Cardiomyopathy and myocarditis Flashcards

1
Q

What is dilated cardiomyopathy?

A
  • dilation of the ventricles and thinner ventricular walls, hence affecting ventricular function
  • strength of muscle contraction will be weaker
  • can be primary/end result of any pathological insult to the myocardium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of dilated myopathy

A
  • Genetic and familial: SCN5A gene, muscular dystrophy
  • inflammatory: viruses, autoimmune, postpartum
  • toxic; drugs, exogenous chemicals, alcohol, endocrine
  • Injury, cell loss, scar replacement
  • Ischaemia/valvular causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Irreversible/reversible causes of dilated cardiomyopathy

A

-alcohol
-endocrine
-tropical disease
-post partum
-haemaochrmatosis ( ion storage disease)
sarcoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms of dilated cardiomyopathy

A

Slow onset

  • dyspnoea
  • fatigue
  • orthopneoa
  • PND
  • ankle oedema
  • weight gain of fluid overload
  • cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PMX of dilated cardiomyopathy

A
  • systemic illness
  • travel
  • vascular disease
  • thyroid, neuromuuscular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Examination of cardiomyopathy (findings)

A

-poor superficial perfusion
-thready pulse
0irregular in AF
-sob at rest
-narrow pulse pressure
-high JVP
-may have TR waves?
-displaced apex
-S3, S4
-MR murmur
=pumnary oedema, PE, ankle oedema, sacral odema, acites, hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Investigation of dilated cardiomyopathy

A
  • ECG
  • CXR
  • N termial prp BNP?
  • Bloods ( FBC, U+E)
  • ECHO
  • CMRI
  • Coronary angiogram
  • Biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Treatment -Non specific

A

Correct:

  • anaemia
  • exacerbating drugs ( NSAIDS)
  • endocrine disturbance
  • reduce fluid/salt intake
  • manage weight
  • reduce alcohol intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment - Specific

A
  • ACEI
  • ATII blockers
  • diuretics
  • beta blockers
  • spironlactone
  • anticoagulants
  • cardiac transplant
  • SCD risk assestment with ICD/CRT-DP implant ( pacing systems)?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is restrictive and infiltrative cardiomyopathy?

A
  • when ventricle has reduced compliance so cannot fill well.

- stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Causes of restrictive and infiltrative cardiomyopathy

A

-Non infiltrative: familial, forms of HCM, scleroderma, diabetic, pseudoxanthoma elasticum

Infiltrative; amyloid, sarcoid

Storage disease; haemachromatosis, fabry disease

Endomyocardial; fibrosis, carcinoid, radiation, drug effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Evalutation of restrictive and infiltrative cardiomyopathy

A
  • ECG
  • CXR
  • N termial prp BNP?
  • Bloods ( FBC, U+E ; look out for sarcoid + haemachromatosis)
  • autoantivoies for sclerotic CT diseases
  • amyloid requires non cardiac biopsy to establish diagnosis
  • fabry; low plasma alpha galactosidase A activity
  • ECHO
  • CMRI
  • Coronary angiogram
  • Biopsy (more helpful but high false negative rate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment - Specific for restrictive infiltrative cardiomyopathy

A
  • limited diuretics as low filling pressures cause problems
  • beta blockers limited
  • anticoagulants
  • cardiac transplant
  • SCD risk assestment with ICD/CRT-D/P implant ( pacing systems)?
  • if Fe overload, specific forms of amyloid of fabrys then specific treatment are available
  • endomyocardial fibrosis has little specific
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Prognosis of restrictive and infiltrative cardiomyopathy

A

-if irreversivle poor prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is hypetrophic cardiomyopathy

A

-part of heart becomes thickened idiopathic. This results in heart being less able to pump properly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of hypertrophic cardiomyopathy

A

Genetics

-sacromere gene defect which is autosomal dominant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the pathology of Hypertrophy cardiommyopathy

A
  • myocyte hypertrophy and disarray
  • segmental wall thickness >14mm or >12mm in primary relative
  • can be apical, septal or generalised
  • impaired relaxation so behaves in a restrictive manner
  • if septal hypertrophy this can with mitral valve defect lead to LVOT obstruction
  • CA also affected with small vessel narrowing and consequent ischaemia and fibrosis, arrythmias are common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Symptoms of hypertrophic cardiomyopathy

A
  • asymptomatic
  • fatigue
  • dyspnoea
  • angina
  • chest pain (exertional)
  • syncope related to arrhythmias
19
Q

Examination of hypertrophic cardiomyopathy

A
  • none
  • notched pulse pattern
  • irregular pulse if in AF or ectopy
  • double impulse over apex, thrills and murmurs, often dynamic, LVOT murmur will will increase with valsalve and decrease with squatting
  • JVP can be raised in very restrictive filling
20
Q

