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Systems: Cardiovascualar AB > Cardiomyopathy, Myocarditis + Pericarditis > Flashcards

Cardiomyopathy, Myocarditis + Pericarditis Flashcards

1
Q

Dilated cardiomyopathy

A

A structural and functional description where the ventricular function is impaired

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2
Q

How can dilated cardiomyopathy occur?

A
  • Primary problem

- End result of pathological injury to myocardium

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3
Q

Excluding ischaemia and valvular causes, what is the aetiology of dilated cardiomyopathy?

A
  • Genetic and familial ( SCN5A gene, Muscular dystrophy)
  • Inflammatory (infectious, autoimmune, postpartum)
  • Toxic (drugs, exogenous chemicals, endocrine)
  • Injury (cell loss, scar replacement)
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4
Q

What is the pathological change in dilated cardiomyopathy?

A
  • Can be 1 but often all chambers are dilated and therefore functionally impaired
  • Thrombosis isn’t uncommon
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5
Q

What are the symptoms of dilated cardiomyopathy?

A
  • Progressive and slow onset
  • Dyspnoea
  • Fatigue
  • Orthopnoes
  • PND
  • Ankle swelling
  • Weight gain of fluid overload
  • Cough
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6
Q

PMH of dilated cardiomyopathy

A
  • Systemic illness
  • Travel
  • HT
  • Vascular disease
  • Thyroid
  • Neuromuscular disease
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7
Q

SH of dilated cardiomyopathy

A
  • Alcohol

- Job

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8
Q

What would be found on examination of dilated cardiomyopathy?

A
  • Poor superficial perfusion
  • Thready pulse
  • Irregular pulse if in AF
  • SOB at rest
  • Narrow pulse pressure
  • JVP elevated +/- TR waves
  • Displace apex beat
  • S3 and S4
  • MR murmur
  • Pulmonary oedema
  • Pleural effusion
  • Ankle oedema
  • Sacral oedema
  • Ascites
  • Hepatomegaly
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9
Q

What investigations should be carried out for dilated cardiomyopathy?

A
  • Repeated ECG noting LBBB if present
  • CXR
  • N terminal pro Brain Natriuretic peptide
  • Bloods
  • ECHO
  • CMRI
  • Coronary angiogram
  • Biopsy
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10
Q

What are the general measures in treating dilated cardiomyopathy?

A
  • Correct anaemia
  • Remove exacerbating factors
  • Correct endocrine disturbances
  • Advise on fluid and salt intake
  • Manage weight
  • HF nurse referral
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11
Q

What are the specific treatments for dilated cardiomyopathy?

A

-ACE inhibitors, ATII blockers, diuretics
-B-blockers
-Spironolactone
-Anticoagulants
-SCD risk assessment
Cardiac transplant

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12
Q

What is the prognosis of dilated cardiomyopathy?

A

Generally poor and often influenced by the causes where known

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13
Q

Restrictive and infiltrative cardiomyopathy.

A

Less common than dilated, describes the physiology of filling and myocyte relaxation capacity, the systolic function may or may not be impaired

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14
Q

What is the aetiology of restrictive and infiltrative cardiomyopathy?

A
  • Non infiltrative (Familial forms of HCM, Scleroderma, Diabetic, pseudoxanthoma elasticum)
  • Infiltrative (Amyloid, Sarcoid)
  • Storage diseases (haemochromatosis, Fabry disease)
  • Endomyocardial (Fibrosis, carcinoid, radiation, drug effects)
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15
Q

What is the pathology of restrictive and infiltrative cardiomyopathy?

A
  • The inability to fill a ventricle whose wall has reduced compliance.
  • relaxation of the ventricular wall us an active process that needs functioning intact myocytes
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16
Q

What are the investigations carried out for restrictive and infiltrative cardiomyopathy?

A

-Repeated ECG noting LBBB and other conduction defects
-CXR
-N terminal pro Brain Natriuretic peptide
-Blood (sarcoid, hemochromatosis)
-Auto antibodies for sclerotic CT disease
-Amyloid needs non cardiac biopsy
-Fabry: low plasma alpha galactosidase A activity
-ECHO
CMRI
-Biopsy

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17
Q

What are the specific treatment measures for restrictive and infiltrative cardiomyopathy?

A
  • Limited diuretic use as low filling pressures
  • B-blockers, limited ACEI use
  • Anticoagulants
  • SCD risk assessment
  • Cardiac transplant
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18
Q

What is the prognosis for restrictive and infiltrative cardiomyopathy?

A

Poor unless reversible

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19
Q

What is the morphological description of hypertrophic cardiomyopathy?

A

Impaired relaxation is a common feature and systolic function is usually adequate albeit with some functional abnormality

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20
Q

Why does hypertrophic cardiomyopathy have a relatively high prevalence?

A
  • Genetic basis
  • Sarcomere gene defect
  • Autosomal dominant
  • Variable expression and incomplete penetrance
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21
Q

What is the pathology of hypertrophic cardiomyopathy?

A
  • Myocyte hypertrophy and disarray
  • Can be genarlised or segmental wall thickness
  • Can be apical, septal or generalised
  • Impaired relaxation so behaves in as restrictive manner
  • If septal hypertrophy this coupled with mitral valve defect lead to LVOT obstruction
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22
Q

What are the symptoms of hypertrophic cardiomyopathy?

A

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

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23
Q

What can be found on examination of hypertrophic cardiomyopathy?

A
  • Can be nothing
  • Notched pulse pattern
  • Irregular pulse if in AF or ectopy
  • Double impulse over apex
  • Thrills and murmurs
  • LVOT murmur will increase with Valsalva and decrease with squatting
  • JVP will be raised in very restrictive filling
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24
Q

What are the investigations for hypertrophic cardiomyopathy?

