Cardiomyopathy Flashcards
What is cardiomyopathy?
The heart muscle becomes thick, enlarged or rigid causing the heart to become weaker as the disease progresses
What is hypertrophic cardiomyopathy?
LV outflow obstruction from the asymmetric septal hypertrophy
- leading cause of sudden cardiac death in the young
Prevalence of hypertrophic cardiomyopathy
0.2% Autosomal dominant inheritance (50%) - 70% have mutations in genes encoding for beta-myosin, alpha-tropomysin and troponin -t Presents at any age Family history of sudden death
Signs and symptoms of hypertrophic cardiomyopathy
Sudden death Angina Dyspnoea Palpitations Syncope Heart failure Jerky pulse Alpha wave in JVP Double apex beat Systolic thrill at lower left sternal edge Harsh ejection systolic murmur
What investigations are required in ?hypertrophic cardiomyopathy
ECG
Echo
MRI
Cardiac catheterisation - assess severity of gradient, coronary artery disease or mitral regurgitation
What would you expect to see on ECG in hypertrophic cardiomyopathy
LVH Progressive T-wave inversion Deep waves - inferior and lateral leads AF Wolff-Parkinson-White syndrome Ventricular ectopies VT
What would you expect to see on echo in hypertrophic cardiomyopathy
Asymmetrical septal hypertrophy
Small LV cavity with hypercontractile posterior wall
Midsystole aortic valve closure
Systolic anterior movement of mitral valve
What is the pharmacological treatment for hypertrophic cardiomyopathy
Beta-blockers or verapamil - for symptoms (decreased ventricular contractility)
Amiodarone - arrhythmia
Anticoagulate any AF
What is the surgical treatment for hypertrophic cardiomyopathy
Septal myomectomy - decreases LV outflow tract gradient
Implantable defibrillator
What are the poor prognostic factors affecting mortality in hypertrophic cardiomyopathy
Age less than 14
Family history
Syncope at presentation
What is dilated cardiomyopathy
Dilated, flabby heart of an unknown cause
- thin walls, less muscle, weaker contractions
What are conditions are associated with developing dilated cardiomyopathy
Alcohol abuse Hypertension Chemotherapeutics - doxorubicin Haemochromatosis Thyrotoxicosis Duchenne's muscle dystrophy Congenital - X-linked
What are the signs and symptoms of dilated cardiomyopathy
Fatigue Dyspnoea Pulmonary oedema Right ventricular failure Emboli/AF Ventricular tachycardia Tachycardia Hypotension Increased JVP Displaced and diffuse apex Mitral regurgitation/Tricuspid regurgitation S3 gallop Pleural effusion Hepatosplenomeagly Oedema Jaundice Ascites
What investigations are required in ?dilated cardiomyopathy
Bloods - BNP (hyponatraemia poor prognostic factor) CXR - cardiomeagly and pulmonary oedema ECG Echo
What changes would you expect to see on ECG and echo in dilated cardiomyopathy
ECG - increased heart rate - non-specific T-wave changes - poor R-wave progression Echo - globally dilated hypokinetic heart - low ejection fraction - look for MR/TR - mural thrombus
