Define cardiomyopathy.

A
  • Group of diseases affecting the heart muscle

- heart muscle becomes enlarged, thick and rigid

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2
Q

What are 3 types of cardiomyopathy?

A
  1. dilated cardiomyopathy
  2. hypertrophic cardiomyopathy
  3. restrictive cardiomyopathy
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3
Q

What is dilated cardiomyopathy?

A
  • characterised by ventricular dilation and ventricular function is impaired
  • symptoms and signs of ventricular failure
  • term used to describe dilated and poorly functional left ventricle where aetiology is uncertain/ idiopathic (which excludes ventricular dysfunction secondary to ischaemic or valvular heart disease or hypertension)
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4
Q

Is dilated cardiomyopathy a primary problem?

A

Can be; or is the end result of any pathological condition of the myocardium

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5
Q

What is the aetiology of dilated cardiomyopathy? (6)

A
  1. genetic and familial, muscular dystrophy
  2. Inflammatory: infectious, autoimmune, postpartum, tropical disease
  3. Toxic: drugs, exogenous chemical, endocrine, alcohol
  4. Injury: cell loss, scar replacement
  5. haemaochromatosis (too much iron absorbed)
  6. sarcoid (red and swollen granulomas appear on skin)
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6
Q

What gene is responsible for genetic/familial dilated cardiomyopathy?

A

SCN5A gene; can be linked to autosomal dominant, recessive, x linked and mitochondrial genes

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7
Q

What chambers are dilated in dilated cardiomyopathy?

A

Usually l. ventricle but most often all chambers dilated and functionally impaired

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8
Q

Is thrombosis common in dilated cardiomyopathy?

A

Can be present

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9
Q

Is dilated cardiomyopathy reversible?

A
  • Some cases can be reversible or partly reversible

- most are progressive and irreversible

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10
Q

What is the incidence of dilated cardiomyopathy?

A

5-8/100,000

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11
Q

What are the symptoms of dilated cardiomyopathy? (7)

A
  1. progressive, slow onset dyspnoea
  2. fatigue, tiredness, lethargy (lack of energy)
  3. orthopnoea (dyspnoea at rest or when lying down)
  4. post natal depression
  5. ankle swelling/ oedema
  6. weight gain of fluid overload
  7. cough
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12
Q

What past medical history may indicate higher likeliness of dilated cardiomyopathy? (6)

A
  1. systemic illness
  2. travelling
  3. hypertension
  4. vascular disease
  5. thyroid disease
  6. neuromuscular disease
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13
Q

What parts of social history should be considered when diagnosing dilated cardiomyopathy? (2)

A
  1. alcohol intake

2. occupation

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14
Q

What is found on examination in a patient with dilated cardiomyopathy? (14)

A
  1. poor superficial perfusion
  2. thready pulse
  3. atrial fibrillation (irregular pulse)
  4. shortness of breath at rest
  5. narrow pulse pressure
  6. JVP elevated +/- TR waves
  7. displaced apex beat
  8. S3 and S4 and mitral regurgitation murmur heard often
  9. pulmonary oedema
  10. pleural effusions
  11. ankle oedema
  12. sacral oedema
  13. acites (accumulation of fluid in abdominal cavity)
  14. hepatomegally
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15
Q

What investigations are done for dilated cardiomyopathy? (12)

A
  1. repeated ECG
  2. chest x ray
  3. N termial pro Brain natriuretic peptide
  4. Full blood count: U+E (urea and electrolytes)
  5. echocardiogram
  6. CMRI (cardiac magnetic resonance imaging)
  7. coronary angiogram
  8. sometimes myocardial biopsy depending on time course of cardiomyopathy
  9. cardiac catherisation (x ray of heart taken)
  10. exercise testing (O2 consumption by resp. gas analysis)
  11. L.ventricular angiography
  12. coronary arteriography (excludes ischaemic heart disease as diagnosis)
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16
Q

What are general treatment measures for dilated cardiomyopathy?

