Cardiomyopathy, Myocarditis and Pericarditis Flashcards
Dilated cardiomyopathy
Dilation of the heart chambers
Aetiology of dilated cardiomyopathy
Genetic and familial DCM
Inflammatory, infectious, autoimmune, postpartum
Toxic - drugs, exogenous chemicals, endocrine
Injury, cell loss, scar replacement
Dilated cardiomyopathy often results in
Thrombosis in chambers
Causes of dilated cardiomyopathy that are reversible to some degree
Alcohol Endocrine Tropical disease Post partum Haemaochromatosis Sarcoid
Symptoms of dilated cardiomyopathy
Dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea Fatigue Ankle swelling Weight gain of fluid overload Cough
Examination findings of dilated cardiomyopathy
Poor superficial perfusion Shortness of breath at rest Narrow pulse pressure JVP elevated Pulmonary oedema Ankle oedema Displaced apex
Investigation of dilated cardiomyopathy
ECG Chest x-ray N terminal pro Brain Natriuetic Peptide Echo Bloods - FBC, U+E Coronary angiogram CMRI
General measures in treatment for dilated cardiomyopathy
Correct anaemia and any endocrine disturbance Reduce fluid and salt intake Advise on managing weight Remove exacerbating drugs Heart failure nurse referral
More specific measures in treatment of dilated cardiomyopathy
Diuretics Beta blockers Anticoagulants ACE inhibitor ARB Sprionolactone
Prognosis of dilated cardiomyopathy
Generally poor and often influenced by the causes where known
Restrictive and infiltrative cardiomyopathy
Inability to fill well a ventricle whose wall has reduced compliance
Aetiology of restrictive and infiltrative cardiomyopathy
Non-infiltrative - familial, diabetic, scleroderma
Infiltrative - amyloid, sarcoid
Storage diseases - haemaochromatosis
Endomyocardial - fibrosis, radiation, carcinoid, drugs
Investigation of restrictive and infiltrative cardiomyopathy
ECG Chest x-ray N terminal pro Brain Natriuetic Peptide Bloods - FBC, U+E Echo CMRI
Specific measures for treatment of restrictive and infiltrative cardiomyopathy
Limited diuretics use Beta blockers Limited ACE inhibitor use Anticoagulants Cardiac transplant
Prognosis of restrictive and infiltrative cardiomyopathy
Poor unless reversible
Features of dilated cardiomyopathy
Ventricular function is impaired
Features of restrictive and infiltrative cardiomyopathy
Impaired filling, myocyte relaxation and potentially systolic function
Hypertrophic cardiomyopathy
Portion of heart becomes thickened
Features of hypertrophic cardiomyopathy
Impaired myocyte relaxation and abnormal systolic function
Gene defect in hypertrophic cardiomyopathy
Sarcomere - autosomal dominant but variable expression and incomplete penetrance
Pathology of hypertrophic cardiomyopathy
Myocyte hypertrophy and disarray - can be generalised, septal or apical
Impaired relaxation so restrictive
Small vessel narrowing - ischaemia, fibrosis, arrhythmias
Symptoms of hypertrophic cardiomyopathy
Asymptomatic Fatigue Dyspnoea Anginas like chest pain Exertional pre syncope Syncope Breathlessness Palpitations
Examination findings of hypertrophic cardiomyopathy
Notched pulse pattern Irregular pulse if in AF Double impulse over apex Thrills Murmurs JVP raised
Investigation of hypertrophic cardiomyopathy
ECG
Echo
CMRI
Risk stratification for SCD
General measures for hypertrophic cardiomyopathy
Avoid heavy exercise and dehydration
Consider genetic testing
Follow up
Specific measures for hypertrophic cardiomyopathy
Beta blockers Verapamil - CCB Disopryrimide Anticoagulant Surgical or alcohol septal ablation ICD if required
Myocarditis
Acute or chronic inflammation of the myocardium
Features of myocarditis
Can impair myocardial function, conduction and generate arrhythmia
Aetiology of myocarditis
Viral, bacterial, fungal or parasitic infection
Toxins
Hypersensitivity
Autoimmune activation
Pathology of myocarditis
Infiltration of inflammatory cells into the myocardial layers
Symptoms of myocarditis
Heart failure
Fatigue
Shortness of breath
Cerebral palsy
Investigation of myocarditis
ECG - abnormal Biomarkers elevated Echo CMRI - oedema Viral DNA pCR Auto antibodies
General measures of myocarditis
Support for brady and tachy arrhythmias
Treatment of heart failure
Immunotherapy if specific diagnosis identified
Stop possible drugs or toxic agent exposure
Pericarditis
Inflammation of the pericardial layers with or without myocardial involvement
Aetiology of pericarditis
Idiopathic Viral or bacterial infection Autoimmune Trauma Congenital Neoplastic disease
Symptoms of pericarditis
Pleuritic chest pain
Fever
Signs of pericarditis
Raised temperature Raised JVP Muffled heart sounds Pericardial rub Very unwell
Investigation of pericarditis
ECG - ST elevation and PR depression
Echo
Troponin if myocardial involvement
General measures of pericarditis
Viral - let it pass
Idiopathic - colchicine and NSAIDs (anti-inflammatory)
Bacterial - antimicrobials
Effusion - drain
Pericardial effusion may be
Cardiac tamponade
Aetiology of pericardial effusion
Viral or bacterial infection
Neoplastic disease
Autoimmune
Trauma
Symptoms of pericardial effusion
Fatigue
Shortness of breath
Dizzy
Chest pain
Signs of pericardial effusion
Pulsus paradoxus JVP raised Low blood pressure Pericardial rub Muffled heart sounds Pulmonary oedema
Investigations of pericardial effusion
Echo - key
Chest x-ray - large cardiac shadow
ECG - alteration of QRS complex
Treatment of pericardial effusion
Drainage
Send for MCS, neoplastic cells, protein and LDH
Persistent effusion - surgical pericardial window to allow flow to abdomen
Constrictive pericarditis
Chronic inflammation of pericardium causing thickening, fibrosis and muscle tightening
Aetiology of constrictive pericarditis
Idiopathic Radiation Post surgery Autoimmune Renal failure Sarcoid
Pathology of constrictive pericarditis
Impaired filling
Symptoms of constrictive pericarditis
Fatigue
Shortness of breath
Cough
Signs of constrictive pericarditis
Oedema High JVP Jaundice AF Pleural effusion Tricuspid regurgitation
Investigation of constrictive pericarditis
Echo
Right heart Cath
Treatment of constrictive pericarditis
Limited diuretics
Pericardiectomy
