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New Mix > HF, constrictive pericarditis, cardiomyopathy, myocarditis > Flashcards

HF, constrictive pericarditis, cardiomyopathy, myocarditis Flashcards

1
Q

Define cardiomyopathy

A

A group of diseases in which the myocardium becomes structurally and functionally abnormal

…in the ABSENCE of coronary artery disease, valvular disease and congenital heart disease

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2
Q

What are the 3 layers of the heart?

A

epicardium = outer protective
myocardium = muscular
endocardium = thin inner layer

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3
Q

Primary versus secondary cardiomyopathy

A

1 = abnormality confined to the myocardium
2 = myopathy is part of a systemic disease

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4
Q

What are the 3 types of cardiomyopathy?

A

DILATED – ventricle dilated, thin walls, reduced ventricular pressure

HYPERTROPHIC – muscle hypertrophies inwards, more rigid, obstruction etc.

RESTRICTIVE – basically the same amount of muscle but it’s rigid and doesn’t pump as well as normal

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5
Q

Symptoms of cardiomyopathy

A

Symptoms of HF:
- SOB on exertion
- Fainting
- Fatigue

Sudden death often 1st presentation

Family history (sudden, unexplained death at young age)

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6
Q

Signs of cardiomyopathy

A

Signs of HF:
- Respiratory crackles
- Murmurs
- S3 = Early ventricular filling- due to ventricular dilation (dilated CM)
- S4 = Atrial contraction- due to stiff, low compliant ventricle (hypertrophic CM)

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7
Q

What investigations are done for cardiomyopathy?

A

GOLD STANDARD = ECHO
- visualise the structure, observe ventricular function

No single diagnostic test for all types:
- BNP
- CXR
- ECG
- cardiac catheterisation
- stress test

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8
Q

Which law applies to the pathophysiology of dilated cardiomyopathy?

A

law of Laplace: increased radius leads to reduced ventricular pressure

Ventricles enlarge and become dilated.
Walls thin and weaken -> can’t contract effectively

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9
Q

RF for dilated cardiomyopathy

A

ALCOHOL
post-viral (myocarditis from viral infection can damage)
haemochromatosis
genetic

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10
Q

Signs of dilated cardiomyopathy

A

DISPLACED APEX BEAT
Signs and symptoms of HF
TR/MR murmur- end diastolic
S3- due to rapid ventricular filling

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11
Q

On echo and x-ray, what findings would indicate dilated cardiomyopathy?

A

echo = dilated ventricle
xray = globular, enlarged heart

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12
Q

State 3 ways in which hypertrophic cardiomyopathy can cause problems

A
  1. Increased stiffness/rigidity of the muscle affects pumping.
  2. Thickened muscle disrupts electrical conduction and causes arrhythmia.
  3. Hypertrophic Obstructive Cardiomyopathy (HOCM) = thickened ventricle obstructs cardiac outflow
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13
Q

RF for hypertrophic cardiomyopathy

A

50% is familial (autosomal dominant)

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14
Q

How does hypertrophic cardiomyopathy present?

A

Usually ASYMPTOMATIC
Sudden cardiac death is often the 1st presentation

Angina, dyspnoea on exertion, palpitations, syncope

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15
Q

Signs of hypertrophic cardiomyopathy

A

EJECTION SYSTOLIC MURMUR- dilated ventricles obstruct outflow

Jerky carotid pulse

Double apex beat but NOT DISPLACED ! (muscle grows inwards)

S4- due to ventricle non-compliance

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16
Q

How do heart sounds differ in dilated versus hypertrophic cardiomyopathy?

A

DILATED = S3 (Ken-tuc-ky)
- during passive ventricular filling (early disatolic)
- due to very compliant LV (ventricle wall vibration)

HYPERTROPHIC = S4 (Ten-es-see)
- during active ventricular filling (late diastolic)
- due to non-complaint LV (forceful atrial contraction)

17
Q

State 2 signs of LVH on ECG

A

V1 + V2 = deep S
V5 + V6 = tall R (>7 large squares)

18
Q

Signs of hypertrophic cardiomyopathy on ECG

A

Q waves
Left axis deviation
signs of LVH: deep S (V1/2) and tall R (V5/6)

19
Q

Explain the pathophysiology of restrictive cardiomyopathy

A
  1. Ventricles become abnormally rigid and lose flexibility.
  2. Impaired ventricular filling during diastole.
  3. Reduced preload -> reduced CO + backing up of blood
20
Q

Causes of restrictive cardiomyopathy

A

INFILTRATIVE -OSIS DISEASES:
sarcoidosis
amyloidosis
haemochromatosis

Familial
Idiopathic

21
Q

Signs and symptoms of restrictive cardiomyopathy

A

usually ASYMPTOMATIC

signs of RIGHT HEART FAILURE:
- raised JVP
- S3
- ascites and oedema
- hepatomegaly
- Kussmaul’s sign = paradoxical rise in JVP during inspiration

22
Q

What is Kussmaul’s sign and what does it indicate?

