Cardiology

Question 1

elective abdominal aortic aneurysm repair

day 4 post-op, she develops a net-like rash over her torso with fevers, myalgias and discolouration of her toes.

Raised eosinophils

Answer 1

cholesterol emboli which presents after a precipitating event such as angiography or abdominal aortic aneurysm repair. Clinical features include livedo reticularis, eosinophilia, purpura, and renal failure.

Question 2

Viral Causes of Myocarditis

Answer 2

Viral Causes of Myocarditis:
Parvovirus B19
Human herpes virus 6
Coxsackie B virus
Adenovirus
Hepatitis C
Cytomegalovirus
Echovirus
Influenza virus
Epstein-Barr virus

Question 3

most common form of cardiomyopathy, accounting for 90% of cases

Answer 3

DCM

idiopathic: the most common cause
myocarditis: e.g. Coxsackie B, HIV, diphtheria, Chagas disease
ischaemic heart disease
peripartum
hypertension
iatrogenic: e.g. doxorubicin
substance abuse: e.g. alcohol, cocaine
inherited: either a familial genetic predisposition to DCM or a specific syndrome e.g. Duchenne muscular dystrophy
Infiltrative - haemachromatosis/sarcoidosis

Question 4

DCM pathphys?

Findings? Murmur? CXR appearance?

Answer 4

Pathophysiology
dilated heart leading to predominately systolic dysfunction
all 4 chambers are dilated, but the left ventricle more so than right ventricle
eccentric hypertrophy (sarcomeres added in series) is seen

Features
classic findings of heart failure
systolic murmur: stretching of the valves may result in mitral and tricuspid regurgitation
S3
‘balloon’ appearance of the heart on the chest x-ray