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Cardiovascular System > Cardiomyopathy, Myocarditis and Pericarditis > Flashcards

Cardiomyopathy, Myocarditis and Pericarditis Flashcards

1
Q

What is cardiomyopathy?

A

Cardiomyopathy is a group of diseases that affect the heart muscle.

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2
Q

What are the 3 main types of cardiomyopathy?

A
  • Hypertrophic cardiomyopathy (HCM)
  • Dilated cardiomyopathy (DCM)
  • Arrhythmogenic right ventricular cardiomyopathy (ARVC)/ restrictive
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3
Q

What are the main types of pericardial disease?

A

Pericarditis and effusion +/- tamponade

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4
Q

Features of dilated cardiomyopathy

A

In dilated cardiomyopathy the ventricles enlarge and weaken.

- Can be one but more often all chambers dilated and functionally impaired. Thrombosis in chambers is not uncommon.

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5
Q

What are associations (causes) of dilated cardiomyopathy?

A
  • Alcohol
  • Increased BP
  • Chemotherapeutics
  • Haemochromatosis
  • Viral infection
  • Autoimmune
    peri- or postpartum
  • Thyrotoxicosis
  • Congenital (X-linked)
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6
Q

Symptoms of dilated cardiomyopathy

A
  • Fatigue
  • Dyspnoea
  • Pulmonary oedema
  • RVF
  • Emboli
  • Atrial fibrillation
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7
Q

Signs of dilated cardiomyopathy

A
  • Increased pulse
  • Decreased blood pressure
  • Increased JVP
  • Displaced and diffuse apex
  • Mitral or tricuspid regurgitation
  • Pleural effusion
  • Oedema
  • Jaundice
  • Hepatomegaly
  • Ascites
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8
Q

Common past medical history for dilated cardiomyopathy

A
  • Systemic illness
  • Travel
  • HT
  • Vascular disease
  • Thyroid
  • Neuromuscular disease
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9
Q

Tests for dilated cardiomyopathy

A
  • Blood: decreased Na+ indicated a poor prognosis.
  • CXR: cardiomegaly, pulmonary oedema
  • ECG
  • Echocardiogram
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10
Q

General measures in treatment of dilated cardiomyopathy

A
  • Correct anaemia
  • Remove exacerbating drugs e.g. NSAIDs
  • Correct any endocrine disturbance
  • Advise on fluid and salt intake, reduce it
  • Advise on managing weight to identify fluid overload
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11
Q

Treatments for dilated cardiomyopathy

A
  • Diuretics
  • Beta blockers
  • ACEi
  • Anticoagulation
  • Biventricular pacing
  • Transplantation
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12
Q

Prognosis of dilated cardiomyopathy

A

Generally poor and often influenced by the causes where known

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13
Q

Features of restrictive cardiomyopathy

A
  • In restrictive cardiomyopathy the ventricle stiffens.
  • Less common, describes the physiology of filling and myocyte relaxation capacity, the systolic function may or not be impaired.
  • About 50% are related to specific clinical disorders, the rest remain unknown.
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14
Q

Causes of restrictive cardiomyopathy

A
  • Idiopathic
  • Amyloidosis
  • Haemochromatosis
  • Sarcoidosis
  • Scleroderma
  • Endocarditis
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15
Q

Basic diagnosis evaluation for restrictive cardiomyopathy

A
  • Repeated ECG noting LBBB if present and other conduction defects
  • CXR
  • N terminal brain natriuretic peptide
  • Basic bloods
  • Auto antibodies for sclerotic CT diseases
  • Amyloid needs non cardiac biopsy to help establish the diagnosis
  • Echocardiogram
  • CMRI
  • Biopsy more helpful but still has high false negative rate
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16
Q

Treatment and specific measures for restrictive cardiomyopathy

A
  • Limited diuretic use as low filling pressures will cause problems
  • Beta blockers limited ACEi use
  • Anticoagulants as required
  • SCD risk assessment
  • Cardiac transplant
  • If iron overload, specific forms of amyloid or Fabrys then specific treatments are available
  • Endomyocardial fibrosis has little specific treatment
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17
Q

Prognosis of restrictive cardiomyopathy

A

Unless reversible then poor prognosis

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18
Q

Features of Hypertrophic cardiomyopathy

A
  • Impaired relaxation is a common feature and systolic function is usually adequate albeit with some functional abnormality.
  • Relatively high prevalence 1:500
  • Sarcomere gene defect. Autosomal dominant but!!

In hypertrophic cardiomyopathy the heart muscle enlarges and thickens.

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19
Q

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 a restrictive manner
  • If septal hypertrophy this can with mitral valve defect lead to LVOT obstruction.
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20
Q

Are coronary arteries affected due to hypertrophic cardiomyopathy?

A

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

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21
Q

Symptoms of Hypertrophic cardiomyopathy

A
  • Breathless
  • Palpitations
  • Syncope
  • Exertional symptoms
  • SCD
  • Angina
  • Dyspnoea

Asymptomatic for many

22
Q

Examination findings in Hypertrophic cardiomyopathy

A
  • Can be none
  • Notched pulse pattern
  • Irregular pulse if in AF or ectopy
  • Double impulse over apex, thrills and murmurs, often dynamic, LVOT murmur will increase with valsalva manoeuvre and decrease with squatting.
  • JVP can be raised in very restrictive filling
23
Q

General measures for hypertrophic cardiomyopathy

A
  • Avoid heavy exercise
  • Avoid dehydration
  • Explore FH and first degree relatives, ECGs and echoes may be required
  • Consider genetic testing
  • Regular FU to reappraise the risks and progress
24
Q

Specific (treatment) measures in hypertrophic cardiomyopathy

A
  • Drugs to try and enhance relaxation, variable results but often if symptomatic, beta blockers, verapamil, disopyrimide
  • If in AF anticoagulate
  • Obstructive form; surgical or alcohol septal ablation
  • ICD if required based on risk stratification
25
Q

Investigation assessments for hypertrophic cardiomyopathy

A
  • ECG, often abnormal but a few are normal where phenotype is poorly expressed in genotype +ve individuals.
  • Echo
  • CMRI
  • Risk stratification for SCD, may need ICD
26
Q

What is Myocarditis?