A
  1. correct anaemia
  2. remove exacerbating drugs (e.g. NSAIDs)
  3. correct any endocrine disturbance
  4. advise on fluid and salt intake (to reduce it)
  5. advise on managing weight to identify fluid overload
  6. heart failure (nurse referral)
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17
Q

What are more specific treatment measures for dilated cardiomyopathy? (8)

A
  1. ACEI, ATII blockers, diuretics
  2. Beta blockers (e.g. metoprolol, bisoprolol, carvedilol)
  3. Spironolactone (K sparing diuretic, prevents excess salt absorption)
  4. anticoagulants as required
  5. SCD (sudden cardiac death) risk assessment with ICD or CRT-D/P implant (cardiac resynchronisation therapy device/pacemaker)
  6. cardiac transplant (especially for young patients)
  7. digoxin and amiodarone
  8. long acting nitrates
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18
Q

What is the treatment and management of dilated cardiomyopathy largely based on?

A

based on treatment of heart failure

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19
Q

What is the general prognosis for dilated cardiomyopathy?

6

A
  • generally poor
  • often influenced by other causes of cardiomyopathy due to;
    1. peripartum (weakness of heart muscle in last month of gestation to 5 months after delivery)
    2. idiopathic
    3. due to ischaemic heart disease
    4. due to doxorubicin therapy (chemotherapy drug)
    5. due to infiltrative myocardial disease
    6. due to HIV infection
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20
Q

What is restrictive and infiltrative cardiomyopathy?

A
  • less common (most uncommon cardiomyopathy)
  • physiology of filling and myocyte relaxation capacity (heart isn’t able to relax)
  • systolic function may or may not be impaired
  • presentation almost identical to constrictive pericarditis except constrictive pericarditis can successfully be treated by surgery whereas management of restrictive cardiomyopathy is largely supportive
  • diastolic dysfunction with restricted ventricular relaxation
  • systolic function and contraction usually well maintained until late when ventricular dilatation and dysfunction occurs
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21
Q

What is restrictive and infiltrative cardiomyopathy related to?

A
  • 50% related to specific clinical disorder

- rest remains unknown (idiopathic)

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22
Q

What is the aetiology of restrictive and infiltrative cardiomyopathy?

A
  1. non-infiltrative disease (non-accumulation)
  2. infiltrative disease (accumulation)
  3. storage disease
  4. endomyocardial diseases
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23
Q

What non-infiltrative disease lead to restrictive cardiomyopathy? (5)

A
  1. familial
  2. forms of HCM (hypertrophic cardiomyopathy)
  3. scleroderma (hardening connective tissue)
  4. diabetic
  5. pseudoxanthoma elasicum
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24
Q

What infiltrative disease lead to restrictive cardiomyopathy? (2)

A
  1. amyloid

2. sarcoid

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25
Q

What storage disease can lead to restrictive cardiomyopathy? (2)

A
  1. haemachromatosis (excess iron taken up by body)

2. Fabry disease (dysfunctional metabolism pf certain lipids)

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26
Q

What endomyocardial disease can lead to restrictive cardiomyopathy? (4)

A
  1. fibrosis
  2. carcinoid
  3. radiation
  4. drug effects
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27
Q

What is the pathology of restrictive cardiomyopathy?

A
  • the inability to fill well a ventricle whose wall has reduced compliance
  • relaxation of ventricle wall is an active process that needs functioning intact myocytes since it isn’t passive (myocytes need to coordinate)
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28
Q

What are the clinical signs and symptoms of restrictive cardiomyopathy? (8)

A
  1. dyspnoea
  2. exercise intolerance
  3. signs of r. ventricle dysfunction
  4. raised JVP
  5. peripheral oedema
  6. hepatomegaly
  7. ascites (fluid in abdominal/ peritoneal cavity)
  8. pulmonary oedema seen in late disease stage
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29
Q

What basic investigations need to be done to diagnose restrictive cardiomyopathy? (11)

A
  1. repeated ECG (noting LBBB and other conduction defects)
  2. chest x ray
  3. N termial pro Brain Natriuretic Peptide
  4. full blood count: urea + electrolytes (look out for sarcoid and haemachromatosis)
  5. auto antibodies for sclerotic CT diseases
  6. amyloid needs non-cardiac biopsy
  7. fabry: low plasma alpha galactosidase A activity
  8. echocardiogram
  9. Cardiac MRI (CMRI)
  10. myocardial biopsy
  11. cardiac catherisation
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30
Q

What are the general and specific treatment measures for restrictive cardiomyopathy? (7)

A
  1. limited diuretic use (as filling pressures will cause problems)
  2. Beta blockers
  3. ACEIs
  4. anticoagulants
  5. Sudden cardiac death risk assessment with ICD or CRT/P (cardiac resynchronisation therapy/pacemaker) implant
  6. cardiac transplant
  7. treatment for fluid retention and arrhythmias
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31
Q

In which 2 conditions can iron overload occur which can happen in restrictive cardiomyopathy?

