Muscle Flashcards
Symptoms and signs of myocarditis
Fatigue Dyspnoea Chest pain Fever Palpitations Tachycardia
What is myocarditis
Inflammation of the myocardium
ECG is myocarditis
ST elevation or depression
T wave inversion
Atrial arrhythmias
Transient AV block
Clinical diagnosis of myocarditis
+ve troponin I or T
Test which -ve excludes myocarditis
Antimyosin scintigraphy
Management and prognosis of myocarditis
Supportive and treat the cause
Patients may recover or get intractable heart failure
What is dilated cardiomyopathy
Dilated, flabby heart of unknown cause
Associations of dilated cardiomyopathy
HTN, alcohol, haemochromatosis, viral infection, autoimmune, pregnancy, thryrotoxicosis, congenital
Presentation of dilated cardiomyopathy
Fatigue, dyspnoea, pulmonary oedema RVF Emboli AF VT
Signs of dilated cardiomyopathy
Tachycardia Hypotension Raised JVP Displaced diffuse apex AV valve regurge Pleural effusion Oedema jaundice and ascites
CXR in dilated cardiomyopathy
Cardiomegaly
Pulmonary oedema
Echo in dilated cardiomyopathy
Low ejection fraction
Management of dilated cardiomyopathy
Bed rest Diuretics Digoxin Ace -I Anticoagulation Pacing Transplant
What is hypertrophic cardiomyopathy
LV outflow tract obstruction from asymmetric septal hypertrophy
Leading cause of sudden cardiac death in young
Inheritance of hypertrophic cardiomyopathy
Autosomal dominant inheritance
50% are sporadic
Mutations in myosin and troponin
Symptoms and signs of HCM
Sudden death may be first sign
Or angina, dyspnoea, palpitations, syncope, CCF
ECG in HCM
Lvh Progressive t wave inversion Deep Q waves AF Ventricular ectopics VT
Treatment of HCM
Beta blockers or verapamil for symptoms Amiodarone for arrhythmias Anticoagulate if AF Rarely dual chamber pacing Maybe implantable defibrillator
Presentation of restrictive cardiomyopathy
Same as constrictive pericarditis
Features of RVF predominate
What is cardiac myxoma?
Benign rare cardiac tumour
Presentation of cardiac myxoma
Mimic infective endocarditis (weight loss, fever, clubbing, raised ESR)
Or mitral stenosis
Treat with excision
What is pericarditis
Inflammation of pericardium
Causes of acute pericarditis
Idiopathic or secondary to infection, MI, drugs
Clinic features of pericarditis
Central chest pain worse on inspiration or lying flat
Relief by sitting forward
Might hear pericardial friction rub
What should you look for as extra to pericarditis
Pericardial effusion (do echo, cardiomegaly on CXR) Cardiac tamponade
ECG in pericarditis
Concave (saddle-shaped) ST elevation
But may be normal or non specific o
Blood tests for pericarditis
Troponin may be raised
Blood culture for pathogen
Treatment of pericarditis
Analgesia
Treat cause
Maybe colchicine before steroids/immunosuppressants if relapse or continuing symptoms
% or recurrence in pericarditis
15-40%
What is a pericardial effusion
Accumulation of fluid in the pericardial sac
Cause of pericardial effusion
Any causes of pericarditis
Clinical features of pericarditis
Dyspnoea
Raised JVP
Bronchial breathing at left base (large pericardial effusion can compress lower left lobe)
Diagnosis of pericardial effusion
CXR shows enlarged globular heart
Echo - Echo free zone surrounding the heart
ECG - low voltage qrs and alternating QRS morphologies (electrical alternans)
Management of pericardial effusion
Treat the cause
Pericardiocentesis can be diagnostic or therapeutic (tamponade)
What is constrictive pericarditis
Heart is encased in a rigid pericardium
Cause of constrictive pericarditis
Often unknown in UK
Elsewhere TB
OR
after any pericarditis
Clinical features of constrictive pericarditis
Mainly those of right heart failure Raised JVP Kaussmals sign (JVP raises with inspiration) Soft diffuse apex beat Quiet heart sounds High pitched s3