A

Kussmaul’s sign = paradoxical rise in JVP during inspiration

Indicates impaired right ventricular filling so blood backs up into the jugular vein.

23
Q

What normally happens to JVP during inspiration?

A

Normally JVP falls with inspiration

due to reduced pressure in the expandingthoracic cavity

therefore increased volume afforded to right ventricular expansion during diastole.

24
Q

Define constrictive pericarditis

A

Chronic inflammation of the pericardium with thickening and scarring
(basically chronic pericarditis with fibrosis)

25
Q

Causes of constrictive pericarditis

A

Infectious (TB, bacterial, viral)- TB commonest cause worldwide
Acute pericarditis
Cardiac surgery and radiation- commonest in UK
Idiopathic

26
Q

signs of constrictive pericarditis

A

Similar to restrictive cardiomyopathy

signs of RIGHT HEART FAILURE:
- raised JVP
- S3
- ascites and oedema
- hepatomegaly
- Kussmaul’s sign = paradoxical rise in JVP during inspiration

27
Q

investigations for constrictive pericarditis

A

CXR: pericardial calcification
Echo: increased pericardial thickness – differentiate from restrictive cardiomyopathy
Cardiac CT/MRI

28
Q

How can constrictive pericarditis be cured?

A

Surgical pericardial resection is the definitive treatment (pericardectomy)
(unlike restrictive CM which requires transplant)

29
Q

Aston was a 33-year-old male who suddenly collapsed on stage. Although the doctors attempted “love CPR”, the patient died, and the post-mortem revealed a hypertrophic heart.
What was the most likely cause of death?

A. Obstructed flow of blood from the heart
B. Arrhythmia
C. Reduced pumping of blood due to stiff myocardium
D. Stroke
E. Sub-arachnoid haemorrhage

A

A. Obstructed flow of blood from the heart
Likely to experience warning symptoms beforehand

B. Arrhythmia
Most likely cause of death from HCM, hypertrophic muscle affects electrical circuits

C. Reduced pumping of blood due to stiff myocardium
Likely to experience warning symptoms beforehand

D. Stroke
Heart issue rather than brain issue, ventricular arrhythmia (not AF)

E. Sub-arachnoid haemorrhage
Heart issue rather than brain issue

30
Q

Marvin presents with a 4-month history of increasing breathlessness and ankle swelling. On examination, he has ascites and Kussmaul’s sign is elicited.
What would be the most useful diagnostic investigation?

A. Echocardiography
B. ECG
C. Endomyocardial biopsy
D. Abdominal X-ray
E. CK

A

A. Echocardiography
Allows differentiation between restrictive cardiomyopathy and constrictive pericarditis

B. ECG
Non-specific signs – not the most useful

C. Endomyocardial biopsy
Pericardial biopsy might be useful – but highly invasive

D. Abdominal X-ray
Chest X-ray would be useful to look for pericardial calcifications, but these are not specific to constrictive pericarditis

E. CK
May be mildly elevated in both constrictive pericarditis and restrictive cardiomyopathy – not that helpful

31
Q

Define myocarditis

A

Inflammation of the myocardium
i.e. Inflammatory cardiomyopathy

32
Q

Causes of myocarditis

A
  • Infectious- Coxakie B virus = most common cause in - Europe
  • Drugs (cocaine)
  • Metals
  • Radiation
33
Q

Signs and symptoms of myocarditis

A

Flu-like prodrome
Chest pain (worse when lying down)
SOB
Palpitations

34
Q

Investigations myocarditis

A

ECG: non-specific ST and T wave changes

Cardiac biomarkers: CK and troponin

Endomyocardial biopsy: diagnostic but not routinely performed

35
Q

What is the most common complication of myocarditis?

A

dilated cardiomyopathy (why dilated cardiomyopathy can be post-viral)

36
Q

How can you differentiate between constrictive pericarditis and my myocarditis?

A

Cardiac biomarkers are not elevated in constrictive pericarditis, but they are in myocarditis because the muscle is affected

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