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Cardio > Cardiomyopathies > Flashcards

Cardiomyopathies Flashcards

1
Q

What is a cardiomyopathy?

A

Any disease of cardiac muscle; leads to changes in size of heart chambers and heart thickness

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2
Q

What are the classifications of cardiomyopathy?

A

Dilated
Restrictive
Hypertrophic

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3
Q

What are some of the causes of dilated cardiomyopathy?

A

genetics
alcohol - common in alcoholics
chemotherapy agents - doxorubicin

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4
Q

Clinical features of dilated cardiomyopathy?

A 
General picture of heart failure;
dyspnoea
pulmonary oedema
fatigue
RVF
emboli
AF 
VT
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5
Q

What are some of the signs of dilated cardiomyopathy?

A

raised pulse and JVP
decreased BP
low ejection fraction (low CO)
displaced apex

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6
Q

What is the effect of a hypertrophic heart on contraction?

A

strong contraction

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7
Q

Hypertrophic myopathy causes dysfunction of systole or diastole?

A

diastole (not systolic since contraction fine)

diastolic dysfunction - heart cannot relax

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8
Q

what are some of the genes involved in hypertrophic cardiomyopathy?

A

sarcomere-related genes:
beta-myosin heavy chain
myosin binding protein C

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9
Q

What would you see on biopsy of hypertrophic cardiomyopathy?

A

disorganised swirls of myofibrils

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10
Q

What is the type of inheritance of hypertrophic obstructive cardiomyopathy?

A

autosomal dominant

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11
Q

What might an ECG of hypertrophic cardiomyopathy show?

A 
LVH
progressive T wave inversion
deep Q waves (inferior & lateral leads)
AF
WPW syndrome
ventricular ectopics
VT
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12
Q

What would an ECHO show of hypertrophic cardiomyopathy?

A

asymmetrical septal hypertrophy

small LV cavity with hyper-contractile posterior wall

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13
Q

What medication would you give for symptomatic benefit of hypertrophic cardiomyopathy?

A

b-blocker or verapamil - aim is to reduce ventricular contractility

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14
Q

Which anti-arrhythmic drug might a person with a hypertrophic cardiomyopathy need, and why?

A

diastolic dysfunction - so heart can’t relax…therefore need something to either slow HR or increase time between APs…
Type 3 are rhythm control of atria or ventricles
So, give amiodarone to increase AP duration and effective refractory period

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15
Q

What would you have to consider when giving amiodarone as an anti-arryhthmic?

A

age of patient - amiodarone has adverse effects when used in the long run

if used along with a beta-blocker or verapamil then there is increased risk of bradycardia

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16
Q

Why would you give a person with hypertrophic cardiomyopathy an anti-coagulant?

A

for paroxysmal AF or systemic emboli

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17
Q

What are main features of restrictive cardiomyopathy?

A 
lack of compliance
stiff heart
diastolic dysfunction (doesn't fill well)
can look normal
bi-atrial dilatation
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18
Q

What causes atrial dilatation in restrictive cardiomyopathy?

A

back pressure from stiff ventricles

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19
Q

What are the main causes of restrictive cardiomyopathy?

A 
deposition of something in the myocardium:
amyloidosis
sarcoidosis
haemochromatosis
tumours
fibrosis
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20
Q

How would a restrictive cardiomyopathy present?

A 
feature of RVF
raised JVP
hepatomegaly
oedema
ascites
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21
Q

What is the sign for amyloidosis on biopsy?

A

stains positive for ‘congo red’
waxy pink material
exhibits apple green bienfringence

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22
Q

What would an ECG of restrictive cardiomyopathy look like?

A

low voltage conduction abnormalities, e.g. AV block or SA node dysfunction

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23
Q

Which cardiomyopathy involves largely the replacement of the right ventricle with fatty material?

A

Arrythmogenic Right Ventricular dysplasia

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24
Q

What does penetrance of genetic disease mean?

A

penetrance describes the proportion of individuals with a disease-causing mutation who exhibit clinical symptoms

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25
Q

Why is arrhythmogenic right ventricular dysplasia difficult to diagnose?

A

the RV normally looks quite fatty
range of non-specific symptoms (syncope & palpitations during exercise)
sudden death can be first time it presents

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26
Q

What is myocarditis?

A

inflammation of the myocardium

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27
Q

What are the common viral causes of myocarditis?

A 
Coxsackie A and B
HIV
Enterovirus
Hepatitis
Mumps
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28
Q

Which autoimmune conditions are associated with myocarditis?

A

SLE
scleroderma
sarcoid
heart transplant rejection

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29
Q

What would the myocardium look like in infectious myocarditis?

A

thickened and ‘beefy’

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30
Q

Which type of hypersensitivity reaction is non-infectious myocarditis?

A

type IV

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31
Q

Hypersensitivity to drugs causes which type of myocarditis?

A

eosinophilic myocarditis

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32
Q

Hypersensitivity to infection causes ?

A

rheumatic fever after strep sore throat

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33
Q

Which gram positive group of organisms causes the classical sore throat?

A

streptococcus - Group A Strep

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34
Q

What changes occur to the heart in rheumatic fever?

A

patchy inflammation of myocardium
short, thick chordae tendinae
mitral stenosis with thickening & fusion of valve leaflets

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35
Q

What does SLE stand for?

A

Systemic Lupus Erythematous

36
Q

Which valves does SLE involve?

A

mitral or tricuspid

37
Q

What are aschoff bodies?

