Cardiomyopathy, Myocarditis and Pericarditis Flashcards
(50 cards)
Explain dilated cardiomyopathy
Is an effect of a structural and functional description
The ventricular function is impaired as weakened and enlarged
Can be primary or as a result to pathological insult to the myocardium
What are some causes of dilated cardiomyopathy?
Genetic and familial DCM - SCB5A gene or muscular dystrophy
Inflammatory, infection, autoimmune, postpartum
Toxic - drugs, chemicals and endocrine
Injury, cell loss or scar replacement
What chambers can be affected by DCM?
Can be one or more often all chamber dilated and functionally impaired
Thrombosis in chambers is not uncommon
What are treatable causes of DCM?
Alcohol, endocrine, tropical disease, post partum, hemochromatosis and sarcoid
What are the symptoms of dilated cardiomyopathy?
Progressive and slow onset
Dyspnoea, fatigue, orthopnoea, PND, ankle swelling, weight gain of fluid overload and cough
What signs of DCM can be seen on examination?
Poor superficial perfusion, low volume pulse, irregular pulse if AF, SOB at rest, narrow pulse pressure, JVP elevated, displaced apex, S3 and S4, MR murmur often, pulmonary oedema, pleural effusions and oedema
What is used to investigate DCM?
Repeated ECG noting LBBB if present
CXR, BNP, Basic bloods (FBC and U+E), Echo, CMRI (best), coronary angiogram and rarely biopsy
What are the general measures for treatment in DCM?
Correct anaemia, remove exacerbating drugs (NSAIDS), correct endocrine disturbance, advise fluid and salt intake, managing weight and HF nurse referral
What are some specific measures for treatment of DCM?
ACEi, ATII blockers, diuretics and Sac/Val
BB, spironolactone and anticoagulants as required
SCD risk assessment with ICD
Cardiac transplant
What is the prognosis of DCM?
Generally poor and often influenced by causes where known
What is restrictive and infiltrative cardiomyopathy?
Less common, describes the physiology of filling and myocyte relaxation capacity which is reduced
Systolic function may or may not be impaired
Half are related to specific clinical disorders
What are the causes for restrictive and infiltrative cardiomyopathy?
Non-infiltrative - familial, HCM, scleroderma, diabetic, pseudoxanthoma
Infiltrative - amyloid and sarcoid
Storage diseases - hemochromatosis and Fabry disease
Endomyocardial - fibrosis, carcinoid, radiation and drug effects
Describe pathology of restrictive and infiltrative cardiomyopathy?
Inability to fill the ventricle well as reduced compliance
Relaxation of ventricle wall is active process that needs functioning intact myocytes
Scar over healthy myocytes so wall thickened
What investigations are done in restrictive and infiltrative cardiomyopathy?
Repeated ECG, CXR, BNP, Basic bloods, Auto-antibodies, biopsy for amyloid, Echo, CMRI
What the measures for treatment for restrictive and infiltrative cardiomyopathy?
Limited diuretic use, BB limited and ACEi use
Anticoagulants as required
SVD risk assessment with ICD
Cardiac transplant
What is the prognosis for restrictive and infiltrative cardiomyopathy?
Unless reversible then poor prognosis
What is hypertrophic cardiomyopathy?
Disease of the heart where heart muscle becomes thickened
Impaired relaxation is a common feature and systolic function is usually adequate with some functional abnormality
Genetics are important
Describe hypertrophic cardiomyopathy and genes
Sarcomere gene defect and autosomal dominant but variable expression and incomplete penetrance
Describe the pathology of hypertrophic cardiomyopathy
Myocyte hypertrophy and disarray
Can be generalised or segmental wall thickness >14mm or 12mm in primary relative
Can be apical, septal or generalised
Impaired relaxation so behaves in restrictive manner
If septal hypertrophy then Mitral valve defect can lead to LVOT obstruction
Explain coronary artery and small vessel involvement with hypertrophic cardiomyopathy?
Coronary arteries also affected with small vessel narrowing and consequent ischaemia and fibrosis so arrhythmias are common
What are the symptoms of hypertrophic cardiomyopathy?
Asymptomatic for many
Fatigue, dyspnoea, anginal like chest pain, exertional pre syncope, syncope related to arrhythmias or LVOT obstruction
What are some examinational findings of hypertrophic cardiomyopathy?
Can be none
Notched pulse pattern, irregular pulse is AF or ectopy, double impulse over apex, thrills and murmurs and JVP can be increased
What is included in the assessment of hypertrophic cardiomyopathy?
ECG, Echo, CMRI and risk stratification for SCD and may need ICD
What are general measures used to treat hypertrophic cardiomyopathy?
Avoid heavy exercise, avoid dehydration, explore FH and ECG may be required, consider genetic testing and regular FU
