Heart Disorders 3

Question 1

what is the pericardial sac?

Answer 1

a double walled sac containing the heart and great vessels

Question 2

what is pericarditis?

Answer 2

inflammation of the pericardial sac

Question 3

what is the aetiology of pericarditis?

Answer 3

• 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

Question 4

what are the different forms of pericarditis?

Answer 4

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

Question 5

what is serous fluid, how it is caused?

Answer 5

hypocellular fluid

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

Question 6

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

Answer 6

the serous fluid is mixed with fibrin
= fibrinous exudate

Question 7

what is Dressler’s syndrome??

Answer 7

an autoimmune reaction to antigens released following myocardial infarction

Question 8

what is Dressler’s syndrome also known as?

Answer 8

secondary pericarditis
AKA Post-MI syndrome

Question 9

what are 3 symptoms of Dressler’s syndrome?

Answer 9

fever
pleuritic chest pain
pericardial effusion

Question 10

what causes suppurative/purulent pericarditis? describe features.

Answer 10

infections

red, granular pus

Question 11

what is it called with inflammation extends beyond pericarditis?

Answer 11

mediastino-pericarditis

Question 12

what is a clinical feature of adhesive mediastinopericarditis?

Answer 12

cardiac hypertrophy/cardiac dilation

Question 13

what is the outcome of pericarditis?

Answer 13

rare for complete resolution
- get scarring
= restrictive pericarditis

Question 14

why is restrictive pericarditis serious?

Answer 14

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

Question 15

how is restrictive pericarditis caused?

Answer 15

scarring of the heart tissue from pericarditis

Question 16

what is a clinical feature of haemorrhage pericarditis?

Answer 16

blood mixed with serous or supparative effusion

Question 17

what are some common causes of haemorrhagic pericarditis?

Answer 17

neoplasia
infections - tuberculosis
post cardiac surgery

Question 18

how can caseous/cheesy pericarditis be caused?

Answer 18

tuberculosis or fungal infection

Question 19

what is constrictive pericarditis? how is it treated?

Answer 19

when the heart is then encased in a fibrous scar

• treated and removed by surgery

Question 20

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

Answer 20

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

Question 21

what is cardiac tamponade? also known as?

Answer 21

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

• pericardial effusion

Question 22

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

Answer 22

<50ml

Question 23

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

Answer 23

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

Question 24

what is pericardial friction rub?

Answer 24

when both sides of the pericardial sac are rubbing together

Question 25

what is myocarditis?

Answer 25

an infective/inflammatory process of the heart muscle

Question 26

what are the common causes of myocarditis?

Answer 26

infections
- Coxsackie A+B virus
- Chugs disease

Question 27

how does myocarditis clinically present?

Answer 27

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

Question 28

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

MFLPR

Answer 28

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

Question 29

what is cardiomyopathy?

Answer 29

disease of the heart muscle

Question 30

what are the 4 different types of cardiomyopathies?

Answer 30

dilated
hypertrophic
restrictive
arrythmogenic right ventricular

Question 31

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

Answer 31

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

Question 32

how is dilated cardiomyopathy caused?

Answer 32

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

10-20% = alcohol

Question 33

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

Answer 33

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

Question 34

how is dilated cardiomyopathy treated?

Answer 34

cardiac transplantation or long-term ventricular assist

Question 35

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

Answer 35

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

Question 36

4 clinical features of hypertrophic cardiomyopathy.

Answer 36

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

Question 37

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

Answer 37

• 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

Question 38

what are the causes of hypertrophic cardiomyopathy?

Answer 38

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

Question 39

what is restrictive cardiomyopathy? give some causes

Answer 39

impaired ventricular filling during diastole

secondary causes:
- fibrosis
- amyloidosis
- sarcoidosis
- metastatic tumours

Question 40

how does restrictive cardiomyopathy appear?

Answer 40

the ventricles are normal size
the myocardium is firm and noncompliant

Question 41

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

Answer 41

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.

Question 42

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

Answer 42

desmosomes detach and die

Question 43

symptoms of Arrhythmogenic Right Ventricular Cardiomyopathy? results in?

Answer 43

silent
syncope - blackouts
chest pain
palpatations

results in sudden cardiac death during exercise