Other Cardio Content

Question 1

Presentation of myocarditis

Answer 1

-Usually young patient with acute history
-Chest pain
-Dyspnoea
-Arrythmias

Question 2

Investigations of myocarditis

Answer 2

-Bloods= ↑ inflammatory markers in 99%, ↑ cardiac enzymes, ↑ BNP
-ECG: tachycardia, arrhythmias, ST/T wave changes including ST-segment elevation and T wave inversion

Question 3

Symptoms and signs of cardiac tamponade

Answer 3

-Dyspnoea
-Tachycardia
-Sharp, constant sternal pain relieved by sitting forward, may radiate to left shoulder/arm
-Abdominal pain (hepatic congestion)
-Hypotension
-Raised JVP (absent Y descent)
-Muffled heart sounds
-Pericardial rub
-Pulsus paradoxus

Question 4

Investigations of cardiac tamponade

Answer 4

-ECG (electrical alternans, low voltage)
-TTE (large pericardial effusion)
-CXR (large cardiac silhouette)

Question 5

Management of cardiac tamponade

Answer 5

-Stable= anti-inflammatory, gastroprotection, observation
-Haemodynamically unstable= percutaneous pericardiocentesis, surgical drainage

Question 6

What is constrictive pericarditis?

Answer 6

Granulation tissue formation in pericardium resulting in loss of pericardial elasticity leading to restriction in ventricular filling

Question 7

Diagnosis of constrictive pericarditis

Answer 7

-X+Y present in raised JVP
-Absent pulsus paradoxus
-Kussmaul’s sign (no fall/increase in JVP during inspiration)
-Pericardial calcification on CXR
-Pericardial knock (loud S3)
-Dyspnoea
-Echocardiogram= thickened pericardium, no effusion, early diastolic filling rapid with impaired late diastolic filling
-CT/MRI assesses pericardial thickness