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Respiratory system 2017 > Cardiomyopathy, myocarditis and pericarditis > Flashcards

Cardiomyopathy, myocarditis and pericarditis Flashcards

1
Q

What is cardiomyopathy?

A

group of diseases of the myocardium which affects the mechanic or electrical function of the heart

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2
Q

What kinds of cardiomyopathy affect the mechanic function of the heart?

A 
Hypertrophic
Arrhythmogenic 
Right ventricular
Dilated
Restrictive
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3
Q

What kinds of cardiomyopathy affect the electrical function of the heart?

A

Conduction system disease

Ion channelopathies e.g. long QT

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4
Q

Describe dilated cardiomyopathy

A

Dilated left ventricle (poorly contracts)
All chambers can be dilated though
Can result from myocarditis

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5
Q

What can cause dilated cardiomyopathy?

A

Genetic and familial DCM: SCN5A, MD
Inflammatory/infectious
Toxic - alcohol
Injury/cell loss/scarring - sarcoidosis

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6
Q

What gene is responsible for familial dilated cardiomyopathy?

A

SCN5A - autosomal dominant inheritance

Muscular dystrophy can also cause it

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7
Q

What are the symptoms of DCM?

A 
Dyspnoea
Fatigue
Orthopnoea
PND
Ankle oedema, weight gain from fluid
Cough
Embolism from mural thrombi
Arrhythmias
Signs of biventricular heart failure
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8
Q

What should you make sure to check during a history for suspected DCM?

A

PMH - systemic illness, travel, vascular disease

FH - familial? MD?

SH- alcohol, job

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9
Q

What would be seen on examination on those with DCM?

A 
Poor superficial perfusion
Thready pulse, irregular if in AF
SOB at rest
Narrow pulse pressure
Elevated JVP pressure
Displaced apex
S3 and S4
Pulmonary oedema
Pleural effusion
Ankle oedema
Sacral oedema
Ascites
Hepatomegaly
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10
Q

What investigations would be carried out on those with suspected DCM?

A 
CXR - cardiac enlargement 
ECG - LBBB
Cardiac imaging - CMRI, angiogram
BNP
ECHO
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11
Q

What general treatments are given to those with DCM?

A 
Correct anaemia - iron tablets
Remove exacerbating drugs
Correct endocrine disturbance (thyroid)
Reduce salt and fluid intake
Weight management
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12
Q

What treatments are given to those with DCM?

A 
BP - ACEIs, ARBs, diuretics
Beta blockers
Spironolactone
Anticoagulants
ICD if patients have later stage HF
Heart transplant if severe
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13
Q

Describe restrictive cardiomyopathy

A

Rigid myocardium restricts ventricular filling, features similar to constrictive pericarditis. Can see gross bi-atrial dilation in an attempt to counteract this

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14
Q

What is the most common cause of restrictive cardiomyopathy?

A

Amyloidosis

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15
Q

List some causes of restrictive cardiomyopathy

A

Non infiltrative - familial, diabetes
Infiltrative - amyloidosis, sarcoid
Storage - haematochromatosis, Fabry dis.
Endomyocardial - fibrosis, carcinoid, toxicity

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16
Q

Describe some investigations for RCM?

A 
ECG - LBBB, other defects
CXR
BNP
Bloods
Autoantibodies for sclerotic disease
Amyloid - non-cardiac biopsy
Fabry - low a-galactosidase A activity
ECHO
Biopsy
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17
Q

How do you diagnosis RCM?

A

Cardiac catheterization

Endomyocardial biopsy

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18
Q

What test would confirm Fabry disease being the cause of RCM?

A

Fabry - low a-galactosidase A activity

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19
Q

What test would confirm amyloidosis being the cause of RCM?

A

Amyloid - non-cardiac biopsy

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20
Q

How do you treat RCM?

A 
NO DIURETICS
Beta blockers and ACEIs
Anticoagulants as required
Treatments for iron overload
ICD
Cardiac transplants
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21
Q

Describe hypertrophic cardiomyopathy

A

Marked ventricular hypertrophy in the absence of abnormal loading conditions such as hypertension and valvular disease. Leads to loss of compliance which impairs diastolic filling, reducing stroke volume

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22
Q

What are most cases of hypertrophic cardiomyopathy caused by?

A

Autosomal dominant mutations in genes encoding sarcomeric proteins e.g. troponin I and beta myosin

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23
Q

What is the most common cause of sudden cardiac death in young people?

A

Hypertrophic cardiomyopathy

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24
Q

What can result from septal hypertrophy due to hypertrophic cardiomyopathy and mitral valve defect?

A

Let ventricular outflow tract obstruction (LVOT)

25
Q

What are the symptoms of hypertrophic cardiomyopathy?

A

Fatigue
Dyspnoea
Anginal like chest pain
Exertional pre-syncope or syncope related to arrhythmias or LVOT

26
Q

What complications are associated with hypertrophic cardiomyopathy?

A 
Sudden death
Atrial and ventricular arrhythmias
Thromboembolism
Infective endocarditis
Heart failure
27
Q

Describe the clinical signs of hypertrophic cardiomyopathy

A 
Jerky carotid pulse
Pansysolic murmur from mitral regurgitation 
Ejection systolic murmur - LVOT
Notched pulse pattern
Double impulse over apex
LVOT murmur increased with valsalva
Decreased LVOT when squatting
Raised JVP
28
Q

What assessments will be carried out for hypertrophic cardiomyopathy?

