Non-ischaemic heart diseases

Question 1

What is restricitive cardiomyopathy ?

Answer 1

• Restrictive cardiomyopathy (RCM) is a form of cardiomyopathy in which the walls of the heart are rigid (but not thickened). Thus the heart is restricted from stretching and filling with blood properly.
• It is the least common of the three original subtypes of cardiomyopathy

Question 2

List the causes of restrictive cardiomyopathy ?

Answer 2

• Amyloidosis
• Post-radiotherapy
• Loeffler’s endocarditis
• Haemochromatosis
• Sarcoidosis

Question 3

What are the clinical features of restrictive cardiomyopathy ?

Answer 3

Presentation is like constrictive pericarditis:

• Right heart failure: elevated JVP, ascites, oedema, hepatomegaly
• JVP shows prominent x and y descent

Question 4

What is rheumatic fever?

Answer 4

Rheumatic fever develops following an immunological reaction to recent (2-6 weeks ago) Streptococcus pyogenes infection.

Question 5

Where is rheumatic fever common & what age group is it most common in ?

Answer 5

It is common in developing conuntries & those aged 5-15

Question 6

How is rheumatic fever diagnosed ?

Answer 6

Diagnosis is based on evidence of recent streptococcal infection accompanied by:

• 2 major criteria
• OR 1 major with 2 minor criteria

Question 7

What are the features suggestive of a recent strep infection?

Answer 7

• Positive throat culture
• Positive tapid streptococcal antigen test
• Elevated or rising streptococcal antibody titre
• Recent scarlet fever

Question 8

What are the major and minor criteria used to diagnose rheumatic fever ?

Answer 8

Major criteria

• erythema marginatum
• Sydenham’s chorea: this is often a late feature
• polyarthritis
• carditis and valvulitis (eg, pancarditis)*
• subcutaneous nodules

Minor criteria

• raised ESR or CRP
• pyrexia
• arthralgia (not if arthritis a major criteria)
• prolonged PR interval

Question 9

What is the treatment of rheumatic fever ?

Answer 9

IV benzypenicillin followed by PO pencillin V

Question 10

What is the classical heart murmur caused by rheumatic fever ?

Answer 10

Mitral stenosis

Question 11

Lupus covered in MSK flashcards

Question 12

How can carcinoid tumours causing carcinoid syndrome affect the heart?

Answer 12

Right heart valvular stenosis - tricuspid and Pulmonary insufficiency

Question 13

What is an atrial myxoma ?

Answer 13

Atrial myxoma is the most common primary cardiac tumour.

Question 14

What are the clinical features suggestive of an atrial myxoma ?

Answer 14

• May mimic endocarditis with fever, weight loss, clubbing
• atrial fibrillation
• mid-diastolic murmur, ‘tumour plop’

Question 15

Where in the heart do atrial myxomas occur ?

Answer 15

90% in atria and usually left

Question 16

How are atrial myxomas diagnosed ?

Answer 16

Echo - pedunculated heterogeneous mass typically attached to the fossa ovalis region of the interatrial septum

Question 17

What is the treatment of atrial myxomas ?

Answer 17

Surgical excision