Heart Disorders 3 Flashcards
what is the pericardial sac?
a double walled sac containing the heart and great vessels
what is pericarditis?
inflammation of the pericardial sac
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
what are the different forms of pericarditis?
acute pericarditis - inflamed and serous
chronic pericarditis - adhesive and fibrinous
what is serous fluid, how it is caused?
hypocellular fluid
caused by non-infectious aetiologies:
- immunologically mediated processes
- miscellaneous - uraemia, neoplasia, radiation
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
what is Dressler’s syndrome??
an autoimmune reaction to antigens released following myocardial infarction
what is Dressler’s syndrome also known as?
secondary pericarditis
AKA Post-MI syndrome
what are 3 symptoms of Dressler’s syndrome?
fever
pleuritic chest pain
pericardial effusion
what causes suppurative/purulent pericarditis? describe features.
infections
red, granular pus
what is it called with inflammation extends beyond pericarditis?
mediastino-pericarditis
what is a clinical feature of adhesive mediastinopericarditis?
cardiac hypertrophy/cardiac dilation
what is the outcome of pericarditis?
rare for complete resolution
- get scarring
= restrictive pericarditis
why is restrictive pericarditis serious?
can cause restrictions in the heart contracting
- no adequate blood supply around the body
how is restrictive pericarditis caused?
scarring of the heart tissue from pericarditis
what is a clinical feature of haemorrhage pericarditis?
blood mixed with serous or supparative effusion
what are some common causes of haemorrhagic pericarditis?
neoplasia
infections - tuberculosis
post cardiac surgery
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
