Cardiomyopathy, MYocarditis and Pericarditis Flashcards
what are the causes of dilated cardiomyopathy
genetic inflammatory toxic injury pregnancy
how is the function of the heart impaired in dilated cardiomyopathy
its a systolic dysfunction
decrease in ejection fraction
cant pump blood as efficiently
what is the general prognosis for dilated cardiomyopathy
most cases are progressive and irreversible
what are the clinical signs of dilated cardiomyopathy
poor superficial perfusion thready pulse SOB @ rest narrow pulse pressure oedema - ankle, pul, sacral
what is the best investigation to diagnose dilated cardiomyopathy
echo
can an ECG be used to detect dilated cardiomyopathy?
yes but findings will be unspecific, ECG will just show there is abnormality
what investigations besides ECG and echo could you carry out for dilated cardiomyopathy
CXR
BNP lvls-elevated in muscle stretching
cardiac MRI
basic bloods
what is the treatment for dilated cardiomyopathy
ACEI ARB diuretics anticoagulants ( if A-fib develops) lifestyle advice possible heart transplant
what function of the heart does restrictive cardiomyopathy affect
ventricles can’t relax properly therefore filling capacity is reducded
what are the causes of restrictive cardiomyopathy
non-infiltrative-familial
infiltrative- amyloid, sarcoid
storage disease- haemachromotosis
fibrosis- radiation, idiopathic
what percent of restrictive carrdiomyopathy cases are idiopathic
50%
what investigations would be done fro restrictive cardiomyopathy, what would they show
CXR- pulmonary congestion with normal heart size
ECG- will sow abnormality but this is non specific
echo-increased ventricular thickness possible biatrial enlargement
what specific tests could be done to look for known cases of restrictive cardiomyopathy
bloods to check for sarcoid or haemachromotosis
would a biopsy be useful in restrictive cardiomyopathy
yes- can detect amyloid
no- high false negative rate
what is the prognosis of restrictive cardiomyopathy
unless reversible diagnosis is poor as fibrosis has little specific treatment
what is the treatment for restrictive cardiomyopathy
diuretics (limited use) Beta blockers ACEI anticoagulants possible heart transplant
how does hypertrophic cardiomyopathy affect the function of the heart
causes impaired relaxation as heart muscle is thickened and this makes it harder to pump
what is the cause of hypertrophic cardiomyopathy
genetic- autosomal dominant transmission in genes coding for myofibrils
what are the symptoms of hypertrophic cardiomyopthy
often asymptomatic exertion SOB chest pain syncope fatigue family history of SCD
what are the clinical findings in hypertrophic cardiomyopathy
left ventricular outflow obstruction, this causes a steep rising jerky pulse
what investigations would you do for hypertrophic cardiomyopathy
ECG Echo-LV wall thickness CXR-can be normal CMRI Genetic test
how would you treat hypertrophic cardiomyopathy
drugs to enhance relaxation: beta blockers, verapamil(CCB) and disopyrimide(treats arrhythmias)
ICD if at risk
when would septal ablation be recommended in hypertrophic cardiomyopathy
if medication does not relieve symptoms
what is myocarditis
inflammation of theheart muscle
what is the consequence of myocarditis
can impair the function and conduction of the heart
what is the cause of myocarditis
infective organism: viral bacterial protozoal autoimmune
what are the symptoms of myocarditis
recent viral illness fatigue dyspnoea chest pain arrhythmias as a result of infla. resting tachycardia
what investigations could be done for myocarditis and what would they show
ECG-abnormal
CXR-cardiac enlarge, venous congestion
echo- wall motion abnormalities
viral DNA PCR
what is the treatment for myocarditis
supportive with treatment of HF and arrhythmias
Immunotherpay if biopsy or other Ix point to a specific diagnosis
what is the prognosis of myocarditis
30% recover
50% mortality @ 4yr
what is pericarditis
inflammation of the pericardial layers
who is most likely to get pericarditis in the UK
males aged 20-50
what are the main causes of pericarditis
viral
idiopathic
pathogenic infection
what are important causes of pericarditis to detect
bacterial post MI dissection of proximal aorta neoplasia perforation
what are the symptoms of pericarditis
chest pain that is worse lying down
fever
breathlessness (consider effusion)
pericardial rub
what investigations would you do for pericarditis
ECG- widespread ST changes
echo- can distinguish from MI
what is the treatment for pericarditis in most cases
NSAIDS to reduce inflammation
colchicine to reduce inflammation by killing certain cells
what is the treatment for bacterial pericarditis
drain effusion and give antimicrobials
what is constrictive pericarditis
thickening and fibrosis of the pericardium causing cardiac compression and impaired diastolic filling
what are the causes of constrictive pericarditis
radiation infective post surgical autoimmune renal failure
what are most cases of constrictive pericarditis in the uk caused by
they are idiopathic
what are the symptoms of constrictive pericarditis
fatigue
SOB
cough
what is the treatment for constrictive pericarditis
careful use of diuretics
treatment of any underlying condition
pericardectomy
