Cardiomyopathies Flashcards
Myocarditis causes
50% idiopathic Infective Drugs (cyclophosphamide, penicillin, sulfonamides) Cocaine, alcohol, lead, arsenic Immunological
Myocarditis presentation
ACS-like symptoms
HF symptoms
Palpitations
Tachycardia
Soft S1, S4 gallop
Myocarditis tests
CRP, ESR + troponin may be raised
ECG shows ST changes, T wave inversion and conduction abnormalities
Echo shows diastolic dysfunction + regional abnormalities
Cardiac MR if stable
Endomyocardial biopsy is gold standard
Myocarditis management
Supportive
Treat underlying cause
Avoid exercise as can precipitate arrythmias
Myocarditis prognosis
50% recover within 4wks
12-25% develop DCM + severe HF, can be years after apparent recovery
What is DCM
Dilated cardiomyopathy, dilated flabby heart of unknown cause
DCM presentation
Fatigue Dyspnoea Pulmonary oedema RVF Emboli AF/VT
DCM signs
S3 gallop
Mitral/triscupid regurgitation
Hepatomegaly ± ascites
DCM investigations
BNP raised
Dec Na shows poorer prognosis
CXR shows cardiomegaly, pulmonary oedema
ECG shows tachy and non-specific T-wave changes
Echo shows globally dilated hypokinetic heart
DCM management
Bed rest
Diuretics
Beta-blockers
ACE-i
Anticoagulation
Biventricular pacing
ICDs + LVADs
Transplantation
DCM mortality
Variable, 40% in 2yrs
What is HCM
LV outflow tract obstruction from asymmetric septal hypertrophy
Leading cause of sudden cardiac death in young
HCM presentation
Sudden death
Angina
Dyspnoea
Syncope
HCM signs
Jerky pulse
a wave in JVP
Systolic thrill at lower left sternal edge
Harsh ejection systolic murmur
HCM investigations
ECG shows LVH, progressive T-wave inversions and deep Q-waves on inferior + lateral leads
Echo shows asymmetrical septal hypertrophy, small LV cavity
Cardiac catheterisation to assess severity of gradient
Exercise test ± Holter to test risk
HCM management
B-blockers/ verapamil for symptoms
Amiodarone for arrhythmias
Anticoagulate for paroxysmal AF
Septal myomectomy (surgical or using alcohol) for severe Implantable defib depending on risk of sudden cardiac death
HCM prognosis
- 9%/yr if <14
- 5% if >14
Syncope at presentation + family hx are poor prognostic factors
Restrictive cardiomyopathy causes
Idiopathic
HH
Sarcoidosis
Amyloidosis
Scleroderma
Restrictive cardiomyopathy presentation
Similar to constrictive pericarditis
RVF features predominate
Restrictive cardiomyopathy diagnosis
Echo
MRI
Cardiac catheterisation
Restrictive cardiomyopathy treatment
Treat cause
What is cardiac myxoma
Rare benign cardiac tumour
May mimic IE or mitral stenosis
Tumour plop may be heard
Cardiac myxoma tests
Echo
Shows pedunculated heterogeneous mass if in atrial wall
Cardiac myxoma management
Excision
