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Cardiovascular System > Cardiomyopathy, Myocarditis & Pericarditis - Presentation & Therapy > Flashcards

Cardiomyopathy, Myocarditis & Pericarditis - Presentation & Therapy Flashcards

1
Q

Briefly outline what dilated cardiomyopathy is.

3

A
  • left ventricle becomes enlarged/weakened
  • heart struggles to pump blood efficiently
  • can affect the hearts relaxing and filling capabilities
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2
Q

What are some of the causes of dilated cardiomyopathy?

A
  • severe IHD/CAD
  • valvular disease (regurgitation)
  • genetics (SCN5a gene)
  • autoimmune (post-partum)
  • alcoholism
  • thyroid disease
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3
Q

What happens on a histological basis with a dilated/overstretched myocardium?

(3)

A
  • scarring
  • muscle becomes non-contractile (HF)
  • thrombus can form between stretched muscle cells
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4
Q

What are some of the reversible causes of DCM or ones which recover well?

(3)

A
  • post partum
  • haemaochromatosis (Fe storage disease)
  • lifestyle induced (e.g. alcoholism)
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5
Q

What is an example of an endocrine cause of DCM?

A

hyperthyroidism

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6
Q

What are the symptoms of dilated cardiomyopathy?

A
  • SOB at rest
  • fatigue
  • orthopnoea
  • PND
  • palpitations
  • syncope
  • peripheral oedema
  • weight gain
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7
Q

What information would you be looking to gather from a history with suspected DCM?

A

PMH: IHD/CAD, hypertension, anaemia, thyroid problems, valvular disease

Fx: Hx of CVD/DCM

Sx: smoker, alcohol, travel

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8
Q

What observations might be picked up on clinical examination which could suggest dilated cardiomyopathy?

(6)

A
  • peripheral oedema
  • S3/S4 (e.g. S3 gallop)
  • hepatomegaly
  • raised JVP
  • ascites
  • pleural effusion (crackles)
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9
Q

What investigations would you carry out for suspected dilated cardiomyopathy?

(7)

A
  • ECG/ECHO
  • Bloods
  • BNP (NT-proBNP)
  • CXR
  • CT
  • MRI
  • biopsy
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10
Q

What blood tests might be requested and why? What can they rule out?

A

FBC - anaemia, infection
TFT - thyroid function
BNP - sign of HF
U+Es - renal function, fluid balance

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11
Q

What might a CXR reveal in patients with DCM?

4

A
  • cardiomegaly
  • hepatomegaly
  • pleural effusion
  • pleural oedema
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12
Q

What are some general measures in treatment that could tackle underlying causes of DCM?

(4)

A
  • correct anaemia
  • remove exacerbating drugs (e.g. NSAIDs)
  • correct endocrine disturbances
  • HF nurse referral
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13
Q

What would be more specific medical drug therapies to treat DCM?

Give examples.

(4)

A
  • ACE inhibitors (e.g. ramipril)/ARB (e.g. candesartan)
  • beta blocker (e.g. bisoprolol)
  • diuretics (e.g. spironolactone)
  • antiplatelets (e.g. aspirin, clopidogrel)
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14
Q

What surgical interventions could be considered in severe cases of DCM?

A
  • ICD (implantable cardioverter defibrillator)
  • pacemaker
  • heart transplant
  • PCI/CABP
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15
Q

Which type of DCM has the best prognosis? Which has the worst?

A
  • peripartum

- DCM due to HIV infection

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16
Q

What are the three main types of cardiomyopathy?

A
  • dilated
  • restrictive
  • hypertrophic
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17
Q

Briefly outline what restrictive cardiomyopathy is.

5

A
  • least common of the three cardiomyopathies
  • heart walls are rigid (but not thickened).
  • heart is restricted from stretching and filling with blood properly.
  • The pumping action of the heart is not usually affected, and the heart can contract to pump blood around the body.
  • However, it is the filling function of the heart, where the heart muscle relaxes and the ventricles fill with blood, that is affected.
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18
Q

What are infiltrative cardiomyopathies?

A
  • diverse group of cardiac diseases that are characterized by the deposition of abnormal substances within the heart tissue
  • causes the ventricular walls to develop either diastolic dysfunction or, less commonly, systolic dysfunction.
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19
Q

Give examples of some infiltrative cardiomyopathies.

2

A 
cardiac amyloidosis (too much amyloid protein)
cardiac sarcoidosis
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20
Q

What are examples of non-infiltrative cardiomyopathies?

A

genetics
cancer treatment
diabetes

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21
Q

Give examples of some storage restrictive cardiomyopathies.

2

A

Fabry disease

Haemochromatosis (too much Fe in diet)

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22
Q

What is a sign of restrictive cardiomyopathy that may be picked up during an imaging investigation?

A

biatrial dilation

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23
Q

What are the symptoms of restrictive cardiomyopathies?

A
  • HF symptoms
  • SOB (fluid in lungs)
  • arrhythmias/heart block
  • fatigue
  • weight gain
  • peripheral oedema
  • syncope
  • palpitations
24
Q

What investigations would you carry out for suspected restrictive cardiomyopathy?

A
  • Hx/examination
  • ECG (LBBB)
  • CXR
  • BNP (NT-proBNP)
  • Bloods (FBC, U+Es - sarcoidosis, haemochromatosis, Fabry disease)
  • ECHO
  • cardiac MRI
  • biopsy (rare)
  • bone scan (amyloidosis)
  • cardiac catheterisation (rare)
25
Q

How is restrictive cardiomyopathy currently medically managed?

