L21 - Heart failure - pericardial disease and cardiomyopathies

Question 1

Examples of cardiomyopathies (4)

Answer 1

1. Hypertrophic cardiomyopathy
2. Arrhythmogenic cardiomyopathy
3. Restrictive cardiomyopathy
4. Dilated cardiomyopathy

Question 2

What is Hypertrophic cardiomyopathy?

Answer 2

• defined by increased LV thickness not solely explained by abnormal loading conditions

Question 3

What is dilated cardiomyopathy?

Answer 3

• left ventricular or bi-ventricular
• systolic dysfunction and dilation
• not explained by abnormal loading conditions or coronary artery disease.

Question 4

Arrhythmogenic ventricular cardiomyopathy

Answer 4

• predominantly a genetically determined heart muscle disorder
• fibrofatty replacement of right ventricular myocardium

Question 5

What is an ICD?

Answer 5

ICD = implantable cardioverter defibrillator

• constantly monitors heart rhythm

Question 6

How does an ICD work?

Answer 6

If life-threatening rhythm detected treatment delivered

1. ATP (anti-tachycardia pacing) - over rides the fast rhythm, brings it back down to normal
2. Defibrillation (large electric shock generated to restore normal rhythm)

Question 7

Describe layers of pericardium

Answer 7

1. Parietal - outer layer of fibrous and serous tissue

2. Visceral - inner: serous tissue only

Question 8

Functions of pericardium (4)

Answer 8

• protection
• prevents over expansion with increasing preload
• minor shock absorber
• immunological/hormonal

Question 9

Treatment for acute pericarditis

Answer 9

1. NSAIDS
2. Analgesia

sometimes acute pericarditis can cause effusion

Question 10

What is pericardial effusion?

Answer 10

Stuff in pericardial space

• fluid
• blood
• pus

Question 11

Cardiac tamponade

Answer 11

clinical syndrome caused by accumulation of fluid in pericardial space.

• reduced ventricular filling
• emergency!

Question 12

What is Beck’s triad

Answer 12

1. Hypotension
2. Jugular distension
3. Diminished heart sounds

Question 13

Dangers of cardiac tamponade

Answer 13

• if pericardium cannot move outwards, pressure transferred to heart
• lowest pressure chambers will be compressed
• impaired cardiac filling

Question 14

What is pericardial constriction? (4)

Answer 14

• damage to pericardium can cause fibrosis
• pericardial sac loses elasticity and becomes stiff.
• pericardium may stick to local structures
• restriction of hearts motion making it harder for heart to beat effectively

Question 15

general symptoms of cardiomyopathies (5)

Answer 15

• shortness of breath
• syncope
• palpitations
• peripheral oedema
• chest pain