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02. Cardiovascular System > Cardiomyopathy, Myocarditis & Pericarditis > Flashcards

Cardiomyopathy, Myocarditis & Pericarditis Flashcards

1
Q

What is cardiomyopathy?

A

Refers to diseases of the heart muscle

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2
Q

What are different kinds of cardiomyopathy?

A

Hypertrophic

Dilated

Restricted

Myocarditis

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3
Q

What are different kinds of pericardial diseases?

A

Pericarditis

Effusion

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4
Q

What is dilated cardiomyopathy?

A

Condition in which the heart becomes enlarged and cannot pump blood effectively

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5
Q

What is a condition where the heart becomes enlarged and cannot pump blood effectively?

A

Dilated cariomyopathy

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6
Q

How many chambers are usually affected in dilated cardiomyopathy?

A

Can be only one chamber but most often all the chambers are affected

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7
Q

Speak about the reversibility of dilated cardiomyopathy?

A

Most causes are progressive/irreversible but some are reversible

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8
Q

What is the incidence of dilated cardiomyopathy?

A

5-8/100000

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9
Q

What is not uncommon in chambers for dilated cardiomyopathy?

A

Thrombosis

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10
Q

Is dilated cardiomyopathy a primary or secondary condition?

A

Can be primary or as the end result of almost any pathological insult to the myocardium

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11
Q

What is the aetiology of dilated myocardium?

A

Genetic

Inflammatory

Toxic

Injury

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12
Q

What are examples of genetic causes of dilated myocardium?

A

SCN5A gene

Muscular dystrophy

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13
Q

What is muscular dystrophy?

A

Group of muscle diseases that results in the weakening and breakdown of skeletal muscles over time

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14
Q

What are examples of inflammatory causes of dilated myocardium?

A

Infectious

Autoimmune

Postpartum (following childbirth)

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15
Q

What does postpartum mean?

A

Following childbirth

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16
Q

What are examples of toxic causes of dilated myocardium?

A

Drugs

Exogenous chemicals

Postpartum

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17
Q

What are exogenous chemicals?

A

Ones that originate from outside organism

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18
Q

What are examples of injury causes of dilated myocardium?

A

Cell loss

Scar replacement

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19
Q

What are some symptoms of dilated myocardium?

A

Progressive

Slow onset

Dyspnoea

Fatigue

Orthopnoea

Paroxysmal nocturnal dyspnoea (PND)

Ankle swelling

Weight gain

Cough

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20
Q

What does PND stand for?

A

Paroxysmal nocturnal dyspnoea

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21
Q

What is paroxysmal nocturnal dyspnoea (PND)?

A

Attack of severe shortness of breath and coughing that generally occurs at night

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22
Q

What is an attack of severe shortness of breath and coughing that generally occurs at night called?

A

Paroxysmal nocturnal dyspnoea (PND)

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23
Q

What is often seen in the past medical history for dilated myocardium?

A

Systemic illness

Travel

Hypertension

Vascular disease

Thyroid

Neuromuscular disease

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24
Q

What does the examination for dilated myocardium often show?

A

Poor superficial perfusion

Thready pulse

Shortness of breath at rest

Displaced apex

Pulmonary oedema

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25
Q

What investigations are done for cardiomyopathy?

A

Repeated ECG

Chest X-ray

Basic bloods

Echocardiogram

Cardiac MRI

Coronary angiogram

Sometimes biopsy

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26
Q

What are general measures for the treatment of dilated cardiomyopathy?

A

Correct anaemia

Remove exacerbating drugs (such as NSAIDs)

Correct any endocrine disturbance

Advice on fluid and salt intake (reduce it)

Advice on managing weight to identify fluid overload

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27
Q

What are specific measures for the treatment of dilated cardiomyopathy?

A

ACEI, ATII blockers, diuretics

Beta blockers

Spironolactone

Anticoagulants as required

Cardiac transplant

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28
Q

What is the prognosis for dilated cardiomyopathy like?

A

Generally poor and often influenced by the causes where known

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29
Q

What is restrictive and infiltrative cardiomyopathy?

A

Form of cardiomyopathy where the walls of the heart are rigid (but not thickened) causing the heart to be restricted from stretching and filling with blood properly

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30
Q

What is a form of cardiomyopathy where the walls are rigid (but not thickened) causing the heart to be restricted from stretching and filling with blood properly?