A
  1. amyloid
  2. Fabry’s
    (specific treatment available but endomyocardial fibrosis has little treatment available)
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32
Q

What is the prognosis for restrictive cardiomyopathy?

A

Unless reversible, then poor prognosis

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33
Q

What is hypertrophic cardiomyopathy?

A
  • characterised by unexplained, usually patchy hypertrophy of the l.ventricular and sometime r. ventricular myocardium
  • variable degree of fibrosis in myocardium
  • myocardial cell disarray and disruption of of myofibrillar components within hypertrophied myocytes
  • impaired relaxation and systolic function is usually adequate with some functional abnormality
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34
Q

Can hypertrophic cardiomyopathy be a primary cause?

A

Yes; can occur without secondary causes of ventricular hypertrophy such as aortic stenosis or systemic hypertension

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35
Q

Which portion of the heart is does hypertrophic cardiomyopathy usually localise in?

A

In the upper section of the intrerventricular septum and anterior free wall of the l.ventricle

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36
Q

What is the prevalence of hypertrophic cardiomyopathy?

A

Relatively high at 1:500

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37
Q

How many genes associated with hypertrophic cardiomyopathy?

A

1500 genes identified

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38
Q

What sort of gene mutation is hypertrophic cardiomyopathy?

A
  • sarcomere gene defect
  • autosomal dominant
  • variable expression and incomplete penetrance (50% chance of inheriting gene but how it’s expressed is unknown until time passes)
  • family history exists due to spontaneous mutations
39
Q

What sarcomere proteins have been isolated that are associate with hypertrophic cardiomyopathy? (2)

A
  1. Beta-cardiac myosin heavy chain on chromosome 14

2. cardiac troponin T gene on chromosome 1

40
Q

What is the pathology of hypertrophic cardiomyopathy?

A
  • myocyte hypertrophy and disarray (disorganisation)
  • can be apical, septal or generalised
  • impaired relaxation so behaves in restrictive manner
41
Q

If there is a septal defect in hypertrophic cardiomyopathy along with a mitral valve defect, what can this lead to?

A

can lead to LVOT (left ventricle outflow tract) obstruction

42
Q

What is the generalised or segmental wall thickness in a primary relative in hypertrophic cardiomyopathy?

A

wall thickness >14mm or >12mm

43
Q

What structures are often affected by hypertrophic cardiomyopathy and what does this cause? (4)

A

Coronary arteries often affected leading to:

  • small vessel narrowing
  • ischaemia
  • fibrosis
  • arrhythmias
44
Q

What are the clinical symptoms for hypertrophic cardiomyopathy? (10)

A
  1. asymptomatic for many
  2. fatigue
  3. dyspnoea
  4. anginal like chest pain
  5. exertional pre syncope (exertional symptoms)
  6. syncope related to arrhythmias
  7. left ventricular outflow tract obstruction
  8. palpitation
  9. dizziness
  10. sudden cardiac death
45
Q

What are the clinical signs on examination found in hypertrophic cardiomyopathy? (9)

A
  1. can be none!
  2. notched pulse pattern
    - 3.irregular pulse if in atrial fibrillation or ectopy
  3. double pulse over apex
  4. thrills and murmurs (often dynamic)
  5. l. ventricular outflow tract obstruction murmur will increase with valsalve and decrease with squatting
  6. JVP can be raised in very restrictive filling
  7. ejection systolic murmur at left sternal edge heard
  8. “jerky”/ rapidly rising pulse
46
Q

What investigations need to be done for hypertrophic cardiomyopathy? (7)

A
  1. ECG (often abnormal but few are normal where phenotype is poorly expressed in genotype positive patients)
  2. Echocardiogram (transthoracic and transoesophageal)
  3. Cardiac MRI (CMRI
  4. risk assessment for sudden cardiac death, may need ICD (implantable cardioverter- defibrillator that detects life threatening rapid heartbeat)
  5. Holter monitor (records heart rhythm continuously; ambulatory ECG)
  6. Doppler ultrasound
  7. cardiac catherisation (angiography)
47
Q

What are general management measures forhypertrophic cardiomyopathy? (5)

