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IPE revision CARDIOLOGY > myocarditis, cardiomyopathy,hyperlipidaemia and CHD > Flashcards

myocarditis, cardiomyopathy,hyperlipidaemia and CHD Flashcards

1
Q

what is myocarditis?

A

inflammation of the myocardium of the heart

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2
Q

what are the causes of myocarditis?

A

Viral infection - coxsackie, adenovirus, HIV etc

Bacterial infection - e.g. syphillis

Can be aitoimmune - SLE, sarcoidosis, scleroderma

Drugs - alcohol

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3
Q

what are the symptoms of myocarditis?

A 
Chest pain
Palpitations
fever
malaise
SoB
Poor exercise tolerance
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4
Q

what are the investigations you would do if you suspected myocarditis?

A 
CK and troponin 
CRP/ESR
ECG
ECHO
MRI
Biopsy
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5
Q

what ECG changes may you see in myocarditis

A

Diffuse T inversion and saddle shaped ST

May have transient AVN block

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6
Q

how can you treat myocarditis

A

Bed rest
NSAIDs
Pain relief
may need diuretics

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7
Q

what are the different types of lipids and which type of lipid is the main risk factor for disease?

A

VLDL (mainly triglycerides)

LDL (mainly cholesterol) - main risk factor

HDL (mainly phospholipids)

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8
Q

what are the different types of hyperlipidaemia

A

Common primary - LDL only

Familial

Secondary

Mixed

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9
Q

what are the cause of secondary hyperlipidaemia?

A

cushings
hypothyroid
nephrotic syndrome
cholestasis

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10
Q

what are the causes of mixed hyperlipidaemia ?

A

Diabetes
Alcohol
CKD

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11
Q

who should we screen for hyperlipidaemia

A

Family Hx

Corneal arcus <50years

xanthoma and xanthelesma

those at risk of CV disease e.g. HTN, smoker, diabetes

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12
Q

what are the symptoms of hyperlipidaemia

A

Asymptomatic most of time

Xanthoma & xanthelesma
Corneal arcus
Palmar striae - orange streaks on palms

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13
Q

what are the complications of hyperlipidaemia ?

A

Anything linked to atherosclerosis:

- MI, Stroke, PVD etc

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14
Q

how can we manage hyperlipidaemia?

A

Conservative - improve diet, lose weight and exercise, omega 3

Pharma:
Statins - simvastatin (40mg primary, 80mg secondary)
Fibrates
Nicotinic acid 
Bile salt sequestrients
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15
Q

what are the different types of cardiomyopathies?

A

Hypertrophic obstructive cardiomyopathy (HOCM)

Dilated Cardiomyopathy

Restrictive cardiomyopathy

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16
Q

what is HOCM ?

A

Autosomal dominant – family history of sudden death in young

Increased ventricular muscle mass and septum hypertrophy

Less blood into heart to pump = diastolic dysfunction

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17
Q

what are symptoms of HOCM?

A

angina, palpitations, dyspnoea, exertional syncope and sudden death

18
Q

what are the signs in HOCM, ECG changes and ECHO changes?

A

Signs = jerky pulse, double apex beat, S4 heart sound

ECG = LV strain pattern, VT/VF

ECHO = atrial, septal and LV hyertrophy

19
Q

how can we treat HOCM?

A

Negative ionotropes - verapamil / Bblockers

Amiodarone - antiarrythmias

surgical - septal myomectomy if severe

20
Q

what are the causes of restrictive cardiomyopathy?

A 
Mnemonic MISSHAPEN:
MI
Sarcoid
Systemic sclerosis
Haemochromatosis
Amyloidosis
Primary - endomyocardial fibrosis
Eosinophilia 
Neoplasia - carcinoid
21
Q

what are the causes of dilated cardiomyopathy?

A

Mnemonic DILATE:

Dystrophy - muscular, myotonic, glycogen storage disease

Infection - complication of myocarditis

Late pregnancy - peri-, post-partum

Autoimmune - SLE

Toxins - EtOH, doxorubicin, cyclophosphamide, DXT

Endocrine - thyrotoxicosis

22
Q

what are the causes of Congenital Heart Disease (CHD)?