A

ECG - patterns of LVH
ECHO - LVH
CMRI - VH and fibrosis
Genetic testing for sarcomeric protein mutations

29
Q

How do you treat hypertrophic cardiomyopathy?

A 
Beta blockers + verapamil - reduce HR
Amiodarone - anti-arrhythmic
Anticoagulants
Surgical resection/ septal ablation 
ICD
30
Q

What general advice do you give to those with hypertrophic cardiomyopathy?

A

Avoid heavy exercise
Avoid dehydration
Encourage family to be tested
Regular follow ups to reappraise progress

31
Q

Describe myocarditis

A

Inflammation of myocardium, which can impact on myocardial function, conduction (heart block) and generate arrhythmias

Late stages appears like DCM

32
Q

List some causes of myocarditis

A 
Infection - Coxsackie virus, diphtheria, RF
Radiation
Injury
Lyme disease?
HIV
33
Q

What is the most common cause of myocarditis?

A

Coxsackie infection

34
Q

List the symptoms of myocarditis

A 
Fever
Varying degrees of biventricular failure
Cardiac arrhythmias and pericarditis
Fatigue
SOB
Heart block?
35
Q

Describe some investigations for myocarditis

A 
ECG - ST changes
ECHO
CMRI - cardiac enlargement, oedema
Viral DNA PCR
Autoantibodies
HIV
Lyme B burgdorferi
36
Q

How do you diagnose myocarditis?

A

Demonstrate increased serum viral titres and inflammation on cardiac biopsy (though these are rarely performed)

37
Q

How do you treat myocarditis?

A

Treat HF and arrhythmia
Immunotherapy
Stop possible drug/toxic agent exposure
Bed rest

38
Q

How much fluid is found in the pericardium normally?

A

50ml

39
Q

What is pericarditis?

A

Inflammation of the pericardial layers with to without myocardial involvement

40
Q

What causes pericarditis?

A 
Infection - Coxsackie B, echovirus, HIV
Tuberculosis
Fungal infections
Perforation/trauma
Dissection of proximal aorta
Neoplasia (breast, lung, leukaemia)
Ureamia
AI rheumatic disease
41
Q

Describe symptoms of pericarditis

A 
Lasts 1-2 weeks normally
Sharp retrosternal chest pain
Pleuritic features - pericardial rub
Postural changes - sitting forward improves, lying back makes it worse
Pain worse on inspiration
Pain radiates to neck and shoulders
Fever (infection)
42
Q

What are the clinical signs of pericarditis?

A 
Fever
Pericardial rub
Raised JVP
Low BP
Muffled heart sounds + increased JVP suggest effusion
No effusion = bacterial infection
43
Q

What investigations are used for pericarditis?

A

ECG - ST elevation (saddle shaped)
ECHO
Troponin increased if myocardium involved

44
Q

How do you treat pericarditis?

A

Antimicrobials, NSAIDs
Drain large effusions/bacterial infected
Systemic corticosteroids if resistant

45
Q

Why cant NSAIDs be used for pericarditis if an MI has happened a few days prior?

A

Increased risk of myocardial rupture

46
Q

What are some complications of pericarditis?

A

Pericardial effusion
Chronic pericarditis (>6 months)
Tamponade

47
Q

What can cause pericardial effusions?

A

pericarditis

hypothyroidism

48
Q

What is pericardial tamponade?

A

Medical emergency, large amount go pericardial fluid restricts diastolic filling and causes a marked reduction in cardiac output

49
Q

What are some symptoms of pericardial tamponade?

A

Fatigue
SOB
Dizzy with low BP
Occasionally chest pain

50
Q

What are some clinical signs of pericardial tamponade?

A 
Pulsus paradoxus 
Raised JVP
Low BP
Pericardial rub
Muffled HS
Pulmonary oedema
Tachycardia
KUSSMAULS SIGN
51
Q

What is Kussmaul’s sign?

A

Elevated JVP which paradoxically increases with inspiration (sign of pericardial tamponade)

Seen in pericarditis

52
Q

What investigations are used for pericardial tamponade?

A

CXR - large heart shadow, globular heart
ECG
ECHO - echo free space around heart

53
Q

How do you treat pericardial tamponade?

A

Emergency pericardiocentesis
Fluid analysed for neoplastic cells, infection
If recurs, excise pericardial “window”

54
Q

Describe constrictive pericarditis

A

Heart becomes encased with fibrotic pericardial sac, preventing adequate diastolic filling of ventricles

55
Q

What causes constrictive pericarditis?

A 
Intrapericardial haemorrhage in surgery
Radiation
AI
RF
Sarcoid disease
56
Q

What are the clinical signs of constrictive pericarditis?

A 
Jugular venous distension
Oedema
Hepatomegaly
Ascites 
Kussmauls sign
Atrial fibrillation
Pericardial knock
57
Q

What are the symptoms of constrictive pericarditis?

A 
Fatigue
SOB
Cough
Jaundice
VERY similar to right HF and restrictive cardiomyopathy
58
Q

What investigations are used for constrictive pericarditis?

A

CXR - normal heart, pericardial calcification
CT/MRI - pericardial thickening/calcification
ECHO - diff from restrictive cardiomyopathy

59
Q

How do you treat constrictive pericarditis?

A

Careful/limited diuretics

Surgical removal of pericardium

Respiratory system 2017 (31 decks)

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