A
  • ECG (often abnormal but can be normal)
  • ECHO
  • CMRI
  • Risk stratification for SCD, may need ICD
  • Holters repeatedly
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25
Q

What are the general treatment measures for hypertrophic cardiomyopathy

A
  • Avoid heavy exercise
  • Avoid dehydration
  • Explore FH
  • Consider genetic testing
  • Regular FU to re appraise the risks and progress
26
Q

What are the specific treatment measures for hypertrophic cardiomyopathy?

A
  • B-blockers
  • Verapamil
  • Disopyrimide
  • Anticoagulation for AF
  • Surgery or alcohol septal ablation if obstructive
  • ICD
27
Q

Myocarditis

A

Acute or chronic inflammation of the myocardium

28
Q

What can myocarditis be in association with?

A

Pericarditis

29
Q

What can myocarditis lead to?

A
  • Impaired myocardial function, conduction and generate arrhythmia
  • Can take on dilated cardiomyopathy appearance
30
Q

Aetiology of myocarditis

A

Long list but is often unknown

31
Q

What is the most common form of myocarditis?

A

Viral

32
Q

What is the 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

33
Q

What are the symptoms of myocarditis?

A
  • Heart failure
  • Fatigue
  • SOB
  • CP
  • Fever
34
Q

What investigations are carried out for myocarditis?

A
  • ECG (usually abnormal)
  • Biomarkers
  • ECHO
  • CMRI
  • Biopsy
  • Viral DNA PCR
  • Auto antibodies
  • Strep antibodies
  • Lyme B burdoferi
  • HIV
  • Bloods
35
Q

What are the general measures for treatment of myocarditis?

A
  • Supportive with treatment of heart failure and support for brady and tachy arrhythmias
  • Immunotherapy if biopsy or other test points to specific diagnosis
  • Stop possible drugs or toxic agent exposure
36
Q

What is the prognosis of myocarditis?

A
  • 30% recover fully
  • 20% mortality at 1 year
  • 56% mortality by 4 years
37
Q

Pericardium

A

A reflected lining over the epicardium and the parietal pericardium that is the inner portion of the exterior sac around the heart and proximal great vessels

38
Q

Pericarditis

A

Inflammation of the pericardial layers with or without myocardial involvement

39
Q

Aetiology of pericarditis

A

Long list:

  • Viral
  • Idiopathic
  • Bacterial
  • Post MI
  • Perforation
  • Dissection of proximal aorta
  • Neoplasia
40
Q

What are the symptoms of pericarditis?

A
  • Chest pain with pleuritic and postural features (sitting forward improves, lying down makes it worse)
  • Fever
41
Q

Duration of symptoms of pericarditis

A

1-2 weeks

42
Q

Signs of pericarditis

A
  • High fever
  • Pericardial rub
  • Raised JVP
  • Hypotensive
  • Muffled heart sounds
43
Q

What investigations should be performed for pericarditis?

A
  • ECG
  • ECHO
  • Troponin
44
Q

What would suggest pericarditis with effusion?

A

Muffled heart sounds with raised JVP

45
Q

What would suggest a bacterial cause of pericarditis?

A

High fever with no effusion

46
Q

What may the ECG of pericarditis look like?

A

Widespread ST changes and PR depression

47
Q

What are the general treatment measures for pericarditis?

A
  • Viral is conservative
  • Idiopathic gets colchicine and limited use of NSAIDs
  • Bacterial must be drained and antimicrobials (high death rate)
48
Q

What can occur with pericardial effusion?

A

Tamponade

49
Q

What are the causes o pericardial effusion?

A

Often the same as pericarditis

50
Q

What are the symptoms of pericardial effusion with tamponade?

A
  • Overt
  • Fatigue
  • SOB
  • Dizzy
  • Hypotensive
  • Chest pain
51
Q

What are the signs of pericardial effusion with tamponade?

A
  • Overt
  • Pulsus paradoxus
  • JVP raised
  • Hypotensive
  • Pleural rub
  • Muffled heart sounds
  • Pulmonary oedema is rare
52
Q

What is the investigation for pericardial effusion with tamponade?

A
  • Urgent ECHO

- CXR

53
Q

What is the main treatment for pericardial effusion with tamponade?

A

Drainage

54
Q

After drainage, what should happen to the fluid from a pericardial effusion?

A

Send for MCS, neoplastic cells, protein and LDH (most are exudates)

55
Q

What is the treatment for persistent effusion?

A

Surgical pericardial window to allow flow to abdomen

56
Q

What may be seen on an ECG with pericardial disease?

A

Electrical altermans in a large effusion

57
Q

What is the prevalence of constrictive pericarditis?

A

Rare

58
Q

What are the causes of constrictive pericarditis?

A
  • Idiopathic
  • Radiation
  • Post surgery
  • Autoimmune
  • Renal failure
  • Sarcoid
59
Q

What is the pathology of constrictive pericarditis?

A
  • Fatigue
  • SOB
  • Cough
60
Q

What are the signs of constrictive pericarditis

A
  • Signs of right heart failure
  • Oedema
  • Ascites
  • Raised JVP
  • Jaundice
  • Hepatomegaly
  • AF
  • TR
  • Pleural effusion
  • Pericardial knock
61
Q

How is constrictive pericarditis investigated?

A
  • ECHO

- Right heart cath (to differentiate from restrictive cardiomyopathy)

62
Q

Treatment for constrictive pericarditis

A

Careful and limited diuretics and pericardectomy

Systems: Cardiovascualar AB (42 decks)

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