Cardiomyopathy, Myocarditis and Pericarditis Flashcards

1
Q

What are the different types of cardiomyopathies?

A

Dilated cardiomyopathy
Restrictive and infiltrative cardiomyopathy
Hypertrophic cardiomyopathy

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2
Q

What is a dilated cardiomyopathy, and what are some causes?

A

Impairment of ventricular function due to enlarged heart

Excluding ischaemic and valvular causes, causes include:

  • genetic and familial (SCN5A gene, muscular dystrophy)
  • inflammatory, infectious, autoimmune, post-partum
  • toxic, drugs, exogenous chemicals, endocrine
  • injury, cell loss, scar replacement
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3
Q

What are the symptoms of a dilated cardiomyopathy?

A
Progressive, slow onset
SOB/Orthopnoea/PND
Fatigue
Ankle swelling
Weight gain of fluid overload
Thyroid issues
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4
Q

What may be in someone’s history/PMH if they have a dilated cardiomyopathy?

A
Systemic illness
Travel
Hypertension
Vascular disease
Thyroid problems
Neuromuscular disease

Alcohol use
Occupation related?

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5
Q

What may you found on examination of someone with a dilated cardiomyopathy?

A
Poor superficial perfusion
Thready pulse, irregular if AF
SOB at rest
Narrow pulse pressure
Elevated JVP
Displaced apex
S3 and S4
MR murmur
Pulmonary Oedema
Pleural effusions
Ankle/sacral oedema
Ascites
Hepatomegaly
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6
Q

What investigations might you do in suspected dilated cardiomyopathy?

A
Repeated ECG noting LBBB
CXR
N terminal pro BNP
Bloods, U+E
Echo
Cardiac MRI
Coronary angiogram
Biopsy?
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7
Q

What is the treatment in a dilated cardiomyopathy?

A
Correct anaemia
Remove exacerbating drugs e.g. NSAIDs
Correct endocrine disturbance
Alter salt/fluid intake
Weight management

Usual heart therapies

  • ACEi/ARB
  • diuretics
  • spironolactone
  • beta blockers
  • anticoagulants
  • SCD risk assessment with ICD or CDT-D/P
  • heart transplant

Often cause is not reversible

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8
Q

What is a restrictive/infiltrative cardiomyopathy?

A

A ventricle with reduced wall compliance, resulting in inability to fill well.

50% are related to specific clinical disorders, rest remain unknown

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9
Q

What are some non-infiltrative and infiltrative causes of restrictive cardiomyopathies?

A

Non-infiltrative

  • Familial
  • Forms of hypertrophic cardiomyopathy
  • Scleroderma
  • Diabetic
  • Pseudoxanthoma elasticum

Infiltrative causes

  • amyloid
  • sarcoidosis

Storage diseases
Endomyocardial causes - (fibrosis, carcinoid, radiation, drug effects)

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10
Q

What investigations might be done in suspected restrictive cardiomyopathy?

A

Repeated ECG noting LBBB
CXR
N terminal pro BNP
Bloods, U+Es (sarcoidosis and haemochromatosis)
Auto antibodies for sclerotic CT diseases)
Amyloid needs non-cardiac biopsy
Fabry - low plasma alpha galactosidase A activity
Echo
Cardiac MRI
Biopsy

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11
Q

What treatments might be given in suspected restrictive cardiomyopathy?

A
Correct anaemia
Remove exacerbating drugs e.g. NSAIDs
Correct endocrine disturbance
Alter salt/fluid intake
Weight management

Usual heart therapies

  • spironolactone
  • beta blockers
  • anticoagulants
  • SCD risk assessment with ICD or CDT-D/P
  • heart transplant

Limited ACEi/diuretic use as low filling pressures will cause problems

If iron overload, specific forms of amyloid, or Fabrys then specific treatments are available.
Endomyocardial fibrosis has little specific treatment

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12
Q

What happens hypertrophic cardiomyopathy?

A

Impaired relaxation
Systolic function usually adequate with functional abnormality

Relatively high prevalence (1:500)
Genetic

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13
Q

What is the pathology of hypertrophic cardiomyopathy?

A

Myocyte hypertrophy and disarray
Can be apical, septal, or generalised
Impaired relaxation so behaves in a restrictive manner

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14
Q

Symptoms of a hypertrophic cardiomyopathy?

