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Cardiovascular > Cardiomyopathy, Myocarditis and Pericarditis > Flashcards

Cardiomyopathy, Myocarditis and Pericarditis Flashcards

1
Q

Explain dilated cardiomyopathy

A

Is an effect of a structural and functional description
The ventricular function is impaired as weakened and enlarged
Can be primary or as a result to pathological insult to the myocardium

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2
Q

What are some causes of dilated cardiomyopathy?

A

Genetic and familial DCM - SCB5A gene or muscular dystrophy
Inflammatory, infection, autoimmune, postpartum
Toxic - drugs, chemicals and endocrine
Injury, cell loss or scar replacement

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3
Q

What chambers can be affected by DCM?

A

Can be one or more often all chamber dilated and functionally impaired
Thrombosis in chambers is not uncommon

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4
Q

What are treatable causes of DCM?

A

Alcohol, endocrine, tropical disease, post partum, hemochromatosis and sarcoid

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5
Q

What are the symptoms of dilated cardiomyopathy?

A

Progressive and slow onset
Dyspnoea, fatigue, orthopnoea, PND, ankle swelling, weight gain of fluid overload and cough

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6
Q

What signs of DCM can be seen on examination?

A

Poor superficial perfusion, low volume pulse, irregular pulse if AF, SOB at rest, narrow pulse pressure, JVP elevated, displaced apex, S3 and S4, MR murmur often, pulmonary oedema, pleural effusions and oedema

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7
Q

What is used to investigate DCM?

A

Repeated ECG noting LBBB if present
CXR, BNP, Basic bloods (FBC and U+E), Echo, CMRI (best), coronary angiogram and rarely biopsy

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8
Q

What are the general measures for treatment in DCM?

A

Correct anaemia, remove exacerbating drugs (NSAIDS), correct endocrine disturbance, advise fluid and salt intake, managing weight and HF nurse referral

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9
Q

What are some specific measures for treatment of DCM?

A

ACEi, ATII blockers, diuretics and Sac/Val
BB, spironolactone and anticoagulants as required
SCD risk assessment with ICD
Cardiac transplant

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10
Q

What is the prognosis of DCM?

A

Generally poor and often influenced by causes where known

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11
Q

What is restrictive and infiltrative cardiomyopathy?

A

Less common, describes the physiology of filling and myocyte relaxation capacity which is reduced
Systolic function may or may not be impaired
Half are related to specific clinical disorders

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12
Q

What are the causes for restrictive and infiltrative cardiomyopathy?

A

Non-infiltrative - familial, HCM, scleroderma, diabetic, pseudoxanthoma
Infiltrative - amyloid and sarcoid
Storage diseases - hemochromatosis and Fabry disease
Endomyocardial - fibrosis, carcinoid, radiation and drug effects

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13
Q

Describe pathology of restrictive and infiltrative cardiomyopathy?

A

Inability to fill the ventricle well as reduced compliance
Relaxation of ventricle wall is active process that needs functioning intact myocytes
Scar over healthy myocytes so wall thickened

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14
Q

What investigations are done in restrictive and infiltrative cardiomyopathy?

A

Repeated ECG, CXR, BNP, Basic bloods, Auto-antibodies, biopsy for amyloid, Echo, CMRI

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15
Q

What the measures for treatment for restrictive and infiltrative cardiomyopathy?

A

Limited diuretic use, BB limited and ACEi use
Anticoagulants as required
SVD risk assessment with ICD
Cardiac transplant

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16
Q

What is the prognosis for restrictive and infiltrative cardiomyopathy?

A

Unless reversible then poor prognosis

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17
Q

What is hypertrophic cardiomyopathy?

A

Disease of the heart where heart muscle becomes thickened
Impaired relaxation is a common feature and systolic function is usually adequate with some functional abnormality
Genetics are important

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18
Q

Describe hypertrophic cardiomyopathy and genes

A

Sarcomere gene defect and autosomal dominant but variable expression and incomplete penetrance

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19
Q

Describe the pathology of hypertrophic cardiomyopathy

A

Myocyte hypertrophy and disarray
Can be generalised or segmental wall thickness >14mm or 12mm in primary relative
Can be apical, septal or generalised
Impaired relaxation so behaves in restrictive manner
If septal hypertrophy then Mitral valve defect can lead to LVOT obstruction

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20
Q

Explain coronary artery and small vessel involvement with hypertrophic cardiomyopathy?

A

Coronary arteries also affected with small vessel narrowing and consequent ischaemia and fibrosis so arrhythmias are common

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21
Q

What are the symptoms of hypertrophic cardiomyopathy?

A

Asymptomatic for many
Fatigue, dyspnoea, anginal like chest pain, exertional pre syncope, syncope related to arrhythmias or LVOT obstruction

22
Q

What are some examinational findings of hypertrophic cardiomyopathy?

