myocardial, pericardial dis Flashcards
what is myocarditis?
most common cause?
susceptibility increase by?
1_acute inflammation of myocardiam
2_viral infection, coxsackie v
3_glucocorticoids treatment, immunosuppression, radiation, exercise, previous myocardial damage.
Mention the causes of myocarditis.
1_viral: coxsackie, influenza A, B, Adenovirus, HIV.
2_bacteria: Borrelia burgdorferi, M. pneumonia.
3_protozoa: trypanosoma cruzi, toxoplasma gondii.
4_fungus: Aspergillus.
5_parasite: shistosoma
6_drugs/toxins: Alcohol, cocaine, lithium Anthracycline, clozapine, doxorubicin.
7_Autoimmune: SL, RA, Sarcoidoisis, sclerosis, hypersensitivity to pencillun, co, lead
what is the clinical practice of myocarditis?
1_fulminant: follow viral infection, result in severe HF or cardiogenic shock.
2_Acute: longer period,cause HF, dilated cardiomyopathy.
3_chronic active: rare, with chronic myocarditis, stable pan with signs of HF.
4_chronic presistent: focal infiltrate, cause chest pain, arrhythmia, without necessarily cause ventricular dysfunction.
what is the progression and prognosis of myocarditis?
what happenes in chagas dis and lyme dis?
good prognosis
death may occur due to arrhythmia or rapidly progressive HF.
1_chagas: the ptn recover from acute infection but develop a chronic dilated cardiomyopathy 10-20 y later.
2_lyme: develoo mycocarditis with AV block.
What are the investigations and treatment needed for myocarditis?
1_inve: after excluding other causes of cardiac dysfunction.
Echo: LV dysfunction, MRI: diagnostic pattern of inflammation, infiltration.
ECG: abnormal but not specific.
troponin I, T, CK may be elevated in early phase.
endomyocardial biobsy, confirm
2_supportive treatment.
treatment of HF, arrhythmia.
avoid intense physical activity .
antimicrobial.
no glucocorticoids or immunosuppressives.
Regarding dilated cardiomyopathy:
what are the histological and pathological changes occur?
1-histo: myofiberllay loss, T cell infiltration, interstitial fibrosis.
2-patho: dilataion and impair function of LV, Often RV.
LV mass increase but wall thickness is normal or reduce.
functional mitral and tricuspid regargue.
Mention the causes of dilated cardiomyopathy.
1_Alcohol.
2_25% inherited as autosomal dominant affecting cytoskeleton of myocytes(dystrophin, lamin A, C, emerin, metavinculin).
3_associated with skeletal m abnormalities (Becker, duchenne).
4_late immune reaction to viral infection (HIV).
what is the clinical picture of dilated cardiomyopathy?
WHAT IS DD
pat with Heart failure or discover in routin examination.
Arrhythmia, thromboembolism, sudden death.
sporadic chest pain
DD: CAD.
Regarding dilated cardiomyopathy:
investigation and treatment?
1_ECHO, MRI
ECG, non specific
genetic testing
2_control hf, cardiac trasplantation may be indicated.
B blockers and ACEI Or ARBS for arrhythmias.
Regarding hypertrophic cardiomyopathy:
ch. ch by?
types?
inappropriate and elaborate LVH with malalignment of myocardial fibers and fibrosis.
may be confined or generalized:
apical hypertrophic
asymmetric septal hypertrophy
concentric hypertrophy.
What is the cause of HCMP?
genitic, autosomal dominant, three common types of mutations:
1_B myosin heavy chain: elaborate VH.
2_Troponin: little or no hypertrophy but marked disarray, exercise induced hypotension high risk of sudden death.
3_Myosin binding pn C: late in life with hypertension and arrhythmia.
in all types HF may develop.
What is HOCM?
type of hypertrophic myopathy, ch. ch. by septal hypertrophy causing dynamic LV outfliw obstruction and mutral regargue due to abnormal systolic ant motion of ant mitral valve leaflet.
Mention the S/S of hypertrophic cardiomyopathy.
1_symptoms: effort related: angina, breathlessness, syncope, arrhythmia, sudden death.
