Cardiomyopathy and Pericardial Disease Flashcards
what is the aetiology of dilated cardiomyopathy?
> genetic and familial (SCN5A gene)
inflammatory (infection and autoimmune)
toxic (drugs and exogenous chemicals)
injury (cell loss and scar replacement)
what is dilated cardiomyopathy?
when some or all of the chambers of the heart are dilated and functionally impaired.
what are the symptoms of cardiomyopathy?
progressive: dyspnoea, ankle swelling, fatigue, orthopnoea (breathlessness preventing patient lying down), weight gain, cough.
what would you find on examination of a patient with dilated myopathy?
> poor superficial perfusion > thread pulse > short of breath at rest > JVP elevated > displaced apex > s3 and s4 > oedema (pulmonary, ankle and sacral)
what might there be in the PMH of someone with dilated cardiomyopathy?
> systemic illness > travel > hypertension > vascular disease > thyroid > neuromuscular disease
what is the basic evaluation for cardiomyopathy?
> ECG > CXR > basic bloods > echo > CMRI > coronary angiogram
what are the general measurements in treatment of cardiomyopathy?
> correct underlying cause
remove exacerbating drugs
reduce fluid and salt intake
management of weight
give some more specific measures in treatment of dilated cardiomyopathy
> diuretics > beta blockers > spironolactone > anti-coagulants (as required) > cardiac transplant
describe the pathology of restrictive and infiltrative cardiomyopathy
there is an inability to fill a ventricle whose wall has reduced compliance as the relaxation of the ventricular wall is an active process that needs functioning myocytes.
what is the basic evaluation of restrictive and infiltrated cardiomyopathy?
> ECG > CXR > basic bloods > U and E's > ECHO > CMRI > amyloids > biopsy (may have false negative)
what are the general measures for restrictive and infiltrative cardiomyopathy?
> beta-blockers
anti-coagulants as required
cardiac transplants
what causes hypertrophic cardiomyopathy?
a sarcomere gene defect that is autosomal dominant but it has variable expression and incomplete penetrance.
describe the pathology of hypertrophic cardiomyopathy
> myocyte hypertrophy and disarray
there is general or segmental wall thickness
it can be apical, septal or generalised
coronary arteries can narrow leading to ischaemia
what can septal hypertrophy lead to?
mitral valve defect
what are the symptoms of hypertrophic cardiomyopathy?
> asymptomatic > fatigue > dyspnoea > angina like chest pain > exertional syncope > LVOT obstruction
what may you find on examination of someone with hypertrophic cardiomyopathy?
> notched pulse pattern
irregular pulse if atrial fibrillation
double impulse over the apex
JVP can be raised in very restrictive filling
what assessments would you perform on someone with a suspected hypertrophic cardiomyopathy?
> ECG
echo
CMRI
what are the general measures for hypertrophic cardiomyopathy?
> avoid heavy exercise, dehydration
consider genetic testing
explore FH
what specific measures are there for hypertrophic cardiomyopathy?
> drugs enhancing relaxation
anti-coagulate if in atrial fibrillation
surgical/alcohol ablation is obstructive
implantable cardioverter defibrillator
what is myocarditis?
acute or chronic inflammation of the myocardium
what problems can myocarditis lead to?
> impaired function
impaired conduction
generation of arrhythmias
describe the pathology of myocarditis
there is infiltration of inflammatory cells into the myocardial layers, this causes reduced function and heart failure. heart block and arrhythmias can occur.
what are the symptoms of myocarditis?
> fatigue
shortness of breath
signs of heart failure
describe what assessments you would carry out on a patient with suspected myocarditis
> ECG > biomarkers (elevated but pattern not consistent with MI) > ECHO > CMRI > biopsy > PCR (shows viral DNA)
