Diseases of heart muscle and pericardial disease Flashcards
What is acute myocarditis and what are the causes?
Acute myocarditis is inflammation of the myocardium often associated with pericardial inflammation. Causes: -50% idiopathic -Viral -Bacterial -Spirochaetes -Protozoa -Drugs -Toxins -Immunological
What are the viral causes of myocarditis?
enteroviruses, adenoviruses etc
What are the bacterial causes of myocarditis
Staph, Strep, Clostridia, diphtheria, TB etc
What are the spirochaetes causes of myocarditis
Leptospirosis, syphilis, lyme disease
What are the protozoa causes of myocarditis
Chagas, toxoplasmosis
What are the protozoa causes of myocarditis
Cyclophosphamide, trastuzumab, penicillin
What are the toxin causes of myocarditis
cocaine, lithium, alcohol
What are the immunological causes of myocarditis?
SLE, sarcoid, scleroderma
What are the signs and symptoms of acute myocarditis?
ACS- like symptoms, heart failure symptoms, palpatations, tachycardia, soft S1, S4 gallop
What tests should be done for acute myocarditis?
Endomyocardial biopsy is gold standard
Should have bloods: crp, esr and troponin may be raised, viral serology and tests for other causes
ECG shows st changes and t wave inversion, atrial arrhythmias, transient AV block, qt prolongation
Echo will show diastolic dysfunction and regional wall defects
What is the treatment of acute myocarditis?
Supportive, treat underlying cause
Treat arrhythmias and heart failure
Avoid exercise that can precipitate arrhythmias
12-25% develop dilated cardiomyopathy
What is dilated cardiomyopathy and how does it present?
It is a dilated flabby heart of unknown cause. presentation: -Fatigue -dyspnoea -pulmonary oedema -RVF -emboli Signs: -Increased pulse _decreased BP -increased JVP -displaced apex -mitral or tricuspid regurge
What investigations should be done for dilated cardiomyopathy?
Bloods show raised BNP - secreted by stretched ventricular myocardium
Decreased sodium shows poor prognosis
CXR- cardiomegaly, pulmonary oedema
ECG - tachy, non specific t wave changes
echo - globally dilated and poor ejection fraction
How is dilated cardiomyopathy treated?
It is treated through bed rest, diuretics, beta blockers, ACE-I, anticogulations, biventricular pacing and transplantation.
Similar to heart failure
What is hypertrophic cardiomyopathy?
LV outflow obstruction from asymmetrical septal hypertrophy. Leading cause of sudden cardiac death in young.
what is the cause of hypertrophic cardiomyopathy?
Autosomal dominant inheritance but 50% are sporadic, ask about family history of sudden death, may occur at any age
What are the signs and symptoms of hypertrophic cardiomyopathy?
Sudden death may be first manifestation Angina Dyspnoea palpitation Jerky pulse Systolic thrill at lower left sternal edge Harsh ejection systolic murmur
What tests should be done for hypertrophic cardiomyopathy?
ECG shoes progressive t wave inversion, deep q waves, ventricular ectopics, VT
echo- asymmetrical septal hypertrophy
Cardiac catheterisation helps assess severity
How do you treat hypertrophic cardiomyopathy?
Beta blockers or verapamil for symptoms (reduce ventricular contractility)
Amiodarone for arrhythmias
Anticoagulate
Surgical intervention in severe cases and implantable defib
What are the causes of restrictive cariomyopathy?
Similar to constrictive pericrditis in terms of presentation It is caused by: Idiopathic Amyloidosis Sarcoidosis Haemochromocytosis Scleroderma Endomyocardial fibrosis
What are the presentations of restrictive cardiomyopathy?
Features of RVF predominate Raised JVP Hepatomegaly Oedema Ascites
How is diagnosis and treatment of restrictive cariomyopathy done?
Echo, MRI, cardiac catheterisation
Treat the cause
What is a cardiac myxoma and what causes it?
It is a rare benign cardiac tumour
It is usually sporadic but can be familial
What is the presentation of a cardiac myxoma?
Itmay mimic infective endocarditis or mitral stenosis
Tumour plop may be heard, signs vary according to posture
What are the causes of acute pericarditis?
Idiopathic Secondary to: -Viruses - EBV, CMV etc -bacteria - TB commonest cause -Fungi and parasites - v rare -autoimmune - systemic autoimmune diseases e.g. SLE, RA -Drugs - procaine, penicillin etc -Metabolic - uraemia, hypothyroidism -Others - trauma, surgery, malignancy, MI
What are the clinical features of acute pericarditis?
Central chest pain on inspiration or lying flat
Sitting forward typically relieves
A pericardial friction rub may be heard
fever may occur
What tests should be done for acute pericarditis?
ECG classically shows saddle shaped concave ST elevation and PR depression
CXR may show cardiomegaly if pericardial effusion
What is the treatment for acute pericarditis?
Nsaids or asprin with gastric protection for 1-2weeks
Colchicine 500mcg OD to reduce inflammatory mediators. Treat the cause. If autoimmune suspected can give steroids but they may increase the risk of recurrence
