Myocardial Disease Flashcards
outline the pathologies in myocardial disease
- myocarditis
- cardiomyopathy
- restrictive
- dilated
- HOCM
- Cardiac myxoma
HOCM: Epidemiology
most common cause of sudden death in young
HOCM: pathophysiology
LV outflow tract obstruction from asymmetrical LVH, especially involving the septum
HOCM: aetiology
- 50% genetic - autosomal dominant
- B-myosin heavy chain mutation commonest
- rest - sporadic
important to ask about history of sudden death!!!
HOCM: symptoms
- often asymptomatic
- dyspnoea
- angina
- exertional syncope
- palpitations
- sudden death
HOCM: signs?
- jerky pulse
- double apex beat
- ejection systolic murmur at LLSE
- gets louder w valsalva, decreses on squatting
- S4
- JVP- prominent a wave
- may impair mitral valve closure thus causing regurgitation
HOCM: associations?
- friederich’s ataxia
- WPW
HOCM: Ix
- ECG
- LVH
- Q waves
- ventricular ectopics or other arrhythmias
- ECHO- MR SAM ASH
- MR
- SAM- systolic anterior motion of anterior mitral valve leaflet
- ASH- asymmetrical septal hypertrophy
- exercise test +/- holter to quantify risk
HOCM: Rx
- medical
- -ve inotropes
- beta blockers
- verapamil
- anti-arrhythmics
- amiodarone
- anticoagulate if AF or emboli
- surgical
- septal myomectomy
- consider ICD
Restrictive Cardiomyopathy: pathology
stiff, rigid ventricles lead to impaired diastolic filling
Restrictive Cardiomyopathy: aetiology
mnemonic
miSSHAPEN–> consider infiltrative diseases
Sarcoidosis
Systemic sclerosis
Haemochromatosis
Amyloidosis
Primary: endomyocardial fibrosis
Eosinophilia
Neoplasia: carcinoid
Restrictive Cardiomyopathy: clinical features?
as constrictive pericarditis
Restrictive Cardiomyopathy: diagnosis?
catheterisation
Restrictive Cardiomyopathy: Rx
treat cause
Dilated Cardiomyopathy: pathophysiology
global ventricular dilatation
- dilated heart leading to predominantly systolic dysfunction
- LV more dilated than RV
- eccentric hypertrophy seen
dilatation=thinning+expanding
Dilated Cardiomyopathy: aetiology?
30% hereditary
DILATE
Dystrophy; muscular, myotonic
Infection: myocarditis /Idiopathic
Late pregnancy: peri/post partum
Autoimmune: SLE
Toxins: Doxorubicin, cyclophosphamide
Endocrine: thyrotoxicosis
Dilated Cardiomyopathy: presentation
- LVF & RVF
- arrythmias
- stretching of chambers may result in MR/TR
Dilated Cardiomyopathy: signs
- raised JVP
- S3
- displaced apex
- reduced BP
Dilated Cardiomyopathy: Ix
- ECG
- T wave inversion
- CXR
- balloon appearance of heart
- Echo
- globally dilated heart
- catheter + biopsy
- myocardial fibre disarray
Dilated Cardiomyopathy: Rx
- bed rest
- diuretics, ACEI, digoxin, anticoagulation
- non-medical
- biventricular pacing
- ICD
- surgical
- heart transplant
Cardiac Myxoma: what is it?
rare, benign cardiac tumour that usually arises in LA
Cardiac Myxoma: epidemiology
- F>M
- 3rd-6th deciles
Cardiac Myxoma: clinical features
- fever
- SOB
- wt loss
- syncope
Cardiac Myxoma: signs
- clubbing
- loud 1st heart sound
- loud 3rd heart sound
Cardiac Myxoma: Ix
- Echo
- raised ESR
Cardiac Myxoma: Rx
surgical excision
