Non-ischaemic Heart Disease Flashcards
Name four non ischaemic heart diseases
- cardiomyopathy
- myocarditis
- pericarditis
- endocarditis
What is cardiomyopathy?
Any disease of the cardiac muscle often resulting in changes to the size and thickness of heart chambers
How can cardiomyopathy be classified?
- Dilated
- Hypertrophic
- Restrictive
- Arrhythmogenic right ventricular dysplasia
What is dilated cardiomyopathy?
Heart is 2/3 times bigger than normal and is floppy
State four causes of dilated cardiomyopathy
- genetics
- toxins
- cardiac infection
- pregnancy
What are the clinical features of cardiomyopathy?
Heart failure (SOB, poor exercise tolerance & low ejection fraction)
Describe the characteristics of hypertrophic cardiomyopathy
Big, solid heart. Strong contraction but cannot relax, eventually causes outflow obstruction usually in young people
What are the causes of hypertrophic cardiomyopathy?
Genetics (mutations in beta myosin heavy chain, myosin binding protein C & alpha tropomyosin)
Describe restrictive cardiomyopathy
stiff heart causes lack of compliance & diastolic dysfunction but the heart may appear normal
State six causes of restrictive cardiomyopathy
- deposition of something in the myocardium
- metabolic byproducts
- amyloid
- sarcoid
- tumours
- fibrosis
Define amyloid
abnormal deposition of an abnormal protein, tends to form beta pleated sheets that the body cannot get rid of
Name some diseases associated with amyloid
- diabetes
- alzehiemers
What is the cause of ARVD?
It is a genetic disease
What is the consequence of ARVD?
Syncope & funny turns leading to arrhythmia & occasionally sudden death
What happens to the right ventricle in ARVD?
It gets replaced by fat
What does ARVD stand for?
Arrhythmogenic Right Ventricular Dysplasia
Define myocarditis
Inflammation of the heart
What are the two types of myocarditis?
- infectious
- non-infectious
What causes most infectious carditis? Give examples
Viruses
- ECHO virus
- Lyme’s disease
- Chaga’s disease
- HIV
Myocarditis results in a thickened myocardium true or false?
True
What is non-infectious myocarditis due to?
- immune mediated hypersensitivity reactions
- drugs
Give an example of an immune mediated hypersensitivity reaction that causes myocarditis
Rheumatic fever after strep throat
What type of myocarditis do drugs cause?
Eosinophilic
Describe the signs of myocarditis as a result of rheumatic fever
classic mitral stenosis with thickening & fusion of leaflet valves. Short, thick chordea tendinae
Name six causes of pericarditis
- infection
- immune mediated
- idiopathic
- uraemic
- post MI
- connective tissue disease
Give an example of a connective tissue disease
Lupus
What viruses cause infective pericarditis?
ECHO
How does bacteria cause infectious pericarditis?
As an extension from elsewhere e.g. pneumonia
Who is usually infected by fungi causing pericarditis?
Immunosuppressed & Post transplant
How does tuberculous cause pericarditis?
Caseous material in the sac produces constrictive percaridits
How can pericarditis occur post MI?
damaged heart muscle releases previously un-encountered material that stimulates an immune response
Usually the inflammation occurs a few days post MI what is the exception to this?
Dresslers Syndrome
Name five complications of post MI pericarditis
- pericardial effusion
- tamponade
- constrictive pericarditis
- cardiac failure
- death
How does endocarditis affect the heart?
It affects the heart lining but it is mainly inflammation of the valves
Describe infectious endocarditis
usually requires a very virulent organism it can occur on normal valves & can be bacterial or fungal caused by `iv drug absue of septicaemia
Who is predisposed to endocarditis?
patients with
- rheumatic heart disease
- prosthetic valves
- congenital defects
- MV prolapse
- calcific disease
Name five organisms that cause endocarditis
- Haemophilus
- Actinobacillus
- Cardiobacteria
- Eikenella
- Kingella.
What organisms cause endocarditis in IV drug users?
- Candida
- Staph aureus
What organisms cause endocarditis in patients with prosthetic valves?
S. epidermidis
Describe the. pathology of infectious endocarditis
Vegetations, bacteria excites acute inflammation cell products digest the valve leaflets
What is vegetation?
Aggregates of organisms on heart valves
What are the complications of infectious endocarditis? (will never remember them all)
- Acute valvular incompetence
- High output cardiac failure
- Abscess, fistula, pericarditis
- osters nodes
- janeway lesions
- roth spots
- splinter haemorrhages
- septicaemia
- septic emboli
- mycotic aneurysms
Name four causes of non-infectious endocarditis
- rheumatic fever
- SLE
- Non-bacterial thrombotic endocarditis
- Carcinoid heart disease
Describe non-bacterial thrombotic endocarditis
small, multipl vegetations that are non-invasice & can cause embolic disease
What is non-bacterial thrombotic endocarditis associated with?
- cancer
- hypercoaguable states
What do excess hormones produced by tumours cause?
flushing of skin, D&V, nausea and ultimately right sided cardiac valve disease
Are primary tumours of the heart common?
no - they are very rare
What is the commonest tumour of the heart?
atrial myxoma
Describe atrial myxoma
90% in atria & usually the left, may cause ball/valve obstruction, tumour, emboli or endocarditis
What are atrial myxomas assoicated with?
- systemic fever
- malaise
