Diseases of Heart Muscle Flashcards
Name at least 3 causes of MYOCARDITIS
idiopathic (50%)
Viral
bacterial
Spirochaetes
Protozoa
Drugs
Toxins (cocaine/lithium)
Immune reaction (SLE, sarcoid, kawasaki)
Give examples of viruses which could cause myocarditis
Enteroviruses
Adenoviruses
EBV
CMV
Influenza
Hepatitis
Mumps
Polio
HIV
HSV
What bacteria can cause myocarditis?
Staph
Strep
Clostridia
Diphtheria
TB
Meningococcus
Mycoplasma
What drugs can be responsible for myocarditis?
Cyclophosphamide
Chloramphenicol
Methyldopa
ECG findings in myocarditis
ST changes
TWI
Atrial arrhythmias
Transient AV block
QT prolongation
What bloods should you order if querying myocarditis?
Troponin
CRP
Viral serology
Treatment of myocarditis
Supportive management
Tx underlying cause (e.g. Abx if bacterial infection)
Tx arryhthmias/ HF as normal
NSAIDs for pain
Dilated cardiomyopathy is associated with…
Alcohol
Hypertension
Chemotherapy
Haemochromatosis
Viral infections
Autoimmune conditions
Peri/Postpartum
Thyrotoxicosis
Congenital (X-Linked)
Symptoms of dilated cardiomyopathy
SOB
Fatigue
Pulmonary Oedema
RV failure
Emboli
AF
VT
Signs of cardiomyopathy on examination
high HR
raised JVP
low BP
displaced apex beat
S3 gallop
MR/TR
pleural effusion
oedema
jaundice
hepatomegaly
ascites
Dilated cardiomyopathy findings on CXR
Cardiomegaly
pulmonary oedema
Dilated cardiomyopathy findings on ECG
tachycardia
non-specific T wave changes
Poor R wave progression
Dilated cardiomyopathy findings on ECHO
globally dilated heart
hypokinetic
low EF%
MR/TR
Left mural thrombus
Treatment of dilated cardiomyopathy
Bed rest
Diuretics for HF symptoms
Beta blockers
ACEi
anticoagulation
Biventricular pacing/ICD
Transplant (prognosis 40% in 2 years)
Definition of Hypertrophic cardiomyopathy
Left ventricular outflow tract obstruction due to asymmetrical hypertrophy of heart septum
=> often leads to sudden cardiac death
How is hypertrophic cardiomyopathy inherited
Autosomal dominant
(but 50% are sporadic mutations)
Genes affected in hypertrophic cardiomyopathy
Beta-myosin
Alpha-Tropomyosin
Troponin T
Symptoms of hypertrophic cardiomyopathy
note some patients may be asymptomatic and present with sudden cardiac death
Angina/chest pain
SOB
Palpitations
Syncope
CCF
Signs of hypertrophic cardiomyopathy
Jerky pulse
raised JVP
double apex beat
systolic thrill, lower left sternal edge
harsh ejection systolic murmur
ECG changes in hypertrophic cardiomyopathy
LVH
TWI
q waves in inferior/lateral leads
AF, WPW
Ectopics
VT
Findings on ECHO in hypertrophic cardiomyopathy
Asymmetrical septal hypertrophy
Small LV cavity
Hypercontractile posterior wall
Treatment for hypertrophic cardiomyopathy
Beta blockers/verapamil for symptoms
Aim to REDUCE ventricular contractility
Amiodarone if arryhthmias
Anticoagulation if AF/emboli
Surgery - septal myomectomy (if severe symptoms)
Consider ICD
Causes of restrictive cardiomyopathy
idiopathic
amyloidosis
haemochromatosis
sarcoid
scleroderma
fibrosis
How do patients present with restrictive cardiomyopathy
Similar to constrictive pericarditis
RV failure
- raised JVP
- hepatomegaly
- oedema
- ascites
What investigations can be used to diagnose restrictive cardiomyopathy
ECHO
MRI
Cardiac catheterisation
What is the name given to a benign cardiac tumour?
Cardiac myxoma
Females are two times as likely as males to develop cardiac myxoma. TRUE/FALSE
TRUE
2:1 females to males
How are cardiac myxomas usually inherited?
Sporadic
Familial - “Carney Complex”(cardiac/cutaneous myxomas)
Presentation of cardiac myxoma
Fever
Weight loss
clubbing
Raised CRP
Systemic emboli
LA obstruction
AF
What sound may be audible on examination of a patient with cardiac myxoma?
Tumour “plop”
How is cardiac myxoma managed?
Excision