Disease of the heart muscle, pericardium and endocarditis Flashcards
Define acute myocarditis
acute inflammation of the myocardium. The heart becomes flabby with focal haemorrhages and inflammatory infiltrate
What are the symptoms of acute myocarditis
fever
chest pain
SOB
palpations
What are the sign of acute myocarditis
Arrhythmia
Cardiac failure
Acute myocarditis aetiology
mainly caused by enteroviruses - Coxseickie A +B, Echovirus
How do you diagnose acute myocarditis
viral PCR
Throat and stool swap for enterovirus
Throat swab for echovirus
What investigation finding would you discover in acute myocarditis
CXR: cardiac enlargement
ECG: ST elevation or deprivation, T wave inversion, arrhythmia, heart block
Elevated CK / Troponium
How would you treat Acute Myocarditis
Treat underlying cause of infection
Antibiotics if necessary
Bed rest
ACEI, B-blockers, Spironolactone, Digoxin
Define hypertrophic cardiomyopathy
Hypertrophy in the absence of other disease
What is the most common cause of sudden cardiac death in children / young people
Hypertrophic (OBSTRUCTIVE) cardiomyopathy
Which disease is autosomal dominant, which many of the mutations in genes encoding for sacromeric proteins
HOCM
What are the signs and symptoms of HOCM
Asymptomatic Chest pain, dyspnoea, syncope LVOT obstruction Double apex pulsation S4 Jerky carotid pulse Systolic murmur Hypertrophy affecting IV septum
ECG: LV hypertrophy, Q waves inferolaterally
ECHO: diagnostic ASYMMETRY
HOCM
Treatment of HOCM
treat symptoms
mild - amiodarone
b-blockers +/- verapamil
‘banana shaped LV cavity’
HOCM
which kind of murmur is HOCM quite often associated with
mitral regurgitation
A dilated flappy heart of unknown cause that is congenitally X-linked
Dilated cardiomyopathy
Symptoms and signs of dilated cardiomyopathy
arrhythmias, HF, thrombembolism
Investigation findings from Dilated cardiomyopathy
CXR: cardiac enlargement
ECG: ST changes, arrhythmias
ECHO: dilated chambers
ANGIOGRAPHY: to exclude CHD
Treatment of Dilated cardiomyopathy
manage HF
cardiac resync therapy
Cardiomyopathy that has decreased volume of both ventricles w/ bi-atrial enlargement, normal wall thickness and impaired filling
Restrictive cardiomyopathy
Very rare, associated with amyloidosis, sarcoidosis, endocardial fibrosis
restrictive cardiomyopathy
Symptoms and signs of restrictive cardiomyopathy
HF symptoms, increased JVP, Hepatomegaly, Oedema, Ascities
Treatment of restrictive cariomyopathy
TREAT CAUSE
Inflammation of the pericardium
acute pericarditis
Causes of acute pericarditis
Viruses, Bacterial, Fungi, MI, Drugs, trauma, surgery, malignancy, radiotherapy, sarcoidosis…etc…
Clinical features of acute pericarditis
central chest pain - worse on inspiration or lying flat
pericardial friction rub
pericardial effusion / pericardial tamponade
fever ?
high-pitched scratching noise
pericardial friction rub
Saddle-shape of ECG
acute pericarditis
Treatment of acute pericarditis
analgesia - ibuprofen
treat the cause
steroids
Accumulation of fluid in the pericardial sac
pericardial effusion
Clinical features of pericardial effusion
Dyspnoea
raised JVP
Bronchial breathing - lung base
To diagnose pericardial effusion
CXR - large, globular heart
ECG - low voltage QRS complexes and alternating QRS morphologies
Management of pericardial effusion
treat the cause - NSAID, Steroids, antibiotics
Pericardiocentesis - diagnostic
echo
Describe constrictive pericarditis
the heart is encased in a rigid pericardium
What are the causes of constrictive pericarditis
Unknown in UK
TB in other countries
Pericarditis
Clinical features of constructive pericarditis
R.HF : raised JVP Kussmaul's sign soft, defuse apex quiet heart sounds pericardial knock hepatosplenomegaly acities oedema
Investigations for constrictive pericarditis
CXR - small heart +/- peripheral calcification
Management of constrictive pericarditis
surgical excision
Accumulation of pericardial fluid raises intrapericardial pressure, hence poor ventricular filling and fall in cardiac output
cardiac tamponade
causes of cardiac tamponade
pericarditis aortic dissection haemodialysis warfarin transmural puncture MI
Signs of cardiac tamponade
Pulsus paradoxus, decreased blood pressure increased pulse increased JVP Kussmaul's sign muffled S1 and S2
Treatment of xardiac tamponade as a complication of an MI
pericardial aspiration
surgery
CXR: large globular heart
ECG: low voltage QRS complexes + alternating QRS morphologies
pericardial effusion
