Disease of the heart muscle, pericardium and endocarditis

Question 1

Define acute myocarditis

Answer 1

acute inflammation of the myocardium. The heart becomes flabby with focal haemorrhages and inflammatory infiltrate

Question 2

What are the symptoms of acute myocarditis

Answer 2

fever
chest pain
SOB
palpations

Question 3

What are the sign of acute myocarditis

Answer 3

Arrhythmia

Cardiac failure

Question 4

Acute myocarditis aetiology

Answer 4

mainly caused by enteroviruses - Coxseickie A +B, Echovirus

Question 5

How do you diagnose acute myocarditis

Answer 5

viral PCR
Throat and stool swap for enterovirus
Throat swab for echovirus

Question 6

What investigation finding would you discover in acute myocarditis

Answer 6

CXR: cardiac enlargement
ECG: ST elevation or deprivation, T wave inversion, arrhythmia, heart block
Elevated CK / Troponium

Question 7

How would you treat Acute Myocarditis

Answer 7

Treat underlying cause of infection
Antibiotics if necessary
Bed rest
ACEI, B-blockers, Spironolactone, Digoxin

Question 8

Define hypertrophic cardiomyopathy

Answer 8

Hypertrophy in the absence of other disease

Question 9

What is the most common cause of sudden cardiac death in children / young people

Answer 9

Hypertrophic (OBSTRUCTIVE) cardiomyopathy

Question 10

Which disease is autosomal dominant, which many of the mutations in genes encoding for sacromeric proteins

Answer 10

HOCM

Question 11

What are the signs and symptoms of HOCM

Answer 11

Asymptomatic
Chest pain, dyspnoea, syncope
LVOT obstruction
Double apex pulsation
S4
Jerky carotid pulse
Systolic murmur
Hypertrophy affecting IV septum

Question 12

ECG: LV hypertrophy, Q waves inferolaterally
ECHO: diagnostic ASYMMETRY

Answer 12

HOCM

Question 13

Treatment of HOCM

Answer 13

treat symptoms
mild - amiodarone
b-blockers +/- verapamil

Question 14

‘banana shaped LV cavity’

Answer 14

HOCM

Question 15

which kind of murmur is HOCM quite often associated with

Answer 15

mitral regurgitation

Question 16

A dilated flappy heart of unknown cause that is congenitally X-linked

Answer 16

Dilated cardiomyopathy

Question 17

Symptoms and signs of dilated cardiomyopathy

Answer 17

arrhythmias, HF, thrombembolism

Question 18

Investigation findings from Dilated cardiomyopathy

Answer 18

CXR: cardiac enlargement
ECG: ST changes, arrhythmias
ECHO: dilated chambers
ANGIOGRAPHY: to exclude CHD

Question 19

Treatment of Dilated cardiomyopathy

Answer 19

manage HF

cardiac resync therapy

Question 20

Cardiomyopathy that has decreased volume of both ventricles w/ bi-atrial enlargement, normal wall thickness and impaired filling

Answer 20

Restrictive cardiomyopathy

Question 21

Very rare, associated with amyloidosis, sarcoidosis, endocardial fibrosis

Answer 21

restrictive cardiomyopathy

Question 22

Symptoms and signs of restrictive cardiomyopathy

Answer 22

HF symptoms, increased JVP, Hepatomegaly, Oedema, Ascities

Question 23

Treatment of restrictive cariomyopathy

Answer 23

TREAT CAUSE

Question 24

Inflammation of the pericardium

Answer 24

acute pericarditis

Question 25

Causes of acute pericarditis

Answer 25

Viruses, Bacterial, Fungi, MI, Drugs, trauma, surgery, malignancy, radiotherapy, sarcoidosis...etc...

Question 26

Clinical features of acute pericarditis

Answer 26

central chest pain - worse on inspiration or lying flat pericardial friction rub pericardial effusion / pericardial tamponade fever ?

Question 27

high-pitched scratching noise

Answer 27

pericardial friction rub

Question 28

Saddle-shape of ECG

Answer 28

acute pericarditis

Question 29

Treatment of acute pericarditis

Answer 29

analgesia - ibuprofen treat the cause steroids

Question 30

Accumulation of fluid in the pericardial sac

Answer 30

pericardial effusion

Question 31

Clinical features of pericardial effusion

Answer 31

Dyspnoea raised JVP Bronchial breathing - lung base

Question 32

To diagnose pericardial effusion

Answer 32

CXR - large, globular heart | ECG - low voltage QRS complexes and alternating QRS morphologies

Question 33

Management of pericardial effusion

Answer 33

treat the cause - NSAID, Steroids, antibiotics Pericardiocentesis - diagnostic echo

Question 34

Describe constrictive pericarditis

Answer 34

the heart is encased in a rigid pericardium

Question 35

What are the causes of constrictive pericarditis

Answer 35

Unknown in UK TB in other countries Pericarditis

Question 36

Clinical features of constructive pericarditis

Answer 36

``` R.HF : raised JVP Kussmaul's sign soft, defuse apex quiet heart sounds pericardial knock hepatosplenomegaly acities oedema ```

Question 37

Investigations for constrictive pericarditis

Answer 37

CXR - small heart +/- peripheral calcification

Question 38

Management of constrictive pericarditis

Answer 38

surgical excision

Question 39

Accumulation of pericardial fluid raises intrapericardial pressure, hence poor ventricular filling and fall in cardiac output

Answer 39

cardiac tamponade

Question 40

causes of cardiac tamponade

Answer 40

``` pericarditis aortic dissection haemodialysis warfarin transmural puncture MI ```

Question 41

Signs of cardiac tamponade

Answer 41

``` Pulsus paradoxus, decreased blood pressure increased pulse increased JVP Kussmaul's sign muffled S1 and S2 ```

Question 42

Treatment of xardiac tamponade as a complication of an MI

Answer 42

pericardial aspiration | surgery

Question 43

CXR: large globular heart ECG: low voltage QRS complexes + alternating QRS morphologies

Answer 43

pericardial effusion