A
  • specific treatments if underlying cause known (e.g. Fabrys, amyloidosis, haemochromatosis)
  • ACE inhibitors (limited)
  • beta blockers
  • antiplatelets
  • antiarrhythmics
  • CCBs
  • diuretics (although limited)
  • surgery (transplant, ICD)
26
Q

Why do diuretics have to be limited?

A

they reduce venous return/CO, and it is the filling pressure that affects this pathology.

27
Q

Briefly outline what hypertrophic cardiomyopathy is.

A
  • portion of the heart myocardium becomes thickened without an obvious cause.
  • can be apical, septal or generalised.
  • impaired relaxation so behaves in a restrictive manner.
  • systolic function is usually ok.
28
Q

What are the complications of hypertrophic cardiomyopathy?

6

A
  • arrhythmias (AF)
  • HF
  • SCD
  • LVOT obstruction
  • Coronary artery disease/ischaemia
  • fibrosis
29
Q

What are the symptoms of hypertrophic cardiomyopathy?

5

A
  • fatigue
  • SOB on exertion
  • syncope (arrhythmias/LVOT)
  • anginal like chest pain
  • peripheral oedema
30
Q

What is the main cause of hypertrophic cardiomyopathy?

A

genetics (sarcomere gene defect)

31
Q

What might be found on examination of a patient with HCM?

4

A
  • could be none
  • irregular pulse (AF)
  • raised JVP
  • peripheral oedema
32
Q

What investigations might be carried out to come to a diagnosis of HCM?

(4)

A
  • ECG
  • Echo
  • CMRI
  • genetic testing
33
Q

What general measures might be taken when managing HCM?

A
  • regular follow ups
  • assessment for risk of SCD, need for ICD
  • avoid dehydration
  • avoid heavy exercise
34
Q

What would be more specific medical drug therapies to treat HCM?

(6)

A
  • beta blockers
  • diuretics (but limited)
  • verapamil (CCB)
  • disoprymide (anti-arrhythmic)
  • antiplatelet (if in AF)
  • surgery (ICD, transplant, septal myectomy)
35
Q

Briefly outline what myocarditis is?

A
  • acute/chronic inflammation of myocardium
  • can be associated with pericarditis
  • reduced function of myocardium
36
Q

There are many causes of myocarditis, which is the most common?

A

viral

37
Q

What are the complications of myocarditis?

A

arrhythmias
heart failure
heart block

38
Q

What are the symptoms of myocarditis?

A
  • fatigue
  • SOB
  • chest pain
  • shorter courses of myocarditis may not have a fever
39
Q

What investigations would be carried out to diagnose myocarditis?

What would the investigation be similar to?(1)

(6)

A

Similar to cardiomyopathy

  • ECG (usually abnormal)
  • biomarkers (but not troponin)
  • Echo
  • CMRI (oedema)
  • viral DNA PCR
  • Bloods: antibodies (HIV, Lymes)
40
Q

How is myocarditis generally managed?

3

A
  • treatment for symptoms of HF/arrhythmias
  • immunotherapy
  • stop possible toxic drug or exposure
41
Q

What is pericarditis?

A

Inflammation of the pericardial layers with or without myocardial involvement.

42
Q

What is the main causes of pericarditis?

A

viral

idiopathic

43
Q

What are some key causes of pericarditis, other than viral?

5

A 
bacterial
post MI
perforation
dissection of proximal aorta
neplasia
44
Q

What are the symptoms of pericarditis?

2

A
  • chest pain (pleuritic)
  • sitting forward helps, leaning back makes it worse
  • fever
45
Q

What are the clinical signs of pericarditis?

5

A
  • fever (bacterial?)
  • pericardial rub (walking in snow)
  • raised JVP (pericardial effusion)
  • hypotensive
  • muffled heart sounds (fluid insulates)
46
Q

What investigations might be carried out to diagnose pericarditis?

A
  • ECG

- Echo

47
Q

What might an ECG reveal in a patient with pericarditis?

A 
PR depression
ST elevation (like an MI)
48
Q

What is the treatment for pericarditis?

A

viral - symptomatic only

bacterial - drain, antimicrobial therapy

49
Q

What might cause a pericardial effusion?

When would a pericardial be haemodynamically significant?

A

same causes of pericarditis

pericardial tamponade

50
Q

What are the symptoms of pericardial effusion (with tamponade)?

(4)

A
  • fatigue
  • SOB
  • dizzy/low BP
  • chest pain
51
Q

What are the signs of pericardial effusion (with tamponade)?

4

A
  • raised JVP
  • low BP
  • pericardial rub
  • muffled heart sounds
52
Q

What changes on an ECG would indicate pericardial effusion?

A

QRS changes (heart is swinging in the fluid)

53
Q

What are the causes of constrictive pericarditis?

6

A
  • idiopathic
  • radiation
  • post-op
  • autoimmune
  • renal failure
  • sarcoidosis
54
Q

What are the symptoms/signs of constrictive pericarditis?

3

A
  • fatigue
  • SOB
  • cough

signs similar to RHF:

  • peripheral oedema
  • raised JVP
  • ascites
  • hepatomegally
55
Q

What is the treatment for constrictive pericarditis?

2

A

limited diuretics

pericardectomy

Cardiovascular System (37 decks)

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