Pericardial/ Myocardial diseases

Question 1

what organisms can cause acute pericarditis?

Answer 1

Viral: coxsackie, flu, EBV, HIV
􏰀
Bacterial: pneumonia, rheumatic fever, TB, staphs

􏰀 Fungi

Question 2

what medication can cause acute pericarditis?

Answer 2

penicillin, isoniazid, procainamide, hydralazine

Question 3

how is the pain described for acute pericarditis?

Answer 3

Sharp
􏰁 Pleuritic
􏰁 Worse lying down
􏰁 Relieved by sitting forward 􏰁 Radiates to left shoulder

Question 4

what does the ECG look like for acute pericarditis

Answer 4

saddle-shaped ST-elevation ± PR depression

Question 5

what is the treatment for acute pericarditis ?

Answer 5

ibuprofen 400mg/8h PO

Question 6

what would a CXR show for constrictive pericarditis ?

Answer 6

small heart + pericardial calcification

Question 7

what is the management for constrictive pericarditis ?

Answer 7

surgical excision

Question 8

what is Ewarts sign?

Answer 8

Ewart’s sign: large effusion compressing left lower lobe

Question 9

with what condition is ewarts sign seen?

Answer 9

pericardial effusion

Question 10

what is the cause of pericardial effusion?

Answer 10

acute pericarditis

Question 11

what does CXR show for pericardial effusion?

Answer 11

enlarged, globular heart

Question 12

what is a cardiac tamponade ?

Answer 12

Accumulation of pericardial fluid → ↑ intra-pericardial pressure → poor ventricular filling → ↓ CO

Question 13

what signs are seen with tamponade?

Answer 13

Beck’s Triad: ↓ BP, ↑ JVP, quiet heart sounds
􏰀 Pulsus paradoxus
􏰀 Kussmaul’s sign

Question 14

what is the treatment for tamponade ?

Answer 14

Urgent pericardiocentesis

􏰁 20ml syringe + long 18G cannula

􏰁 45 degrees, just left of xiphisternum, aiming for tip of left
scapula.

􏰁 Aspirate continuously and watch ECG.

Question 15

what organisms can cause acute myocarditis?

Answer 15

Viral: coxsackie B, flu, HIV

􏰀 Bacterial: S. aureus, syphilis

Question 16

what medication can cause acute myocarditis ?

Answer 16

cyclophosphamide, Herceptin, carbamazepine, phenytoin

Question 17

what are the symptoms of acute myocarditis ?

Answer 17

Flu-like prodrome: fever, sore throat, myalgia Dyspnoea, fatigue
Chest pain

Question 18

what are the heart sounds of acute myocarditis ?

Answer 18

Soft S1

S4 gallop

Question 19

what does blood results show for acute myocarditis ?

Answer 19

+ve trop, ↑CK

Question 20

what is the commonest mutation with HOCM?

Answer 20

β-myosin heavy chain mutation

AD inheritance

Question 21

what are the symptoms of HOCM?

Answer 21

Angina
Dyspnoea
Palpitations: AF, WPW, VT Exertional syncope or sudden death

Question 22

what are the signs of HOCM?

Answer 22

Jerky pulse
Double apex beat
Harsh ESM @ LLSE ̄c systolic thrill S4

Question 23

what is the medical treatment for HOCM?

Answer 23

􏰁 -ve inotropes:
1st – β-B,
2nd –verapamil 􏰁

Amiodarone: arrhythmias
􏰁
Anticoagulate if AF or emboli

Question 24

what is the surgical option for HOCM?

Answer 24

Septal myomectomy (surgical or chemical) if severe symptoms

Question 25

what is Cardiac Myxoma?

Answer 25

Rare, benign cardiac tumour - occurs in females more 90% in L atrium (fossa ovalis)

Question 26

how is a diagnosis of Cardiac Myxoma made?

Answer 26

ECHO

Question 27

what is the treatment for Cardiac Myxoma?

Answer 27

excision

Question 28

what heart disease does carcinoid syndrome cause?

Answer 28

TR and PS

Question 29

what are the causes of restrictive cardiomyopathy?

Answer 29

``` Sarcoid 􏰀 Systemic sclerosis 􏰀 Haemochromatosis 􏰀 Amyloidosis 􏰀 Primary: endomyocardial fibrosis 􏰀 Eosinophilia (Loffler’s eosinophilic endocarditis) 􏰀 Neoplasia: carcinoid (→ TR and PS) ```

Question 30

what is the treatment for restrictive cardiomyopathy?

Answer 30

treat the cause

Question 31

what are the causes of dilated cardiomyopathy?

Answer 31

Dystophy: muscular, myotonic, glycogen storage disease 􏰀 Infection: complication of myocarditis 􏰀 Late pregnancy: peri-, post-partum 􏰀 Autoimmune: SLE 􏰀 Toxins: EtOH, doxorubicin, cyclophosphamide, DXT 􏰀 Endocrine: thyrotoxicosis

Question 32

what are the signs of dilated cardiomyopathy?

Answer 32

``` JVP ↑↑ 􏰀 Displaced apex 􏰀 S3 gallop 􏰀 ↓BP 􏰀 MR/TR ```

Question 33

what is the medical treatment for dilated cardiomyopathy?

Answer 33

Medical: diuretics, ACEi, digoxin, anticoagulation

Question 34

what is the surgical treatment for dilated cardiomyopathy?

Answer 34

Non-medical: biventricular pacing, ICD

Question 35

what does ICD stand for ?

Answer 35

Implantable Cardioverter Defibrillator

Question 36

what does a CXR of dilated cardiomyopathy show?

Answer 36

cardiomegaly, pulmonary oedema