Cardiomyopathies & Pericarditis Flashcards Preview

CVPR - CV Unit 1 > Cardiomyopathies & Pericarditis > Flashcards

Flashcards in Cardiomyopathies & Pericarditis Deck (20):
1

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

2

Which virus is most commonly associated with acute myocarditis?

Coxsackie virus

3

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

4

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

5

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

6

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

7

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

8

Hypertrophic obstructive cardiomyopathy - Treatment

Avoid extreme exertion (i.e. sports)

Decrease contractility - B-blockers/Verapamil

Surgical mymectomy

ICD implantation

9

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

10

Most common symptoms of acute pericarditis

Sudden onset of chest pain - often sharp and severe

Chest pain varies with position and breathing

11

Most common causes of pericarditis

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

12

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

13

Treatment of acute pericarditis

Ibuprofen, aspirin

14

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

15

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

16

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)

17

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

18

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

19

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

20

Constrictive Pericarditis - ECG Findings

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