Heart Disorders 3 Flashcards by Simran Sandhu

what is the pericardial sac?

a double walled sac containing the heart and great vessels

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what is pericarditis?

inflammation of the pericardial sac

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what is the aetiology of pericarditis?

infections - virus e.g. coxsackie B
immunologically mediated processes e.g. rheumatic fever, late post-MI, drug hypersensitivity
other conditions e.g. uraemia, cardiac surgery, neoplasia, trauma, radiation, Dressler’s syndrome

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what are the different forms of pericarditis?

acute pericarditis - inflamed and serous
chronic pericarditis - adhesive and fibrinous

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what is serous fluid, how it is caused?

hypocellular fluid

caused by non-infectious aetiologies:
- immunologically mediated processes
- miscellaneous - uraemia, neoplasia, radiation

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with chronic pericarditis, the characteristic is fibrous, how does the serous fluid compare to acute pericarditis?

the serous fluid is mixed with fibrin
= fibrinous exudate

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what is Dressler’s syndrome??

an autoimmune reaction to antigens released following myocardial infarction

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what is Dressler’s syndrome also known as?

secondary pericarditis
AKA Post-MI syndrome

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what are 3 symptoms of Dressler’s syndrome?

fever
pleuritic chest pain
pericardial effusion

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what causes suppurative/purulent pericarditis? describe features.

infections

red, granular pus

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what is it called with inflammation extends beyond pericarditis?

mediastino-pericarditis

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what is a clinical feature of adhesive mediastinopericarditis?

cardiac hypertrophy/cardiac dilation

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what is the outcome of pericarditis?

rare for complete resolution
- get scarring
= restrictive pericarditis

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why is restrictive pericarditis serious?

can cause restrictions in the heart contracting
- no adequate blood supply around the body

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how is restrictive pericarditis caused?

scarring of the heart tissue from pericarditis

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what is a clinical feature of haemorrhage pericarditis?

blood mixed with serous or supparative effusion

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what are some common causes of haemorrhagic pericarditis?

neoplasia
infections - tuberculosis
post cardiac surgery

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how can caseous/cheesy pericarditis be caused?

tuberculosis or fungal infection

what is constrictive pericarditis? how is it treated?

when the heart is then encased in a fibrous scar

treated and removed by surgery

what are clinical features of pericarditis? how can chest pain be exaggerated, relived and radiated?

sharp central chest pain
- exaggerated by movement, respiration, laying flat
- relieved by - sitting forward
- radiates - shoulder/neck
- similar to - angina, pleurisy

pericardial friction rub

other complications - cardiac tamponade

what is cardiac tamponade? also known as?

compression of the heart by accumulation of fluid in the pericardial sac

pericardial effusion

how much fluid is there usually with cardiac tamponade/pericardial effusion?

<50ml

what if there is a sudden build up of pericardial effusion, up to 200-300ml?

the heart has no time to enlarge
- impairs cardiac function due to compression of atria, ventricles or vena cavae

what is pericardial friction rub?

when both sides of the pericardial sac are rubbing together

what is myocarditis?

an infective/inflammatory process of the heart muscle

what are the common causes of myocarditis?

infections - Coxsackie A+B virus - Chugs disease

how does myocarditis clinically present?

asymptomatic heart failure sudden death arrhymias can mimic acute MI non specific symptoms - fatigue, palpatations, blackout, discomfort, fever

what are the names for the most 5 common type of heart tumours? MFLPR

Myxomas - most common - 90% in atria - present due to valvular obstruction Fibromas Lipomas Papillary Elastofibroma - spike shaped tumours - indolent but can present via embolisation - mostly arises on valves Rhabdomyoma - common in children

what is cardiomyopathy?

disease of the heart muscle

what are the 4 different types of cardiomyopathies?

dilated hypertrophic restrictive arrythmogenic right ventricular

what is dilated cardiomyopathy? what does it lead to? describe the clinical presentation and how it appears under a microscope.

dilation of the heart leading to contractile, systolic dysfunction - heart appears **enlarged, heavy, flabby** - fatigue - shortness of breath - poor exertion capacity - under microscope = myocyte hypertrophy with **fibrosis**

how is dilated cardiomyopathy caused?

20-50% = genetic - autosomal dominant - cytoskeletal protein gene mutation 10-20% = alcohol

what are the chances of surviving 5 years after initial dilated cardiomyopathy?

25% - due to congestive cardiac failure, arrhythmias, embolisms

how is dilated cardiomyopathy treated?

cardiac transplantation or long-term ventricular assist

what is hypertrophic cardiomyopathy? what does it result in? how does it appear?

- the heart muscle becomes thickened - results in a stiff left ventricular myocardium - diastolic dysfunction - preserved systolic function - appears thick-walled, heavy and hyper-contracting

4 clinical features of hypertrophic cardiomyopathy.

- reduced stroke volume due to impaired diastolic filling - obstruction to the left ventricular outflow - extertional dyspnoea - systolic ejection murmur

what can be the complications of hypertrophic cardiomyopathy (5) and treatment?

- atrial fibrillation - mural thrombus formation - stroke - cardiac failure - ventricular arrhythmias - sudden death treatment: - beta-adrengic blockers - decrease heart rate and contractibility - reduce the mass of the septum = relieves outflow tract obstruction

what are the causes of hypertrophic cardiomyopathy?

100% genetic - genetic defect to sarcomeric proteins in cardiac myocytes

what is restrictive cardiomyopathy? give some causes

impaired ventricular filling during diastole secondary causes: - fibrosis - amyloidosis - sarcoidosis - metastatic tumours

how does restrictive cardiomyopathy appear?

the ventricles are normal size the myocardium is firm and noncompliant

what is Arrhythmogenic Right Ventricular Cardiomyopathy also known as? how is it caused, affecting how many people?

arrhythmogenic right ventricular dysplasia - a genetic disease. 1/5000 causes right ventricle to dilate and become thin - the right ventricle muscle becomes fibrofatty - cell-cell desmosomes become disordered.

with arrhythmogenic Right Ventricular Cardiomyopathy, what happens when the heart is exercised and stressed?

desmosomes detach and die

symptoms of Arrhythmogenic Right Ventricular Cardiomyopathy? results in?

silent syncope - blackouts chest pain palpatations results in sudden cardiac death during exercise