A

1, avoid heavy exercise

  1. avoid dehydration
  2. explore family history (ECGs and Echos may be required)
  3. consider genetic testing
  4. regular follow ups to re-apraise risks and progress
48
Q

What are specific management measures for hypertrophic cardiomyopathy? (5)

A
  1. drugs to try and enhance relaxation
  2. if in atrial fibrillation, then anticoagulate
  3. obstructive form: surgical or alcohol septal ablation (scarring/ destroying small areas of heart causing arrhythmias)
  4. implantable cardioverter-defibrillator based on risk (implantable defibrillator as prophylaxis)
  5. dual chamber cardiac pacing
49
Q

What drugs are used for hypertrophic cardiomyopathy? (3)

A
  • beta blockers
  • Ca channel blockers e.g. Verapamil
  • Disopyrimide (Na channel blocker)
50
Q

What is (acute) myocarditis?

A
  • acute or chronic inflammation of the myocardium (heart muscle)
  • can be associated with pericarditis
  • can impair myocardial function, conduction and generate arrhythmia
  • myocyte necrosis and inflammatory infiltration histologically present
51
Q

What is the aetiology of myocarditis?

A
  • most of the time it’s unknown (idiopathic)~50%

- there are many recognised infective (viral, bacterial, fungal, protozoal) and non-infective (drugs or toxins) causes

52
Q

What infective causes are there for myocarditis?

A
  • any infection (bacterial, fungal, viral, protozoal)
  • Coxsackie is the most common viral infection in Europe and US to cause myocarditis
  • Trypanosomiasis (Chagas’ disease) is the most common cause in S.America
  • can appear as a manifestation of HIV (either directly or as a result of opportunistic infection)
53
Q

What conditions can myocarditis eventually lead to? (2)

A
  • dilated cardiomyopathy

- chronic inflammation and heart failure

54
Q

What is the prevalence of myocarditis?

A

8-10/100,000

55
Q

What is the most common cause of infective myocarditis?

A

viral

56
Q

What is the pathology behind myocarditis?

A
  • infiltration of inflammatory cells into myocardial layers
  • reduced cardiac function and heart failure
  • heart blocks occurs as conduction system is involved and arrhythmias
57
Q

What are symptoms of myocarditis? (8)

A
  1. fatigue (heart failure)
  2. dyspnoea
  3. signs of heart failure (pulmonary oedema and sever haemodynamic compromise)
  4. fever may not be present
  5. chest pain
  6. pro-dromal flu like illness
  7. lethargy and tiredness
  8. palpitations ( due to AF or ventricular arrhythmias)
58
Q

What can be seen on ECG in myocarditis patients? (2)

A
  • concave upwards ST elevation

- troponin rise

59
Q

What are common non-infective causes of myocarditis? (2+)

A
  1. AUTOIMMUNE DISORDERS
    - rheumatoid arthirits
    - systemic lupus erythematosus
    - polymyositis
    - systemic sclerosis
    - thyrotoxicosis
    - sarcoidosis
    - diabetes mellitus
  2. HYPERSENSITIVITY REACTIONS
    - heavy metals
    - drugs
    - radiation
    - electricity
    - transplant rejection
60
Q

What drugs particularly can lead to myocarditis? (3)

A
  1. anthracyclines
  2. cyclophosphamide
  3. fluorouracil
61
Q

What investigations need to be done for myocarditis? (10)

A
  1. ECG (usually abnormal)
  2. Biomarkers (often elevated but no falling in pattern consistent with MI)
  3. Echo
  4. Cardiac MRI (CMRI); oedema can be seen
  5. low threshold for myocardial biopsy
  6. Viral DNA PCR
  7. Auto antibodies
  8. step antibodies
  9. lyme B burgdorferi
  10. HIV
62
Q

What are the general treatment measures for myocarditis?

A
  • largely supportive treatment
  • treatment of heart failure
  • support for brady and tachy arrhythmias
  • immunotherapy if biopsy (immunosuppressive agents)
  • stop possible drugs or toxic agent exposure
  • pericardial drainage (if temponade or pericardial effusion)
  • NSAIDs for pericardial pain
  • steroids
  • treat underlying cause
63
Q

What are possible outcomes for myocarditis? (3)

A
  • patient may recover fully (30%)
  • patient may get intractable heart failure
  • patient may die (20% for 1 year and 56% for 4 years)
64
Q

What is the pericardium?

