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Flashcards in FN: Myocardial Disease Deck (31):
1

Acute Myocarditis Causes

idiopathic (50%)
Viral
Bacterial
Drugs
Autoimmine

2

Acute Myocarditis viral causes

coxsackie B, Flu, HIV

3

Acute Myocarditis bacterial causes

S. aureus, syphilis

4

Acute Myocarditis drug causes

Cyclophosphamide
Herpception
CBZ
Phenytoin

5

Acute Myocarditis autoimmune cuases

giant cell myocarditis associated with SLE

6

Acute Myocarditis symptoms

Flu-like prodrome: fever, sore throat, myalgia Dyspnoea, fatigue
Chest pain (may coexist ̄c Bornholm disease) Arrhythmia → palpitations

7

Acute Myocarditis signs

Soft S1 S4 gallop

8

Acute Myocarditis Ix

ECG
􏰁- ST-elevation or depression 􏰁
-T wave -inversion
􏰁- Transient AV block
Bloods: +ve trop, ↑CK

9

Acute Myocarditis Rx

Supportive
Rx cause

10

HOCM aetiology

􏰀 LVOT obstruction from asymmetric septal hypertrophy
􏰀 AD inheritance (but 50% sporadic)
􏰀 β-myosin heavy chain mutation commonest
􏰀 Ask re family Hx of sudden death

11

HOCM Symptoms

Angina
Dyspnoea
Palpitations: AF, WPW, VT Exertional syncope or sudden death

12

HOCM signs

Jerky pulse
Double apex beat
Harsh ESM @ LLSE ̄c systolic thrill S4

13

HOCM Ix

ECG
􏰁 - LVH/LAD/L strain,
- 􏰁 Ventricular ectopics, VT, VF Echo: ASH
Exercise test ± holter monitor to quantify risk

14

HOCM Mx Medical

􏰁 -ve inotropes: 1st – β-B, 2nd –verapamil 􏰁 Amiodarone: arrhythmias
􏰁 Anticoagulate if AF or emboli

15

HOCM non-medical

􏰁 Septal myomectomy (surgical or chemical) if severe symptoms

16

HOCM other Mx

Consider ICD

17

Cardiac Myxoma epi

􏰀 Rare, benign cardiac tumour
F>M = 2:1

18

Cardiac Myxoma familial causes presentation

: e.g. Carney Complex
􏰁 Cardiac and cutaneous myxoma, skin pigmentation, endocrinopathy (e.g. Cushing’s)

19

Cardiac myxoma presentation

90% in left atrium (fossa ovalis)

20

Cardiac Myxoma features

􏰁 Clubbing, fever, ↓wt., ↑ESR
􏰁 Signs similar to MS (MDM, systemic emboli, AF)
but vary ̄c posture.

21

Cardiac myxoma Dx

echo

22

Cardiac myxoma Rx

Excision

23

Restrictive Cardiomyopathy causes

miSSHAPEN
􏰀 Sarcoid
􏰀 Systemic sclerosis
􏰀 Haemochromatosis
􏰀 Amyloidosis
􏰀 Primary: endomyocardial fibrosis
􏰀 Eosinophilia (Loffler’s eosinophilic endocarditis) 􏰀 Neoplasia: carcinoid (→ TR and PS)

24

Restrictive Cardiomyopathy Clinical features

as constrictive pericarditis

25

Restrictive Cardiomyopathy Dx

Catherisation

26

Restrictive Cardiomyopathy Rx

Rx cause

27

Dilated Cardiomyopathy Causes: DILATE

􏰀 Dystophy: muscular, myotonic, glycogen storage disease 􏰀 Infection: complication of myocarditis
􏰀 Late pregnancy: peri-, post-partum
􏰀 Autoimmune: SLE
􏰀 Toxins: EtOH, doxorubicin, cyclophosphamide, DXT
􏰀 Endocrine: thyrotoxicosis

28

Dilated Cardiomyopathy Presentation

􏰀 LVF and RVF
􏰀 Arrhythmias

29

Dilated Cardiomyopathy signs

􏰀 JVP ↑↑
􏰀 Displaced apex
􏰀 S3 gallop
􏰀 ↓BP
􏰀 MR/TR

30

Dilated Cardiomyopathy Ix

􏰀 CXR: cardiomegaly, pulmonary oedema
􏰀 ECG: T inversion, poor progression
􏰀 Echo: globally dilated, hypokinetic heart + ↓EF
􏰀 Catheter + biopsy: myocardial fibre disarray

31

Dilated Cardiomyopathy Mx

􏰀 Bed rest
􏰀 Medical: diuretics, ACEi, digoxin, anticoagulation
􏰀 Non-medical: biventricular pacing, ICD
􏰀 Surgical: heart Tx

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