2_jerky pulse.
plapable LVH
S4
mid systolic murmur
pansystolic murmur.
Mention the risk factors for sudden death in HCM
1_history of previous cardia arrest, sustained tachycardia.
2_recurrent syncope
3_adeverse family history
4_exercise induced hypotension
5_non sustained tachycardia on AECG
6_Marked increase in LV wall thickness.
Regarding hypertrophic cardiomyopathy: investigation, treatment.
1_inve: ECHO is of choice: greater than physiological hypertrophy and asymmetric pattern.
ECG shows V H, deep T inversion.
genitic testing.
2_B blockers, rate limiting Ca cb, disopyramide relieve symptoms and prevent syncope.
amiodarone for arrhythmia.
no pharmacological treatment can improve prgnosis, but partial surgical resection( myectomy), iatrogenic infarction (septal ablation) may improve outflow obstruction.
ICD for those with risk factors for death.
digoxin and vasodilators are contraindicated
what do you know about Arrhythmogenic ventricular cardiomyopathy?
patho
clinical picture
prognosis
cause
diagnosis
management
1_prodominantlu affect RV, replacement of patches of myocardium with fibrous and fatty tissue.
2_V arrhythmia, RHF, Sudden death
3_if LV is affected, poor prognosis
4_autosomal dominant, defect in dismosomal pn gene (PKP2).
5_based on complex set of criteria: ECG, Genetic arrhythmia, structural assessment.
ECG: broden QRS, inverted T wave in right leads.
MRI: is helpful with ECG for screening.
6_treatment of RHF with diuertics +B blockers for arrhythmia or defibrillators.
regarding restrictive cardiomyopathy:
1_pathology
2_cause
3diagnosis
4 prognosis
5_treatment
1_rare in which LV filling is impaired cuz it is stiff-high atrial pressure-hypertrophy-dilation_AF.
2_Amyloidosis, glycogen storage dis, idiopathic prrimyocyte fibrosis, familial.
3_difficult, require doppler Echo, ct, MRI, Biobsy
4_poor
5_symptomatic treatment, cardiac trasplantation may be indicated.
regarding obliterative cardiomyopathy:
1_patho
2_clinical picture
3_cause
4_prognosis
5_treatment
1_rare form of restrictive cardiomyopathy involving endocardium of one or both ventricle, ch ch by thrombosis and fibrosis, with gradual obletration of cavity, MR, TR.
2_HF, Pulmonary and systemic embolism.
3_associated with esinophilia and esinophilic leukemia, granulomatosis, with polyangitis (churg-strauss syn).
4_mortality rate 50%at 2years.
5_anticoagulant, antiplatelete,diuertics may help in HF.
surgery for M AND T replacement, decortication of endocardium.
what do you know about Takotsubo cardiomyopathy.
ch ch by?
mechanism
cause
clinical picture
Diagnosis
treatment
mimics on ECG?
1_acute LV dysfunction ch ch by dilation of apex, and adjacent myocardium, with LV imoairment.
2_noradrenergic coronory vasoconstriction, ALV outflow obstruction.
3_stress
4_chest pain, breathlessness, HF.
5-made by coronary angiography, Echo show apex ballooning.
6_recover within 4-5 days but can take weeks.
B blockers to prevent arrhythmia.
Ace to treat LV dysfunction.
7_acute ST elevation of ACS.
what are the conditions giving a picture that mimics:
1_dilated cardiomyopathy
2_Restrictive
3_hylertrophic
1_Alcohol, CT dis: sarcoidosis, hemochromatosis.
2_amyloidosis, esinophilic heart dis
3_friedreichs ataxia.
give a short glance about cardiac tumors.
primary are rare, metastasis can occur.
most primary are benign, majority are myxomas; common in LA
others: Lipomas, fibroma, fibroelastomas, haemangiomas.
myoxomas are gelatinous but can be solid, calcified with superimposed thrombus.
on exam:
loud S1,murmur of MR, with variable diastolic sound(tumer plop).
detected by echo.
cause: pyrexia, syncope, arrhythmia, emboli, malaise.
elevated ESR.
