Cardiomyopathy, Myocarditis and Pericarditis Flashcards
What are the different types of cardiomyopathies?
Dilated cardiomyopathy
Restrictive and infiltrative cardiomyopathy
Hypertrophic cardiomyopathy
What is a dilated cardiomyopathy, and what are some causes?
Impairment of ventricular function due to enlarged heart
Excluding ischaemic and valvular causes, causes include:
- genetic and familial (SCN5A gene, muscular dystrophy)
- inflammatory, infectious, autoimmune, post-partum
- toxic, drugs, exogenous chemicals, endocrine
- injury, cell loss, scar replacement
What are the symptoms of a dilated cardiomyopathy?
Progressive, slow onset SOB/Orthopnoea/PND Fatigue Ankle swelling Weight gain of fluid overload Thyroid issues
What may be in someone’s history/PMH if they have a dilated cardiomyopathy?
Systemic illness Travel Hypertension Vascular disease Thyroid problems Neuromuscular disease
Alcohol use
Occupation related?
What may you found on examination of someone with a dilated cardiomyopathy?
Poor superficial perfusion Thready pulse, irregular if AF SOB at rest Narrow pulse pressure Elevated JVP Displaced apex S3 and S4 MR murmur Pulmonary Oedema Pleural effusions Ankle/sacral oedema Ascites Hepatomegaly
What investigations might you do in suspected dilated cardiomyopathy?
Repeated ECG noting LBBB CXR N terminal pro BNP Bloods, U+E Echo Cardiac MRI Coronary angiogram Biopsy?
What is the treatment in a dilated cardiomyopathy?
Correct anaemia Remove exacerbating drugs e.g. NSAIDs Correct endocrine disturbance Alter salt/fluid intake Weight management
Usual heart therapies
- ACEi/ARB
- diuretics
- spironolactone
- beta blockers
- anticoagulants
- SCD risk assessment with ICD or CDT-D/P
- heart transplant
Often cause is not reversible
What is a restrictive/infiltrative cardiomyopathy?
A ventricle with reduced wall compliance, resulting in inability to fill well.
50% are related to specific clinical disorders, rest remain unknown
What are some non-infiltrative and infiltrative causes of restrictive cardiomyopathies?
Non-infiltrative
- Familial
- Forms of hypertrophic cardiomyopathy
- Scleroderma
- Diabetic
- Pseudoxanthoma elasticum
Infiltrative causes
- amyloid
- sarcoidosis
Storage diseases
Endomyocardial causes - (fibrosis, carcinoid, radiation, drug effects)
What investigations might be done in suspected restrictive cardiomyopathy?
Repeated ECG noting LBBB
CXR
N terminal pro BNP
Bloods, U+Es (sarcoidosis and haemochromatosis)
Auto antibodies for sclerotic CT diseases)
Amyloid needs non-cardiac biopsy
Fabry - low plasma alpha galactosidase A activity
Echo
Cardiac MRI
Biopsy
What treatments might be given in suspected restrictive cardiomyopathy?
Correct anaemia Remove exacerbating drugs e.g. NSAIDs Correct endocrine disturbance Alter salt/fluid intake Weight management
Usual heart therapies
- spironolactone
- beta blockers
- anticoagulants
- SCD risk assessment with ICD or CDT-D/P
- heart transplant
Limited ACEi/diuretic use as low filling pressures will cause problems
If iron overload, specific forms of amyloid, or Fabrys then specific treatments are available.
Endomyocardial fibrosis has little specific treatment
What happens hypertrophic cardiomyopathy?
Impaired relaxation
Systolic function usually adequate with functional abnormality
Relatively high prevalence (1:500)
Genetic
What is the pathology of hypertrophic cardiomyopathy?
Myocyte hypertrophy and disarray
Can be apical, septal, or generalised
Impaired relaxation so behaves in a restrictive manner
Symptoms of a hypertrophic cardiomyopathy?
Asymptomatic for many Fatigue SOB Angina Palpitations Exertional pre-syncope Syncope related to arrhythmias or LVOT SCD
What might you find on physical examination of someone with a hypertrophic cardiomyopathy?
Can be no findings
Notched pulse pattern
Irregular pulse if AF or ectopy
Double impulse over apex
Thrill and murmurs
LVOT murmur will increase with valsalva and decrease with squatting
JVP can be raised in very restrictive filling