A
  • membrane enclosing the heart consisting of outer fibrous layer (fibrous pericardium) and an inner double membrane of serous pericardium (visceral/epicardium and parietal serous pericardium)
  • lies above the epicardium (visceral serous membrane) and parietal pericardium (inner portion of exterior sac around the heart) and proximal great vessels
65
Q

What is pericarditis?

A
  • inflammation of the pericardial layers with or without myocardial involvement
66
Q

What is the cause of pericarditis?

A
  • may be idiopathic
  • may be secondary to other causes:
    1. viral infection (esp. Coxsackie, flu, Epstein-Barr, mumps, varicella, HIV usually rapid onset)
    2. Bacterial (pneumonia, rheumatic fever, TB, staph, streps)
    3. MI: Dressler’s syndrome(post- MI syndrome)
    4. Autoimmune disease (systemic lupus erythematosus, rheumatoid, systemic sclerosis)
    5. ureaemia
    6. neoplasia (abnormal growth of tissue)
    7. trauma/ surgery
    8. malignancy
    9. sarcoidosis
    10. radiotherapy
    11. Drugs
67
Q

Since the list of pericarditis causes is long, what are the main causes to remember? (5)

A
  1. bacterial
  2. post MI
  3. perforation
  4. dissection of proximal aorta
  5. neoplasia (and antineoplastic/anticancer drugs)
68
Q

What drugs are associated with aetiology for pericarditis? (5)

A
  1. procainamide (for cardiac arrhythmias)
  2. hydralazine (for high BP and heart failure)
  3. penicillin (antibiotic)
  4. cromolyn sodium (prevents inflammation)
  5. isoniazid (for TB)
69
Q

What are symptoms of pericarditis? (5)

A
  1. central chest pain with pleuritic features and postural features (sitting forward improves it and lying back/supine makes it worse), worse on inspiration and radiating to neck and shoulders
  2. fever
  3. left precordial pain (persistent, positiona, radiating to neck and shoulders)
  4. dyspnoea
  5. systemic inflammation symptoms: fever, malaise, arthralgia (joint pain)
70
Q

What are signs of pericarditis?

A
  1. fever
  2. pericardial friction rub at left sternal edge (one systolic and two diastolic sounds, extra heart sound)
  3. raised JVP (if effusion present)
  4. low BP
  5. muffled heart sounds
  6. malaise and lethargy
  7. signs of cardiac temponade (if pericardial effusion significantly elevates intrapericardial pressure);always look for pericardial effusion and temponade signs
71
Q

What to suspect in terms of pericarditis diagnosis if patient has high fever and very unwell despite no effusion?

A

bacterial cause for pericarditis

72
Q

What does pericardial rub sound like on auscultation when diagnosing pericarditis?

A
  • high pitched
  • scratching sound
  • intensity varies with patient position
  • often evanescent (fading away) heart sounds
73
Q

What investigations are needed for pericarditis diagnosis? (9)

A
  1. ECG
  2. Echo
  3. troponin levels tested (raised if myocardial involvement too)
  4. virology and autoimmune screening (may show underlying cause)
  5. full blood count: U+E, erythrocyte sedimentation rate (can indicate inflammatory activity in body)
  6. chest x ray ( cardiomegaly may indicate pericardial effusion or cardiac temponade)
  7. viral serology and blood cultures
  8. antistreptolysin- O titres (elevated in rheumatic fever and mycoplasma infection)
  9. thyroid function tests (to exclude hyperthyrodism and estimation for renal function)
74
Q

What is seen in ECG for pericarditis patients?

A
  • elevated convex upward elevation of ST segment for all leads
75
Q

What are general treatment measures for pericarditis?

A
  • treatment directed at underlying condition and control of symptoms
76
Q

What is the possible treatment for pericarditis? (4)

A
  1. Colchicine (decreases swelling) and NSAIDs (if relapse and continuing symptoms or if idiopathic)
  2. Analgesia e.g. ibuprofen 400mg/8h with food (if viral, conservative treatment)
  3. Drain pericardium and use antimicrobials (if bacterial or small or large effusion present)
  4. Steroid treatment (if pain not rapidly controlled but should be avoided unless directed at underlying connective tissue, may increase risk of recurrence)
77
Q

What causes a pericardial effusion?

A
  • response to any parietal pericardial inflammation
  • may be haemodynamically significantly; temponade or not
  • often has same causes as pericarditis
78
Q

What effect does pericardial effusion have on heart function?