A
Asymptomatic for many
Fatigue
SOB
Angina
Palpitations
Exertional pre-syncope
Syncope related to arrhythmias or LVOT
SCD
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15
Q

What might you find on physical examination of someone with a hypertrophic cardiomyopathy?

A

Can be no findings
Notched pulse pattern
Irregular pulse if AF or ectopy
Double impulse over apex
Thrill and murmurs
LVOT murmur will increase with valsalva and decrease with squatting
JVP can be raised in very restrictive filling

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16
Q

What investigations might be done in suspected hypertrophic cardiomyopathy?

A
ECG often abnormal
Echo
Cardiac MRI
Risk stratification for SCD, may need ICD
Holter monitoring
ETT
FH?
17
Q

What treatment/advice would be given in hypertrophic cardiomyopathy?

A

Avoid heavy exercise
Avoid dehydration
Explore FH and 1st degree relatives with ECG and Echos

Drugs to enhance relaxation

  • beta blockers
  • if AF, anticoagulants
  • obstructive form? surgery/ablation
  • ICD
18
Q

What is myocarditis?

A

Inflammation of the myocardium

19
Q

What is the pathology of myocarditis?

A

Commonly viral
Infiltration of inflammatory cells into the myocardial layers
Reduced function and heart failure
Heart block as conduction system is involved
Arrhythmias possible

20
Q

What are the symptoms of myocarditis?

A

Heart failure with fatigue

SOB

21
Q

What investigations might be done in suspected myocarditis?

A
ECG (usually abnormal)
BIomarkers often elevated but not consistent with MI
Echo - regional wall motion abnormalities
Cardiac MRI - oedema
Low threshold for biopsy
Viral DNA PCR
Auto antibodies
Strep antibodies
Lyme B burgdorgeri
HIV
22
Q

What is the treatment for myocarditis?

A

Supportive with treatment for heart failure and arrhythmia treatment
Immunotherapy if biopsy or other test points to specific diagnosis
Stop possible drug causes, or toxin exposure

23
Q

What is pericarditis?

A

Inflammation of the pericardial layers with or without myocardial involvement

24
Q

What can cause pericarditis?

A

Majority are viral or idiopathic

Key ones to pickup are bacterial, post MI, perforation, dissection of proximal aorta, neoplasia

25
Q

What are the symptoms of pericarditis?

A

Usually 1-2 week duration
Chest pain with pleuritic and postural features
Sitting forward usually improves, lying down makes it worse
Fever

26
Q

What might you find on physical examination in pericarditis?

A

High temperature
Pericardial rub
Elevated JVP if effusion present
Low BP
Muffled heart sounds + elevated JVP? Consider effusion
High fever and very unwell despite no effusion may suggest bacterial cause

27
Q

What investigations might you do in suspected pericarditis?

A

ECG
Echo
Troponin may be raised if myocardial involvement present

28
Q

What is the treatment for pericarditis?

A

Idiopathic? Colchicine and limited NSAID

Bacterial? must be drained even if small effusion, and antimicrobials, poor prognosis

If large effusion present then drain

Viral? conservative

29
Q

What might be some symptoms of a pericardial effusion?

A

Fatigue
SOB
Dizzy with low BP
Occasional chest pain

30
Q

What are some signs of pericardial effusion?

A
Pulsus paradoxus
Elevated JVP
Low BP
Rub or muffled heart sounds
Pulmonary oedema very rare
31
Q

What tests are done for pericardial effusion?

A

Urgent Echo
CXR can show large cardiac shadow
Drainage is treatment
Send for MCS, neoplastic cells, protein and LDH, most are exudates
Persistent effusion needs a surgical pericardial window made to allow flow to abdomen

32
Q

What can cause constrictive pericarditis?

A
Rare
Idiopathic
Radiation
Post-surgery
Autoimmune
Renal failure
Sarcoidosis

Pathology is impaired filling also myocardium normal most of the time

33
Q

What are the symptoms of constrictive pericarditis?

A

Fatigue
SOB
Cough

34
Q

What are signs of constrictive pericarditis?

A
RHF
Oedema
Ascites
Elevated JVP
Jaundice
Hepatomegaly
AF, TR
Pleural effusion
Pericardial knock
35
Q

What tests are done in suspected constrictive pericarditis?

A

Assess with Echo with right heart catheter to differentiate from restrictive cardiomyopathy which can be difficuly

36
Q

What is the treatment in constrictive pericarditis?

A

Careful and limited diuretics

Pericardectomy?