Myocardial disease Flashcards
What is acute myocarditis
Acute inflammation of the cardiac muscle that is usually viral in etiology. May be focal or diffuse. Often in young adults and children
Clinical presentation of acute myocarditis
50% have preceding respiratory or GI symptoms. Common Presentations:
–Fever
–Chest pain with ECG changes
–Arrhythmia
–Heart failure, S3, pulmonary congestion/edema, cardiac dilation resulting in mitral or tricuspid murmurs. -hight mortality if LEF and HF, but some will recover, some develop chronic dilated cardiomyopathy50% have preceding respiratory or GI symptoms. Common Presentations:
–Fever
–Chest pain with ECG changes
–Arrhythmia
–Heart failure, S3, pulmonary congestion/edema, cardiac dilation resulting in mitral or tricuspid murmurs. -hight mortality if LEF and HF, but some will recover, some develop chronic dilated cardiomyopathy
treatment of acute myocarditis
If HF is present, diuresis, beta blockers and ACEI.
types of cardiomyopathies
dilated (minimal hypertrophy) is most common, hypertrophic, restrictive (infiltrated or fibrotic LV)
Dilated cardiomyopathy general and etiology
HF with large, silent heart with impaired systolic function and congested lung fields on X ray. Left ventricle is always involved, +/- all other chambers of heart. Etiology: Usually idiopathic, Genetic, Viral, Ischemic
clinical manifestations of dilated cardiomyopathy
- Heart failure: Chest Film-Cardiomegaly
ECHO- Both ventricles dilated & more spherical, diffuse poor wall motion, low ejection fraction, 2. Arrhythmia: injury, fibrosis, dilation, 3. Thromboembolism: dilation, poor contraction, abnormal surface
Dilated cardiomyopathy treatment
Treat heart failure (digoxin, diuretics, etc. plus biventricular pacing if ventricular asynchrony), anticoagulation, anti-arrhythmic agents/ implantable defibrillator, transplant
Hypertrophic cardiomyopathy definition
Disproportionate thickening of the intraventricular septum. Hypertrophy is usually eccentric with predominant diastolic dysfunction. Outflow obstruction may or may not be present. Strong genetic component
Hypertrophic cardiomyopathy w/out aortic outflow obstruction
Impaired diastolic dysfunction due to impaired diastolic relaxation and increased stiffness. Elevated LV diastolic pressure causes increased pulmonary venous and capillary pressures. Dyspnea on exertion
Hypertrophic cardiomyopathy with obstruction
Asymmetric myocardial hypertrophy with diastolic dysfunction and enhanced systolic function. Left ventricular outflow obstruction with propensity for syncope and sudden death. Obstruction is due to the mitral valve blocking the aorta
Hypertrophic obstructive cardiomyopathy clinical manifestations
Dyspnea, angina, sudden death (arrhythmia, common in athletes)
Hypertrophic obstructive cardiomyopathy treatment
Avoid exertion, decrease contractility (beta blockers), surgical myomectomy or alcohol ablation, ICD
Restrictive cardiomyopathy
Usually infiltrative (amyloidosis, sarcoidosis), impaired ventricular filling due to stiff ventricles. Systolic function normal and ventricles are not dilated. Poor prognosis
How do you diagnose restrictive cardiomyopathy?
Doppler assessment of ventricular filling or MRI
What is BNP
brain natriuretic peptide that is high in heart failure. Can be used to distinguish btw heart failure and pulmonary disease