A

Genetic - Fam Hx, syndromes e.g. turners, downs

infection - Rubella, CMV

Drugs - alcohol, lithium

maternal diabetes

23
Q

list the Acyanotic forms of CHD?

A

L to R shunts:

  • VSD
  • ASD
  • PDA
24
Q

what is the most common CHD?

A

VSD - most common
Severity depends on size
Usually closes
Murmur loudest with smaller lesions

25
Q

for a VSD what does the murmur loudness tell you?

A

Murmur loudest with smaller lesions

26
Q

what is eisenmengers syndrome?

A

Left to right shunt

More blood entering lungs

Pulmonary pressure increases

Capillary damage leads to bursting and proliferation

Overall increased pulmonary pressure

Plus right side has more to preload AND afterload

Right hypertrophy

Reversal of shunt

27
Q

list the different cyanotic CHDs?

A

Tetralogy of fallot

Pulmonary atresia

Tricuspid atresia

Transposition of great vessels

Hypoplastic left heart

28
Q

what is tetralogy of fallot?

A
  • Pulmonary stenosis – determines severity
  • Right atrial hypertrophy
  • VSD
  • Overriding aorta
29
Q

what is transposition of great vessels?

A

Failure of the spiral septum to form properly

  • Incompatible with life unless shunt – PDA/ ASD
30
Q

what is meant by a hypoplastic left heart?

A
  • Right atrium to right ventricle to PA to PDA / Lung

- PDA to aorta

31
Q

in coacrtation of aorta what signs are seen on examination

A

Radio-femoral delay

upper body HTN, lower body hypotension

32
Q

What is the pathophysiology of rheumatic heart disease?

A

Bacterial tonsillitis or sore throat - Streptococcal group A B haemolytic infection

Results in antibodies forming

2 to 4 weeks later antibodies cross link with heart, joints and brain

Results in granulomatous inflammation of heart - pericarditis with Aschoff body granulomas

10 to 20 years later results in chronic heart disease
- Valve thickening, mitral stenosis, aortic regurg (diastolic murmurs)

33
Q

What are the contraindications to the exercise stress test?

A

Aortic stenosis
Recent MI
Uncontrolled arrhythmia
Acute myocarditis / pericarditis

Stop test if any symptoms or ECG changes

34
Q

What are the uses and complications of cardiac catheterisation?

A

Uses:

  • Sample blood
  • Inject dye and view coronary arteries
  • Angioplasty and stenting
  • Valvuloplasty

Complications

  • Haemorrhage
  • Reaction to contrast
  • AKI/ CKD – contrast
  • Thrombosis
  • Infection
  • Arrhythmias – AVN
35
Q

what are the 5 signs of infective endocarditis?

A

2 in hands = clubbing splinter haemorrhage

2 in abdomen = splenomegaly and microscopic haematuria

1 in heart = changing murmur

36
Q

What are the 4 stages of clubbing?

A

Stage 1: increased fluctuancy of nail bed
Stage 2: loss of angle
Stage 3: increased curvature of nail
Stage 4: expansion of terminal phalanx

37
Q

what are the main causes of splinter haemorrhages?

A

Gardening no.1

Vasculitis
I.E

38
Q

what are the causes of an irregularly irregular pulse?

A

AF
3rd degree heart block
ventricular ectopics

39
Q

How do you determine if an irregularly irregular pulse is from AF or ventricular ectopics?

A

ventricular ectopics disappear with exercise (because ventricular ectopics usually occur in diastole and during exericise diastole is shortened)

40
Q

what is the pulse deficit seen in AF?

A

LOSS OF DIASTOLIC FILLING WITH HIGH VENTRICULAR RATES

Therefore pulse not felt peripherally because low CO
But heart beat heard at the apex due to contraction of heart

THEREFORE IN SOMEONE WITH AF WILL LOOK GOOD IF YOU MEASURE APEX BEAT WITH STETHOSCOPE

41
Q

what are the target INRs for:

  1. AF and warfarin
  2. prosthetic heart valves
A

1 = 2-3

2 = 3-4

42
Q

what are the reasons for a non-palpable apex beat?

A

mnemonic = DOPE

  • Dextrocardia
  • Obesity
  • Pericardial effusion
  • Emphysema

IPE revision CARDIOLOGY (9 decks)

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