FN: Myocardial Disease

Question 1

Acute Myocarditis Causes

Answer 1

idiopathic (50%)
Viral
Bacterial
Drugs
Autoimmine

Question 2

Acute Myocarditis viral causes

Answer 2

coxsackie B, Flu, HIV

Question 3

Acute Myocarditis bacterial causes

Answer 3

S. aureus, syphilis

Question 4

Acute Myocarditis drug causes

Answer 4

Cyclophosphamide
Herpception
CBZ
Phenytoin

Question 5

Acute Myocarditis autoimmune cuases

Answer 5

giant cell myocarditis associated with SLE

Question 6

Acute Myocarditis symptoms

Answer 6

Flu-like prodrome: fever, sore throat, myalgia Dyspnoea, fatigue
Chest pain (may coexist  ̄c Bornholm disease) Arrhythmia → palpitations

Question 7

Acute Myocarditis signs

Answer 7

Soft S1 S4 gallop

Question 8

Acute Myocarditis Ix

Answer 8

ECG
􏰁- ST-elevation or depression 􏰁 
-T wave -inversion
􏰁- Transient AV block
Bloods: +ve trop, ↑CK

Question 9

Acute Myocarditis Rx

Answer 9

Supportive

Rx cause

Question 10

HOCM aetiology

Answer 10

􏰀 LVOT obstruction from asymmetric septal hypertrophy
􏰀 AD inheritance (but 50% sporadic)
􏰀 β-myosin heavy chain mutation commonest
􏰀 Ask re family Hx of sudden death

Question 11

HOCM Symptoms

Answer 11

Angina
Dyspnoea
Palpitations: AF, WPW, VT Exertional syncope or sudden death

Question 12

HOCM signs

Answer 12

Jerky pulse
Double apex beat
Harsh ESM @ LLSE ̄c systolic thrill S4

Question 13

HOCM Ix

Answer 13

ECG
􏰁 - LVH/LAD/L strain,
- 􏰁 Ventricular ectopics, VT, VF Echo: ASH
Exercise test ± holter monitor to quantify risk

Question 14

HOCM Mx Medical

Answer 14

􏰁 -ve inotropes: 1st – β-B, 2nd –verapamil 􏰁 Amiodarone: arrhythmias
􏰁 Anticoagulate if AF or emboli

Question 15

HOCM non-medical

Answer 15

􏰁 Septal myomectomy (surgical or chemical) if severe symptoms

Question 16

HOCM other Mx

Answer 16

Consider ICD

Question 17

Cardiac Myxoma epi

Answer 17

􏰀 Rare, benign cardiac tumour

F>M = 2:1

Question 18

Cardiac Myxoma familial causes presentation

Answer 18

: e.g. Carney Complex

􏰁 Cardiac and cutaneous myxoma, skin pigmentation, endocrinopathy (e.g. Cushing’s)

Question 19

Cardiac myxoma presentation

Answer 19

90% in left atrium (fossa ovalis)

Question 20

Cardiac Myxoma features

Answer 20

􏰁 Clubbing, fever, ↓wt., ↑ESR
􏰁 Signs similar to MS (MDM, systemic emboli, AF)
but vary ̄c posture.

Question 21

Cardiac myxoma Dx

Answer 21

echo

Question 22

Cardiac myxoma Rx

Answer 22

Excision

Question 23

Restrictive Cardiomyopathy causes

Answer 23

miSSHAPEN
􏰀 Sarcoid
􏰀 Systemic sclerosis
􏰀 Haemochromatosis
􏰀 Amyloidosis
􏰀 Primary: endomyocardial fibrosis
􏰀 Eosinophilia (Loffler’s eosinophilic endocarditis) 􏰀 Neoplasia: carcinoid (→ TR and PS)

Question 24

Restrictive Cardiomyopathy Clinical features

Answer 24

as constrictive pericarditis

Question 25

Restrictive Cardiomyopathy Dx

Answer 25

Catherisation

Question 26

Restrictive Cardiomyopathy Rx

Answer 26

Rx cause

Question 27

Dilated Cardiomyopathy Causes: DILATE

Answer 27

􏰀 Dystophy: muscular, myotonic, glycogen storage disease 􏰀 Infection: complication of myocarditis
􏰀 Late pregnancy: peri-, post-partum
􏰀 Autoimmune: SLE
􏰀 Toxins: EtOH, doxorubicin, cyclophosphamide, DXT
􏰀 Endocrine: thyrotoxicosis

Question 28

Dilated Cardiomyopathy Presentation

Answer 28

􏰀 LVF and RVF

􏰀 Arrhythmias

Question 29

Dilated Cardiomyopathy signs

Answer 29

􏰀 JVP ↑↑
􏰀 Displaced apex
􏰀 S3 gallop
􏰀 ↓BP
􏰀 MR/TR

Question 30

Dilated Cardiomyopathy Ix

Answer 30

􏰀 CXR: cardiomegaly, pulmonary oedema
􏰀 ECG: T inversion, poor progression
􏰀 Echo: globally dilated, hypokinetic heart + ↓EF
􏰀 Catheter + biopsy: myocardial fibre disarray

Question 31

Dilated Cardiomyopathy Mx

Answer 31

􏰀 Bed rest
􏰀 Medical: diuretics, ACEi, digoxin, anticoagulation
􏰀 Non-medical: biventricular pacing, ICD
􏰀 Surgical: heart Tx