Symptoms of hypertrophic cardiomyopathy

A
  • breathlessness
  • palpitations
  • syncope
  • exertional symptoms
  • SCD
  • asymptomatic
  • fatigue, anginal chest pain, exertional pre syncope
21
Q

Examination findings of hypertrophic cardiomyopathy

A
  • none
  • notched pulse pattern/irregular
  • double impulse over apex, thrills, murmurs, dynamic, LVOT murmur will increase with valsalve and decrease with squatting
  • JVP can be raised in a restrictive filling
22
Q

Investigation of hypertrophic cardiomyopathy

A
  • ECG ( abnormal but few normal where phenotype is poorly expressed in genotype +ve individuals)
  • Echo
  • CMRI
  • risk for SCD, may need ICD
23
Q

Non specific treatment for hypertrophic cardiomyopathy

A
  • avoid heavy excercise/dehydration
  • consider genetic testing
  • regular FU to re appraise risks and progress
24
Q

Specific treatmet for hypertrophic caridomyopathy

A
  • drugs to try and enhance relaxation
  • beta blockers, verapamil, disopyrimide
  • if AF anricoagulate
  • surgical/alcohol septal ablation
  • ICD if required based on risk stratification
25
Q

What is myocarditis

A
  • inflammation of myocardium

- acute/chronic. Impaired myocardial function, conduction and generates arrythmia

26
Q

Causes of myocarditis

A
  • can eventually take on dilated cardiomyopathy appearance

- viral

27
Q

Describe the pathology of myocarditis

A

-infiltration of inflammatory cells into myoscardial layers, reduced function and HF, heart block as confuction system is involed and arrhythmias

28
Q

Symptoms of myocarditis

A
  • HF
  • fatigue
  • SOB
  • CP? ( 26%)
29
Q

Investigation of myocarditis

A
  • ECG ( abnormal)
  • biomarkers elevated
  • ECHO
  • CMRI ( oedema)
  • biopsy ( low threshold?)
  • viral DNA PCR
  • auto antibodies
  • step antibodies
  • Lyme B burgoderferi
  • HIV
30
Q

Treatment of myocarditis

A
  • immmunotherapt if biopsy or others indicated diagnosis

- stop drugs / toxic agent exposure

31
Q

What is pericardial disease/pericarditis

A
  • reflected lining over epicardium and parietal

- inflammation of pericardial layers with/without myocardial involvement

32
Q

Causes of pericardial disease/pericarditis

A
  • idiopathic
  • viral
  • bacterial, post MI, perforation, dissection of proximal aorta
  • neoplasia
33
Q

Symptoms of pericardial disease

A
  • chest pain with pleuritic features
  • postual fetures?
  • sitting forward improves it, vise versa
  • fever

-pericardial rub LSE, raise JVP if effusion present, low BP, muffled HS,

34
Q

Investigations of pericarditis

A
  • ECG ( ST elevation and PR depression)
  • ECHO
  • high troponin if myocardial involvement
35
Q

Treatment of pericarditis

A
  • viral conservative
  • idiopathic = colchicine + limited use of NSAIDS
  • bacterial must be drained even if small effusion and antimicrobrials
  • if large effusion, haemodynamic effects then drain
36
Q

What is a pericardial effusion?

A
  • where tamponade is present?

- build up of fluid in pericardial space

37
Q

Symptoms of PE

A
  • fatigue
  • SOB
  • dizziness
  • low BP
  • chest pain
  • pulsus paradoxus
  • JVP high
  • low BP
  • may/may not jhave pericardial rub /muffled HS
  • pulmonary oedema (rare in pericardial effusion/tamponade)
38
Q

Investigations of pericardial effusion

A
  • ECHO ( cardiac shadow)
  • CXR ( cardiac shadow)
  • drainage
  • send for MCS, neoplasic cells, protein and LDH ( most are exudates)
39
Q

What is constrictive pericarditis

A
  • thickening, fibrosis of pericardium which limits heart ability to function
  • myocardium unaffected
40
Q

Causes of contrictive pericarditis

A
  • idiopathic
  • radiation
  • post surgery
  • autoimmine
  • renal failure
  • sarcoid
41
Q

Pathology of constrictive pericarditis

A

-impaired filling although myocardium is normal

42
Q

Symptoms of constrictive pericarditis

A
  • SOB
  • cough
  • fatigue

-RHF (oedema), ascites, high JVP, jaundice, hepatomegaly, AF, TR, pleural effusion, perickardal knock

43
Q

Investigation + treatment of constrictive pericarditis

A

-ECHO
-right heart catherter
( to differentiate from restrictive cardiomyopathy)

-limited diuretic and pericardectomy