A
  • as pericardial effusion enlarges, cardiac temponade is created (pressure on heart when fluid or blood builds up in pericardial space)
  • causes fall in diastolic filling, fall in stroke volume, fall in cardiac output
79
Q

What are symptoms of pericardial effusion? (4)

A

Clear and apparent:

  • fatigue
  • dyspnoea
  • dizzy with low BP
  • occasional chest pain
80
Q

What are signs of pericardial effusion? (7)

A
  1. pulsus paradoxus (on inspiration big drop in BP and pulse)
  2. JVP raised
  3. low BP
  4. pericardial rub ( additional heart sounds) muffled heart sounds
  5. pulmonary oedema (rare)
  6. bronchial breathing at left base
  7. signs of cardiac temponade (syncope, trouble breathing, discomfort in chest relieved by sitting forward, low BP, anxiety)
81
Q

What investigations are needed to diagnose pericardial effusion and temponade?

A
  1. echo (echo-free zone around heart)
  2. chest x ray ( cardiac shadow, enlarged globular heart)
  3. drainage
  4. send for MCS (multiple chemical sensitivity test); neoplasmic cells, protein and LDH (most are exudates)
  5. ECG (low voltage QRS complexes and alternating QRS morphologies)
  6. pericardiocentesis (tapping of pericardial fluid; used diagnostically to check for bacterial pericarditis)
82
Q

What is the treatment for pericardial effusion?

A
  1. pericardiocentesis ( tapping of pericardial fluid used therapeutically for cardiac temponade)
  2. Send pericardial fluid for culture, ZN Stain/ TB culture and cytology (cells checked)
  3. surgical approach (if recurrent effusions)
  4. pericardial drainage
83
Q

What is the difference between pericardial effusion and cardiac temponade?

A
  • Pericardial effusion is accumulation of fluid in the pericardial sac
  • Cardiac temponade is accumulation of pericardial fluid which raises intrapericardial pressure,hence poor ventricular filling and fall in cardiac output
84
Q

How much fluid is contained within a normal pericardiac sac?

A

15-30ml

85
Q

How much fluid can be accumulated in pericardial sac without haemodynamic features of a temponade if the effusion builds up GRADUALLY?

A

up to 2L

86
Q

What happens if as little as 250ml of fluid builds up in the pericardial sac rapidly?

A

It will have a bigger haemodynamic consequence and more complications that large volume of fluid which built up gradually

87
Q

What is constrictive pericarditis?

A
  • rare

- heart is encased in a rigid pericardium

88
Q

What is the aetiology of constrictive pericarditis? (6)

A 
- often uknown (idiopathic due to following an episode of unrecognised acute pericarditis) 
can be: 
- TB
-after pericarditis
- after radiation exposure
- post cardiac surgery 
- autoimmune disease (e.g. systemic sclerosis) 
 -renal failure 
- sarcoid  
-malignant disease
89
Q

What is the pathology of constrictive pericarditis? What does it cause?

A

-impaired filling although myocardium is normal most of the time

90
Q

What are symptoms of constrictive myocarditis? (5)

A
  1. fatigue
  2. dyspnoea
  3. cough
  4. abdominal discomfort (due to hepatic and gut enlargement)
  5. reduced exercise tolerance
91
Q

What are signs of constrictive myocarditis? (9)

A
  1. right heart failure with oedema
  2. ascites (accumulation of fluid in perioteneal/abdomen cavity)
  3. high JVP
  4. jaundice
  5. hepatomegaly
  6. atrial fibrillation
  7. tricuspid regurgitation
  8. pleural effusion
  9. pericardial knock (heart sound)
92
Q

What is the investigation to diagnose constrictive myocarditis? (4)

A
  1. echo (abnormal diastolic function. thickened pericardium)
  2. right heart cardiac catherisation (to differentiate from restrictive cardiomyopathy which is difficult; shows equilibrium of pressures in all 4 chambers)
  3. chest x ray/radiograph (increased heart size, pericardial calcification)
  4. CT/MRI (helps distinguish from other myopathies and shows cardiac function)
  5. ECG changes are not very specific ( AF, low voltage QRS and abnormal ST/T waves)
93
Q

What is the treatment for constrictive myocarditis? (2)

A
  1. careful and limited diuretics (pallative)

2. pericardectomy (surgical): removal of pericardium (part or most)

2. Cardiovascular System (42 decks)

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