A

nodules found in the heart in rheumatic fever;

contain fibrinoid collagen necrosis and abnormal macrophages

38
Q

What is pericarditis?

A

inflammation of pericardial layers

39
Q

Characteristic symptoms of pericarditis?

A

central chest pain

relieved sitting forwards

40
Q

What would you typically see on ECG of pericarditis?

A

saddle-shaped ST elevation (V5&6)

41
Q

What are the causes of pericarditis?

A 
DR IS TRUMP
Dressler's syndrome
Radiotherapy
Infection
SLE
TB
Rheumatic fever (immune mediated)
Uraemic (renal failure)
Malignancy
Post-MI (24-48hrs)
42
Q

Which type of infections cause a purulent pericardial effusion?

A

bacterial (TB) and fungi

43
Q

ECHO virus would produce what type of pericardial effusion?

A

serous

44
Q

What causes Dressler’s syndrome?

A

Assumed to be immune mediated; myocardial injury stimulus formation of autoantibodies against heart muscle

45
Q

What are symptoms of Dressler’s syndrome?

A

Recurrent fever & chest pain
± pleural or pericardial rub
cardiac tamponade may occur

46
Q

What is endocarditis?

A

inflammation of heart lining but generally refers to inflammation of heart valves

47
Q

What are the risk factors of infectious endocarditis?

A 
rheumatic heart disease
prosthetic / bicuspid valves
congenital defects
calcific disease
IV drug abuse
septicaemia
48
Q

What is the basic pathogenesis of endocarditis?

A

Damages heart valve causes turbulent blood flow over roughened endothelium.
Platelets and fibrin deposited (thrombi), upon which bacteria settle and form a vegetation.

49
Q

Which side of the heart is usually affected in infective endocarditis?

A

left side

50
Q

Which heart valve is most likely infected in PWIDs?

A

tricuspid

51
Q

Which organism will most likely infect a prosthetic valve?

A

staph epidermis

52
Q

Which organism is most likely to cause infective endocarditis in PWIDs?

A

staph aureus

candida

53
Q

Which organisms make up HACEK?

A 
Haemophilus 
Aggregatibacter
Cardiobacterium
Eikenella
Kingella
54
Q

What gram stain are HACEK?

A

gram negative

55
Q

Which antibiotics would you give for native valve endocarditis?

A

amoxicillin IV

gentamicin IV

56
Q

Which antibiotic would you give for drug user endocarditis?

A

flucloxacillin IV

57
Q

Which antibiotics would you give if you suspected MRSA?

A

vancomycin IV
rifampicin PO
gentamicin IV

58
Q

Which antibiotics would you give for prosthetic valve infection?

A

vancomycin IV
rifampicin PO
gentamicin IV

59
Q

What is the commonest coagulase -ve Staph organism?

A

staph epidermis

60
Q

How long are antibiotics given for?

A

4-6 weeks

61
Q

Which organism is most likely to cause native valve endocarditis?

A

staph aureus

62
Q

What are Janeway lesions?

A

non-tender, small haemorrhage nodal lesions on palms or soles of feet

63
Q

What are Roth spots?

A

retinal haemorrhages with white/pale centres

64
Q

What are Osler’s nodes?

A

painful, raised red lesions on hands and feet

65
Q

What are signs on ECHO of endocardial involvement?

A

vegetation, abscess or new valvular regurgitation

66
Q

What does staph epidermis usually contaminate?

A

skin

prosthetic material

67
Q

Which organism is 2nd most common cause of native valve endocarditis?

A

strep viridians

68
Q

What is NBTE?

A

Non-bacterial Thrombotic Endocarditis

non-infectious endocarditis

69
Q

What are the risk factors for NBTE?

A

embolic disease

hyper-coagulable states

70
Q

What predisposes you to hyper-coagulable states?

A 
MI
oral contraceptive pill
post-surgery 
malignancy
pregnancy
SLE
71
Q

What is the cause for Libman-Sacks endocarditis?

A

lupus

72
Q

Which valve does SLE endocarditis affect?

A

mitral particularly

73
Q

What is a carcinoid tumour?

A

neoplasms of neuroendocrine cells

74
Q

What is carcinoid syndrome?

A

when a carcinoid tumour has spread to the liver

75
Q

What does a neuroendocrine tumour produce in excess?

A

hormones

76
Q

Which hormones do a carcinoid tumour produce?

A

histamine
serotonin
bradykinin

77
Q

What is the effect of bradykinin on the vasculature?

A

inflammatory mediator - blood vessels dilate

78
Q

Which anti-hypertensive drugs increase bradykinin effect?

A

ACE inhibitors block bradykinin degradation

79
Q

What is the effect of serotonin on the vasculature?

A

vasoconstriction

80
Q

What is the effect of histamine on the vasculature?

A

vasoconstriction -> bronchoconstriction

81
Q

Why are primary tumours of the heart rare?

A

cardiac muscle cells are end-differentiated

82
Q

What is the commonest tumour of the heart? Which chamber is it found?

A

atrial myxoma

left atrium

83
Q

What are some of the complications of an atrial myxoma?

A

valve obstruction: tumour emboli and endocarditis

84
Q

Which diseases might an atrial myxoma mimic?

A

infective endocarditis

mitral stenosis

85
Q

What are some of the overlapping signs & symptoms of atrial myxoma and infective endocarditis?

A

clubbing
fever
weight loss
systemic emboli

86
Q

What are some of the overlapping signs & symptoms of atrial myxoma and mitral stenosis?

A

left atrial obstruction

AF

Cardio (15 decks)

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