Constrictive pericarditis on CXR
Small heart with or without pericardial calcification
Management of constrictive pericarditis
Surgical excision
What is cardiac tamponade
Accumulation of pericardial fluid - raises intrapericardial pressure
Therefore poor ventricular filling and fall in cardiac output
Causes of cardiac tamponade
Pericarditis Aortic dissection Haemodialysis Warfarin Post cardiac biopsy
Signs of cardiac tamponade
Tachycardia Hypotension Pulsus paradoxus Raised JVP Kaussmauls sign Muffled s1 and s2
Triad for diagnosing cardiac tamponade
Becks triad: falling BP, rising JVP and muffled heart sounds
CXR in cardiac tamponade
Big globular heart
ECG in cardiac tamponade
Low voltage QRS
With or without electrical alternans
Echo in cardiac tamponade
Diagnostic
Echo free zone around the heart
May also be diastolic collapse of right atrium and right ventricle
Management of cardiac tamponade
Urgent drainage of pericardial effusion - pericardiocentesis
Significance of bicuspid aortic valve
Work work at birth
Can go on to develop aortic stenosis with or without aortic regurge
This predisposes to infective endocarditis and subacute bacterial endocarditis
Also risk of aortic dilatation/dissection
Intense exercise may accelerate complications - therefore yearly echos
What is an atrial septal defect?
A hole that connects the two atria
Two types of ASD
1) Ostium secundum - high in septum - most common
2) Ostium primum defect - lower down - associated with av valve anomalies
Presentation of two ASD
Primum present early
Secundum often asymptomatic until early adulthood
Why does Ostium secundum not present until adulthood
because left to right shunt depends on compliance of the ventricles - and compliance of left ventricle decreases with age therefore augmenting the shunt
Symptoms of ASD
Pulmonary hypertension Cyanosis Arrhythmia Haemoptysis Chest pain
Signs of ASD
AF Raised JVP Wide, fixed split s2 ejection systolic murmur Pulmonary hypertension can cause pulmonary or tricuspid regurge
What is complication of ASD?
Reversal of shunt - eisenmengers complex - left to right shunt causes pulmonary hypertension - this leads to shunt reversal - causes cyanosis
ECG in ASD Ostium primum
RBBB with LAD and prolonged PR interval
ECG is Ostium secundum
RAD
When do you close an ASD
In children before age 10
Adults if symptomatic or if pulmonary to systemic blood flow ratio of 1.5>1
What is a ventricular septal defect?
Hole between the two ventricles
Symptoms of VSD
May present with severe heart failure in children
Or can remain asymptomatic and be diagnosed incidentally
Sign of VSD
Smaller the hole - louder the murmur
Typically harsh pan systolic murmur with systolic thrill
Larger holes - signs of pulmonary hypertension
Complications of VSD
Infundibular stenosis
IE/sbe
Pulmonary hypertension
Eisenmengers complex
ECG in small, moderate and large VSD
Normal - small
Lad + lvh - moderate
Lvh + RVH - large
CXR in large VSD
Cardiomegaly, large pulmonary arteries and marked pulmonary plethora
Treatment of VSD
Medical at first as many close spontaneously
Surgical closure if medical failed, symptomatic or shunt >3:1, IE/SBE
What is coarctation of the aorta
Congenital narrowing of descending aorta
Where does coarctation of the aorta usually occur?
Just distal to origin of left subclavian artery
Associations of coarctation of the aorta
Bicuspid aortic valve
Turners syndrome
Signs of coarctation of the aorta
Radio femoral delay Weak femoral pulse Hypertension Scapular bruit Systolic murmur (best heard over left scapula)
Complications of coarctation of the aorta
Heart failure
Infective endocarditis
Diagnosis of coarctation
Ct or MRI aorta gram
Treatment of coarctation
Surgery or balloon dilatation/stenting
