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Cardiovascular system > Cardiomyopathy and Pericardial Disease > Flashcards

Cardiomyopathy and Pericardial Disease Flashcards

1
Q

what is the aetiology of dilated cardiomyopathy?

A

> genetic and familial (SCN5A gene)
inflammatory (infection and autoimmune)
toxic (drugs and exogenous chemicals)
injury (cell loss and scar replacement)

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2
Q

what is dilated cardiomyopathy?

A

when some or all of the chambers of the heart are dilated and functionally impaired.

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3
Q

what are the symptoms of cardiomyopathy?

A

progressive: dyspnoea, ankle swelling, fatigue, orthopnoea (breathlessness preventing patient lying down), weight gain, cough.

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4
Q

what would you find on examination of a patient with dilated myopathy?

A 
> poor superficial perfusion
> thread pulse
> short of breath at rest
> JVP elevated
> displaced apex
> s3 and s4
> oedema (pulmonary, ankle and sacral)
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5
Q

what might there be in the PMH of someone with dilated cardiomyopathy?

A 
> systemic illness
> travel
> hypertension
> vascular disease
> thyroid
> neuromuscular disease
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6
Q

what is the basic evaluation for cardiomyopathy?

A 
> ECG
> CXR
> basic bloods
> echo
> CMRI
> coronary angiogram
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7
Q

what are the general measurements in treatment of cardiomyopathy?

A

> correct underlying cause
remove exacerbating drugs
reduce fluid and salt intake
management of weight

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8
Q

give some more specific measures in treatment of dilated cardiomyopathy

A 
> diuretics
> beta blockers
> spironolactone
> anti-coagulants (as required)
> cardiac transplant
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9
Q

describe the pathology of restrictive and infiltrative cardiomyopathy

A

there is an inability to fill a ventricle whose wall has reduced compliance as the relaxation of the ventricular wall is an active process that needs functioning myocytes.

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10
Q

what is the basic evaluation of restrictive and infiltrated cardiomyopathy?

A 
> ECG
> CXR
> basic bloods
> U and E's
> ECHO
> CMRI
> amyloids
> biopsy (may have false negative)
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11
Q

what are the general measures for restrictive and infiltrative cardiomyopathy?

A

> beta-blockers
anti-coagulants as required
cardiac transplants

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12
Q

what causes hypertrophic cardiomyopathy?

A

a sarcomere gene defect that is autosomal dominant but it has variable expression and incomplete penetrance.

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13
Q

describe the pathology of hypertrophic cardiomyopathy

A

> myocyte hypertrophy and disarray
there is general or segmental wall thickness
it can be apical, septal or generalised
coronary arteries can narrow leading to ischaemia

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14
Q

what can septal hypertrophy lead to?

A

mitral valve defect

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15
Q

what are the symptoms of hypertrophic cardiomyopathy?

A 
> asymptomatic
> fatigue
> dyspnoea
> angina like chest pain
> exertional syncope
> LVOT obstruction
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16
Q

what may you find on examination of someone with hypertrophic cardiomyopathy?

A

> notched pulse pattern
irregular pulse if atrial fibrillation
double impulse over the apex
JVP can be raised in very restrictive filling

17
Q

what assessments would you perform on someone with a suspected hypertrophic cardiomyopathy?

A

> ECG
echo
CMRI

18
Q

what are the general measures for hypertrophic cardiomyopathy?

A

> avoid heavy exercise, dehydration
consider genetic testing
explore FH

19
Q

what specific measures are there for hypertrophic cardiomyopathy?

A

> drugs enhancing relaxation
anti-coagulate if in atrial fibrillation
surgical/alcohol ablation is obstructive
implantable cardioverter defibrillator

20
Q

what is myocarditis?

A

acute or chronic inflammation of the myocardium

21
Q

what problems can myocarditis lead to?

A

> impaired function
impaired conduction
generation of arrhythmias

22
Q

describe the pathology of myocarditis

A

there is infiltration of inflammatory cells into the myocardial layers, this causes reduced function and heart failure. heart block and arrhythmias can occur.

23
Q

what are the symptoms of myocarditis?

A

> fatigue
shortness of breath
signs of heart failure

24
Q

describe what assessments you would carry out on a patient with suspected myocarditis

A 
> ECG
> biomarkers (elevated but pattern not consistent with MI)
> ECHO
> CMRI
> biopsy
> PCR (shows viral DNA)
25
Q

what are the general measures for myocarditis?

A

> supportive treatment for heart failure
support for brady/tachy cardiac arrhythmias
immunotherapy
stop drug/toxic agent exposure

26
Q

what is pericarditis?

A

this is inflammation of the pericardial layers (with or without myocardial involvement)

27
Q

what are the symptoms of pericarditis?

A

> chest pain with pleuritic features

> fever

28
Q

what are the signs of pericarditis?

A

> high temp
pericardial rub
raised JVP
muffled heart sounds (effusion)

29
Q

what investigations would you carry out for pericarditis?

A

> ECG
echo
troponin levels

30
Q

what are the general measures for pericardial disease?

A

> idiopathic: colchicine and NSAIDs

> bacterial must be drained

31
Q

what are the symptoms of pericardial effusion?

A

> fatigue
shortness of breath
low BP
occasionally chest pain

32
Q

what are the signs of pericardial effusion?

A

> pulsus paradoxus
raised JVP
low BP

33
Q

what key tests should you carry out on someone with pericardial effusion?

A

> echo

> CXR

34
Q

what is the treatment for pericardial effusion?

A

> drainage

> surgical pericardial window if there is persistent effusion

35
Q

what are the causes constrictive pericarditis?

A 
> idiopathic
> post surgery
> autoimmune
> renal failure
> sarcoid
36
Q

what is the pathology of constrictive pericarditis?

A

there is impaired filling even though the myocardium is normal

37
Q

what are the symptoms of constrictive pericarditis?

A

> fatigue
shortness of breath
cough

38
Q

what are the signs of constrictive pericarditis?

A 
> ascites
> high jvp
> jaundice
> hepatomegaly
> atrial fibrillation
> pleural effusion
> pericardial knock
39
Q

what is the treatment for constrictive pericarditis?

A

> careful diuretics

> pericardectomy

Cardiovascular system (34 decks)

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