Cardiomyopathies & Pericarditis Flashcards Preview

CVPR - CV Unit 1 > Cardiomyopathies & Pericarditis > Flashcards

Flashcards in Cardiomyopathies & Pericarditis Deck (20):

Acute myocarditis - Etiology and Presentation

Acute inflammation of the cardiac muscle usually associated with immune response to viral infection (URI or GI) 2-3 weeks prior; often seen in young adults and children

Commonly presents with fever, chest pain with pericarditis-type ECG changes, arrhythmia, and heart failure

50% mortality; many survivors will develop dilated cardiomyopathies


Which virus is most commonly associated with acute myocarditis?

Coxsackie virus


Dilated cardiomyopathy - Etiology & Presentation

Mild hypertrophy is common but there is a greater proportional expansion in ventricular chamber volume; marked enlargement of cardiac mass - most often involves LV

Presentation - heart failure with large heart & impaired systolic function

Etiology - Usually idopathic


Clinical Manifestations of Dilated cardiomyopathy

Chest film - Cardiomegaly with lung congestion

ECHO - Ventricular dilation with poor wall motion & low ejection fraction

Arrhythmia - 2/2 injury, dilation, fibrosis of normal conductive pathways; BBB common

Thromboembolism - due to poor contraction, stasis, and clotting


Brain Natriuretic Peptide (BNP)

Blood marker for CHF

Good negative predictive value: BNP < 150 is probably not CHF

CHF patients have high BNP values that can be used to follow their cardiac status over time


Hypertrophic cardiomyopathy without aortic outflow obstruction

Diastolic dysfunction due to impaired diastolic relaxation & increased stiffness

Elevated LV diastolic pressure causes increased pulmonary congestion - DOE is usual symptom


Hypertrophic obstructive cardiomyopathy

Asymmetric myocardial hypertrophy causing diastolic dysfunction and systolic outflow obstruction

Clinical manifestations include dyspnea due to increased LV filling pressure, angina, and sudden death due to arrhythmia


Hypertrophic obstructive cardiomyopathy - Treatment

Avoid extreme exertion (i.e. sports)

Decrease contractility - B-blockers/Verapamil

Surgical mymectomy

ICD implantation


Restrictive Cardiomyopathy

Most often infiltrative due to amyloidosis or sarcoidosis

Impaired ventricular filling due to stiff ventricles; systolic function often normal and ventricles not usually dilated


Most common symptoms of acute pericarditis

Sudden onset of chest pain - often sharp and severe

Chest pain varies with position and breathing


Most common causes of pericarditis

1. Viral illness / idiopathic
2. Connective tissue or autoimmune disease
3. Uremia / renal disease
4. Metastatic malignancy


Diagnosis of acute pericarditis

Acute onset of sharp, pleuritic chest pain
Pericardial rub on cardiac exam
ECG - Diffuse ST elevation
ECHO - Pericardial fluid
Responds to anti-inflammatory agents


Treatment of acute pericarditis

Ibuprofen, aspirin


Pericardial effusion with tamponade

Caused by rapidly accumulating, moderate to large pericardial effusions; high intrapericardial pressure impairs diastolic filling

Decreased RV diastolic filling during inspiration - neck veins are distended

Paradoxical Pulse - inspiratory decrease in arterial pressure


Paradoxical Pulse

Often seen with severe pericardial effusion with tamponade - signals acute emergency

Due to high intrapericardial pressure, the RV cannot expand to accomodate increased venous return during inspiration; increased RV pressure upon inspiration pushes on the septum, impinging the LV and lowering stroke volume


Diagnosis of pericardial effusion

X-ray / Auscultation - Large cardiac silhouette without lung rales

ECHO - collapse of RA and RV in end diastole; dilation of the IVC which does not collapse during inspiration (signals high venous pressure)


ECG findings of cardiac tamponade

Low voltage with sinus tachycardia (not specific - also seen in restrictive cardiomyopathy)

Electrical alternans with sinus tachycardia - decreased QRS amplitude with every other beat


Constrictive Pericarditis - Causes

Caused by scarring & loss of elasticity of the pericardium, sometimes following cardiac surgery, radiation, or infection

Usually a chronic disease that takes considerable time to develop


Constrictive Pericarditis - Presentation & Treatment

Constriction selectively impairs filling of RV - characterized by impaired diastolic filling with elevated JVP, tachycardia, hepatomegaly, edema, ascites; lungs are clear

Often mistaken for liver disease

Treated with surgical stripping of the pericardium


Constrictive Pericarditis - ECG Findings

Dip and Plateau ("square root sign") during diastole