A

Restricted and infiltrative cardiomyopathy

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31
Q

What kind of process is relaxation of the ventricular walls?

A

Active process that needs functioning intact myocytes

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32
Q

What is the aetiology of restricted cardiomyopathy?

A

Non-infiltrative

Infiltrative

Storage diseases

Endomyocardial

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33
Q

What are examples of non-infiltrative causes of restricted cardiomyopathy?

A

Familial

Scleroderma

Diabetic

Pseudoxanthoma elasticum

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34
Q

What are examples of infiltrative causes of restricted cardiomyopathy?

A

Amyloid

Sarcoid

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35
Q

What are examples of storage disease causes of restricted cardiomyopathy?

A

Haemachromatosis

Fabry disease

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36
Q

What are endomyocardial causes of restricted cardiomyopathy?

A

Fibrosis

Carcinoid

Radiation

Drug effects

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37
Q

What investigations are done for restricted cardiomyopathy?

A

Repeated ECG

Chest X-ray

Basic bloods

Auto antibodies for sclerotic CT diseases

Echocardiogram

Chest MRI

Biopsy more helpful but still has high false negatives

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38
Q

What are some specific measures for the treatment of restrictive cardiomyopathy?

A

Limited diuretic use as low folling pressures will cause problems

Beta blockers

Limited ACEI use

Anticoagulants as required

Cardiac transplant

39
Q

What is the prognosis of restricted cardiomyopathy?

A

Poor unless it is reversible

40
Q

What is hypertrophic cardiomyopathy?

A

A disease in which the heart muscle (myocardium) becomes abnormally thick (hypertrophied), making it harder for the heart to pump blood

41
Q

What is a disease where the heart muscle (myocardium) becomes abnormally thick, making it harder for the heart to pump blood?

A

Hypertrophic cardiomyopathy

42
Q

What is the prevalence of hypertrophic cardiomyopathy?

43
Q

What is hypertrophic cardiomyopathy often due to?

44
Q

What gene defect most commonly causes hypertrophic cardiomyopathy?

A

Sarcomere gene defect which is autosomal dominant

45
Q

What is the pathology of hypertrophic cardiomypathy?

A

Myocyte hypertrophy and disarray

Generalised or segmental wall thickness

Impaired relaxation so behaves in a restrictive manner

46
Q

What is septal hypertrophy often to do with?

A

Mitral valve defect leading to left ventricular outflow tract obstruction

47
Q

What are symptoms of hypertrophic cardiomyopathy?

A

Asymptomatic for many

Fatigue

Dyspnoea

Anginal like chest pain

Exertional pre-syncope

Syncope related to arrhythmias of LVOT obstruction

48
Q

What does LVOT obstruction mean?

A

Left ventricular outflow tract obstruction

49
Q

What are examination findings for hypertophic cardiomyopathy?

A

Can be none

Notched pulse pattern

Irregular pulse

Double impulse over apex

JVP can be raised in very restrictive filling

50
Q

What investigations are done for hypertrophic cardiomyopathy?

A

ECG

Echocardiogram

Chest MRI

51
Q

What are general measures for hypertrophic cardiomyopathy?

A

Avoid heavy exercise

Avoid dehydration

Explore family history

Consider genetic testing

52
Q

What are specific measures for hypertrophic cardiomyopathy?

A

Drugs to try and enhance relaxation (beta blockers, verapamil, disopyrimide)

Anticoagulate if in atiral fibrillation

If obstructive form then surgical or alcohol septal ablation

53
Q

What is myocarditis?

A

Acute or chronic inflammation of the myocardium

54
Q

What is acute or chronic inflammation of the myocardium called?

A

Myocarditis

55
Q

What is myocarditis often in association with?

A

Pericarditis

56
Q

What is the prevalence of myocarditis?

A

8-10/100000

57
Q

What is the most common cause of myocarditis?

58
Q

What can myocarditis impair?

A

Myocardial function

Conduction

Generate arrhythmia

59
Q

What can be said about the cause of myocarditis?

A

Long list, often not found dispite investigations

60
Q

What is the pathology of myocarditis?

A

Infiltration of inlammatory cells into the myocardial layers

Causing reduced function and heart block as conduction system is involved, and arrhythmia

61
Q

What are symptoms of myocarditis?