A

Acute or chronic inflammation of the myocardium

  • Can be in association with pericarditis .
  • Can impair myocardial function, conduction and generate arrhythmia.
27
Q

Pathology of myocarditis

A

Infiltration of inflammatory cells into the myocardial layers, reduced function and heart failure, heart block as conduction system is involved and arrhythmias

28
Q

Signs and symptoms of myocarditis

A
  • Heart failure symptoms
  • Palpitations
  • Tachycardia
  • Soft S1, S4 gallop
29
Q

Investigation assessments for myocarditis

A
  • ECG usually abnormal
  • Biomarkers often elevated but not falling in a pattern consistent with MI
  • Echo, can get RWMA
  • CMRI can see oedema in certain images
  • Low threshold for biopsy
  • Viral DNA PCR
  • Auto antibodies
  • Strep antibodies
  • Lyme B burgdorferi
  • HIV
30
Q

General measures for myocarditis

A
  • Supportive with treatment of heart failure and support for brady and tachy arrhythmias
  • Immunotherapy if biopsy or other lx point to a specific diagnosis
  • Stop possible drugs or toxic agent exposure
31
Q

Prognosis of Myocarditis

A

30% recovery fully but 20% mortality at 1 year and 56% by 4 years.

At 11 years those still alive are 93% transplant free.

32
Q

What is the pericardium?

A

It is a reflected lining over the epicardium (the visceral pericardium) and the parietal pericardium that is the inner portion of the exterior sac around the heart and proximal great vessels.

33
Q

What is Pericarditis?

A

Inflammation of the pericardial layers with or without myocardial involvement.

34
Q

What are the causes of pericarditis?

A

THere is a SUbstantial number of CAuses

Do we need to know them? (idk)

35
Q

Symptoms of pericarditis

A
  • Central chest pain worse on inspiration or lying flat.
  • Relieved by sitting forward.
  • A pericardial friction rub may be heard
  • Fever
36
Q

Signs of pericarditis

A
  • Increased temperature
  • Pericardial rub LSE
  • Look for JVP as if an effusion is present
  • Low blood pressure
  • Muffled HS
  • Raised JVP should make you consider not just pericarditis but effusion
  • High fever and very unwell despite no effusion may suggest bacterial investigations.
  • Troponin may be raised if myocardial involvement to.
37
Q

General measures for pericarditis

A
  • Viral is conservative
  • Idiopathic gets colchicine and limited use of NSAIDs
  • Bacterial must be drained even if small effusion and antimicrobials, high death rate.
  • If large effusion present and some haemodynamic effects, then drain.
38
Q

What is pericardial effusion?

A

Accumulation of fluid in the pericardial sac

39
Q

Causes of pericardial effusion

A
  • Pericarditis
  • Myocardial rupture
  • Aortic dissection
  • Pericardium filling with pus
  • Malignancy
40
Q

Features of pericardial effusion

A
  • May be haemodynamically significant = tamponade or not
  • Often same causes as pericarditis
  • Where tamponade is present
41
Q

Symptoms of pericardial effusion

A
  • Dyspnoea
  • Fatigue
  • Dizzy with low BP
  • Chest pain
  • Nausea (diaphragm)
  • Bronchial breathing at left base
  • Muffled heart sounds
42
Q

Signs of pericardial effusion

A
  • Pulsus paradoxus
  • JVP raised
  • Low BP +/- rub
  • Pulmonary oedema is very rare in pericardial effusions/tamponade
43
Q

What is a key test and investigations in pericardial effusion?

A

Key test is urgent echo

  • CXR can show large cardiac shadow
  • Drainage is the destination treatment
  • Send for MCS, neoplasic cells, protein and LDH, most are exudates.

Persistent effusion needs a surgical pericardial window made to allow flow to abdomen

44
Q

Features of constrictive pericarditis

A

The heart is encased in a rigid pericardium.

- This is rare

45
Q

Pathology of constrictive pericarditis

A

Pathology is that of impaired filling although myocardium is normal most of the time

46
Q

Symptoms of constrictive pericarditis

A
  • Fatigue
  • SOB
  • Cough
47
Q

Signs of constrictive pericarditis

A
  • Signs more of right heart failure with oedema
  • Ascites
  • High JVP
  • Jaundice
  • Hepatomegally
  • AF
  • Pleural effusion
  • Pericardial knock
48
Q

What is a pericardial knock?

A

Diastolic sound caused by loss of pericardial elasticity that limits ventricular filling

49
Q

Investigation techniques for constrictive pericarditis

A

Assess with echo and right heart catheter to differentiate from restrictive cardiomyopathy which can be very difficult

50
Q

Treatment of constrictive pericarditis

A

Treatment is with careful and limited diuretics and pericardectomy

Cardiovascular System (36 decks)

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