A

Can be none
Notched pulse pattern, irregular pulse is AF or ectopy, double impulse over apex, thrills and murmurs and JVP can be increased

23
Q

What is included in the assessment of hypertrophic cardiomyopathy?

A

ECG, Echo, CMRI and risk stratification for SCD and may need ICD

24
Q

What are general measures used to treat hypertrophic cardiomyopathy?

A

Avoid heavy exercise, avoid dehydration, explore FH and ECG may be required, consider genetic testing and regular FU

25
Q

What are specific measures used to treat hypertrophic cardiomyopathy?

A

Drugs to enhance relaxation, if symptomatic then BB, verapamil and disopyrimide
If in AF anticoagulation
Obstructive form then surgical or alcohol septal ablation
ICD possibly

26
Q

What is myocarditis?

A

Acute or chronic inflammation of the myocardium
Can be associated with pericarditis
Can impair myocardial function, conduction and generate arrhythmias

27
Q

What are some causes of myocarditis?

A

Viral - most common, bacterial, fungal, protozoal, toxins, hypersensitivity and autoimmune

28
Q

Describe the pathology of myocarditis

A

Infiltrate of inflammatory cells into myocardial layers with reduced function and HF
Heart block as conduction system is involved and arrhythmias

29
Q

What are the symptoms of myocarditis?

A

HF with fatigue, SOB and Chest pain
Shorter course of a few weeks
May not have a fever
Signs of HF

30
Q

What is involved in the assessment of myocarditis?

A

ECG, Biomarker elevation, Echo, CMRI, low threshold for biopsy, Viral DNA PCR, auto antibodies, step antibodies, Lyme disease and HIV

31
Q

What are the general measures for treating myocarditis?

A

Supportive with treatment of HF and support for brady and tachycardias
Immunotherapy possible
Stop possible drugs or toxic agent exposure

32
Q

What is the prognosis for myocarditis?

A

High mortality

33
Q

What is the parietal pericardium?

A

Inner portion of the exterior sac which is around the heart and proximal great vessels

34
Q

What is pericarditis?

A

Inflammation of the pericardial layers with or without myocardial involvement
Large amount of causes

35
Q

What are the main causes of pericarditis?

A

Mostly viral or idiopathic
Bacterial, post MI, Perforation, dissection of proximal aorta and neoplasia

36
Q

What are the symptoms of pericardial disease?

A

Duration is usually 1-2 weeks
Chest pain with pleuritic features and postural features
Sitting forward improves and lying back makes it worse
Fever

37
Q

What are the signs of pericardial disease?

A

Pericardial rub, Raised JVP if effusion, low BP, muffled HS, high fever

38
Q

What are the investigations for pericardial diseases?

A

ECG and echo
Troponin may be raised if myocardial involvement too

39
Q

What might ECG look like in pericardial disease?

A

Widespread ST changes and PR depression of pericarditis

40
Q

What are general measures of treatment for pericardial disease?

A

Viral is conservative
Idiopathic gets colchicine and limited use of NSAIDs
Bacterial must be drained even if small and antimicrobials
If large effusion then drain

41
Q

What are the symptoms of tamponade present in pericardial effusion?

A

Symptoms are overt, fatigue, SOB, dizzy with low BP and occasionally chest pain

42
Q

What are the signs of tamponade present in pericardial effusion?

A

Signs are overt, pulsus paradoxus, JVP raised, Low BP and possible plural rub and muffled HS. Pulmonary oedema is very rare

43
Q

What investigations are used for pericardial effusions?

A

Urgent Echo, and CXR to show large cardiac shadow

44
Q

What is the treatment for pericardial effusions?

A

Drainage is the destination treatment
Persistent effusion needs a surgical pericardial window made to allow flow to abdomen

45
Q

What does an ECG when patient has pericardial effusion?

A

In V5 the QRS complex varies from large to small

46
Q

What are the causes of constrictive pericarditis?

A

Idiopathic, radiation, post surgery, autoimmune, renal failure and sarcoid

47
Q

Describe the pathology of constrictive pericarditis

A

Impaired filling although myocardium is normal most of the time
Pericardium is restricting the filling

48
Q

What are the symptoms and signs of constrictive pericarditis?

A

Fatigue, SOB and cough
Signs are of right HF with oedema, ascites, high JVP, jaundice, hepatomegaly, AF, TR, pleural effusion and pericardial knock

49
Q

What investigations are used for constrictive pericarditis?

A

Assess with echo and right heart cath. to differentiate between restrictive cardiomyopathy which can be different

50
Q

What is the treatment of constrictive pericarditis?

A

Careful and limited diuretics and pericardiectomy

Cardiovascular (33 decks)

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