A

Heart failure

Fatigue

May not have fever

Signs of heart failure

62
Q

What investigations are done for myocarditis?

A

ECG usually abnormal

Biomarkers often elevated

Echocardiogram

Chest MRI can see oedema

Biopsy

63
Q

What are general measures for myocarditis?

A

Supportive treatment of heart failure and support for brady and tachy arrhythmias

Immunotherapy if biopsy suggests specific diagnosis

Stop possible drugs or toxic agent exposure

64
Q

What is the prognosis for myocarditis?

A

30% recover fully

20% mortality at 1 year

55% mortality by 4 years

At 11 years those till alive are 90% transplant free

65
Q

What is the pericardium?

A

Reflected lining over the epicardium, inner portion of the exterior sac around the heart and proximal great vessels

66
Q

What are examples of pericardial diseases?

A

Pericarditis

Pericardial effusion

Constructive pericarditis

67
Q

What is pericarditis?

A

Inflammation of the pericardial layers with or without myocardial involvement

68
Q

What is inflammation of the pericardial layers with or without myocardial involvement called?

A

Pericarditis

69
Q

What are key causes of pericarditis?

A

Bacteria

Post myocardial infarction

Perforation

Dissection of proximal aorta

Neoplasia

70
Q

What is a perforation?

A

Small hole

71
Q

What are symptoms of pericarditis?

A

Chest pain with pleuritic and postual features (sitting forward usually improves it and lying back makes it worse)

Fever

72
Q

What are signs of pericarditis?

A

Raised temperature

Look for JVP as if an effusion is present then it will be raised

Low blood pressure

Muffled heart sounds

73
Q

What investigations are done for pericarditis?

A

ECG

ECHO

Blood tests

74
Q

What could blood tests for pericarditis reveal?

A

Troponin raised if myocardial involvement

75
Q

What are general measures for pericarditis?

A

Viral is conversative

Idiopathic gets colchicine and limited use of NSAIDs

Bacterial must be drained even if small effusion

If large effusion is present then drain

76
Q

What is pericardial effusion?

A

Accumulation of fluid in the pericardial cavity

77
Q

What is an accumulation of fluid in the pericardial cavity called?

A

Pericardial effusion

78
Q

What may a pericardial effusion be related to?

A

Forces involved in blood circulation

79
Q

What are some symptoms of pericardial effusion?

A

Overt (plainly apparent)

Fatigue

Shortness of breath

Dizzy with low blood pressure

Occasionally chest pain

80
Q

What are signs of pericardial effusion?

A

Overt

Pulsus paradoxus

JVP raised

Low blood pressure

Maybe or maybe not muffled heart sound

Pulmonary oedema is very rare

81
Q

What does overt mean?

82
Q

What is pulsus paradoxus?

A

Abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration

83
Q

What is an abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration called?

A

Pulsus paradoxus

84
Q

What investigations are done for pericardial effusion?

A

Urgent echocardiogram

Chest X-ray (can show large cardiac shadow)

Blood tests

85
Q

What is the treatment of pericardial effusion?

A

Drainage

Persistent effusion needs surgical pericardial window to allow flow to abnomen

86
Q

What is constructive pericarditis?

A

Thickened, fibrotic pericardium limiting the hearts ability to function normally

87
Q

What is a thickened, fibrotic pericardium limiting the hearts ability to function normally called?

A

Constructive pericarditis

88
Q

What are some of the causes of constructive pericarditis?

A

Idiopathic

Radiation

Post-surgery

Autoimmune

Renal failure

Sarcoid

89
Q

What are some symptoms for constructive pericarditis?

A

Fatigue

Shortness of breath

Cough

Signs of right heart failure with oedema

High JVP

Jaundice

Hepatomegaly

Atrial fibrillation

Pleural effusion

90
Q

What investigations are done for constructive pericarditis?

A

Echocardiogram

91
Q

What is the treatment of constructive pericarditis?

A

Careful and limited diuretics

Pericardectomy

92
Q

What is a pericardectomy?

A

Surgical removal of a portion or all of the pericardium

93
Q

What is surgical removal of a portion or all of the pericardium called?

A

Pericardectomy

02. Cardiovascular System (72 decks)

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