cardiomyopathies and myocarditis + endocarditis Flashcards
50% AD
disordered LV hypertrophy (not parallel like LVH in chronic HTN)
hypertrophied IV septum too close to anterior mitral valve leaflet → outflow obstruction (blood can’t get out of ventricle) → ↓ SOB + syncope
hypertrophic cardiomyopathy
ENLARGED + DIFFUSE apical impulse (normal: nickel-sized)
S4 heart sound (thick/non-compliant LV - can’t fill ventricle)
systolic murmur (subaortic stenosis - obstructed proximal to valve - LOUDER valsalva - vs aortic stenosis)
hypertrophic cardiomyopathy
systolic murmur LOUDER with valsava (usually makes murmurs quieter) + SOFTER with squatting
hypertrophic cardiomyopathy
↑ intrathoracic pressure →↓ preload (filling of heart) → IV septum is closer to lateral wall of ventricle → worsening of LV outflow tract obstruction
squatting →↑ afterload (more blood in LV) → IV septum moves away from lateral wall → less obstruction
most common cause of death among young healthy athletes in US
hypertrophic cardiomyopathy
exercise: volume depleted →↓ preload → outflow obstruction → die
treatment of hypertrophic cardiomyopathy
slow heart → prolong diastole →↑ filling of heart + ↓ O2 demand ß blocker non-dihydropyridine CCB: verapamil restrict physical exertion avoid volume depletion
deposition in myocardium thickens myocardium → disrupts diastolic function
S4 heart sound
restrictive cardiomyopathy
due to mycoidies → eosinophilia
loffler eosinophilic pneumonitis
causes of restrictive cardiomyopathy
LEASH - to restrict a dog
Loffler syndrome: fibrosis of endocaridum + EOSINOPHILS infiltrate
Endocardial fibroelastosis: thick fibroelastic tissue in endocardium of young children
Amyloidosis
Sarcoidosis: granulomas
Hemochromatosis: iron in myocardium (more commonly causes DILATED CM)
–radiation for lung/breast cancer: causes fibrosis in myocardium
most common type of cardiomyopathy (90%)
dilated cardiomyopathy
causes of dilated cardiomyopathy
CHF from chronic myocardial ischemia
hemochromatosis (most commonly dilated, can be restrictive too)
chemo drugs: doxorubicin, daunorubicin
chronic cocaine and alcohol use (alcohol alone is toxic to myocardium)
wet beriberi (caused by thiamine deficiency due to chronic alcoholism)
chagas disease (protozoa: trypanosoma cruzi)
coxsackie B virus (myocarditis → dilated DM)
adding myocytes/sarcomeres in series (not parallel) → dilated → systolic dysfunction (unable to contract)
dilated cardiomyopathy
S4 heart sound suggests
stiffened LV:
hypertrophic cardiomyopathy
restrictive cardiomyopathy
S3 heart sound suggests
systolic dysfunction of ventricle
LATERAL apical impulse (not at mid-clavicular line)
S3 heart sound
dilated cardiomyopathy
beriberi is caused by
ber1ber1: thiamine B1 deficiency
chronic alcohol use → thiamine deficiency (vitamin B1)
dry: causes wernicki-korsakaff syndrome
wet: dilated CM + congestive heart failure → peripheral edema (wet)
dilated CM
megacolon
megaesophagus
chagas disease: protozoa trypanosoma cruzi
generalized inflammation of myocardium (not due to ischemia)
myocarditis
most common cause of myocarditis in US
Coxsackie B virus
other viruses can cause it too
diffuse interstitial infiltrate of lymphocytes with myocyte necrosis (inflammation causes necrosis)
myocarditis
inflammation of endocardium:
involves VALVES, may involve septum, chordae tendinae
vegetations (mass of platelets + fibrin) on valve leaflets → fibrosis or calcification of vegetations
infective (bacterial) endocarditis
sterile (noninfective) endocarditis:
inflammation of endocardium (not infection)
libman-sacks endocarditis: caused by SLE (SLE causes LSE - BOTH sides of valve)
marantic endocarditis: vegetations due to
metastatic cancer cells or platelet-fibrin aggregates due to
hypercoaguable state
FEVER (most common), chills, weakness, anorexia
NEW REGURGITATION heart murmur or heart failure: MITRAL valve most common (L sided endocarditis), TRICUSPID most common in IVDU → septic pulmonary infarcts (chest pain, SOB, tachycardia)
signs of bacterial emobli from vegetations of L heart:
splinter hemorrhage in fingernails
Osler nodes: PAINFUL red nodules on finger + toe pads
Janeway lesions: PAINLESS erythematous macules on palms + soles
Roth spots (Rare): Retinal hemorrhage with clear central white areas
brain infarct → focal neuro deficits (stroke)
renal infarct → hematuria
splenic infarct → ab or referred shoulder pain
systemic immune reaction: glomerulonephritis, arthritis
infective endocarditis
Retinal hemorrhage with clear central white areas
Roth spots (Rare):
PAINLESS erythematous macules on palms + soles
Janeway lesions
PAINFUL red nodules on finger + toe pads
Osler nodes
diagnosis of infective endocarditis
multiple blood cultures BEFORE starting antibiotics
echocardiogram(TEE): vegetations on valves
organisms that cause infective endocarditis
s. aureus: 30% of endocarditis cases
viridans streptococci (strep mutans): 20-30%
enterococci: 10%
s. epidermidis (coagulase neg staph): 5-10%
ACUTE endocarditis: sick quickly in DAYS
large vegetations on previously NORMAL valves
s. aureus endocarditis
SUBACUTE endocarditis: gradual onset (WKS-MO)
smaller vegetations on valves that were already ABNORMAL (bicuspid aortic valve, prosthetic, hx of damage from rheumatic heart disease)
DENTAL procedures if gingival manipulation (give prophylactic ab if abnormal valves)
viridans streptococci endocarditis
some strains are developing resistance to VANCOMYCIN (VRE)
enterococcus endocarditis
IVDU (bacteria on skin)
staph epidermidis endocarditis
types of endocarditis in IVDU
most common overall: s. aureus and viridans strep
s. epidermidis
pseudomonas
fungal (candida)
endocarditis associated with colon cancer
strep bovis endocarditis
if blood culture is + for strep bovis
need to get colonoscopy to screen for colon cancer
signs + symptoms of infective endocarditis
echo: + for vegetations
blood culture: -
culture-negative endocarditis
causes of culture-negative endocarditis
all INTRACELLULAR bacteria: coxiella burnetti (causes Q fever) bartonella spp (incl. henslae - Cat scratch fever) brucella spp. (unpastuerized milk) HACEK: Haemophilus Actinobacillus Cordiobacterium Eikenella Kingella
complications of infective endocarditis
embolic complications: stroke, renal infarct, splenic infarct
glomerulonephritis
damage to infected valve → valve regurgitation or stenosis
ruptured chordae tendineae (connect papillary muscles to mitral + tricuspid)→ acute onset of mitral or tricuspid regurg
suppurative pericarditis: infection now outside heart
vegetations on both sides of valve
Libman-Sacks endocarditis (due to SLE)
preferred empiric treatment of infective endocarditis
empiric IV vancomycin pending culture results (vanco covers staph (incl. MRSA) + strep) → once culture back, switch to ab susceptible to organism
