Heart Muscle Diseases

Question 1

What happens during dilated cardiomyopathy ?

Answer 1

Heart becomes dilated

- all four chambers can be affected but left ventricle is most affected

Question 2

Is diastole or systole affected with dilated cardiomyopathy?

Answer 2

systole

Question 3

What is the difference between primary and secondary dilated cardiomyopathy?

Answer 3

primary - no previous condition which could have caused the dilation

secondary - another condition had caused the dilation

Question 4

Name some secondary causes for dilated cardiomyopathy

Answer 4

Genetics
autoimmune, inflammatory or infectious disease
toxic exposure: drugs, chemicals
injury: cell loss

Question 5

Is the risk of thrombosis increased or decreased with dilated cardiomyopathy

Answer 5

increased as the blood flow is more stagnant as the blood is not being pumped effectively out of the heart

Question 6

What secondary conditions can be treated to decrease the extent of dilation of the heart?

Answer 6

• post pregnancy
• sarcoid
• endocrine
• alcohol intake

Question 7

Is the onset of symptoms slow or fast with dilated cardiomyopathy?

Answer 7

slow (can take months)

Question 8

What symptoms do people with dilated cardiomyopathy have?

Answer 8

• fatigue
• orthopnoea - SOB when lying
• ankle swelling
• fluid overload
• cough

Question 9

What clinical signs may be seen with dilated cardiomyopathy?

8 signs

Answer 9

Peripheral cyanosis 
Severe SOB 
Displaced apex beat 
Elevated JVP
MR murmur 
Pulmonary oedema 
Sacral oedema 
Enlarged liver

Question 10

What investigations would be done for dilated cardiomyopathy?

Answer 10

CXR - Pulmonary oedema 
Bloods - FBC, U+Es
Regular ECG 
Echo 
Coronary angiogram 
CMRI

Question 11

What 4 drugs should be given as treatment?

Answer 11

B blockers - decrease contractibility of the heart
ACEI - decrease BP
Anticoagulants - blood thinner to reduce risk of thrombosis
Spironolactone - a steroid drug which promotes sodium excretion

Question 12

What drug makes dilated cardiomyopathy worse?

Answer 12

NSAIDS

Question 13

What other treatment/management should be done to treat the dilated heart?

Answer 13

• manage body weight
• watch diet (fluid and salt intake)
• nurse referral
• correct anaemia (if present)

Question 14

What occurs during Restrictive and infiltration cardiomyopathy ?

Answer 14

Filling process of the heart is abnormal

Heart chambers are not compliant and don’t stretch as they should so pre load is reduced.

Question 15

Is Restrictive and infiltration cardiomyopathy common or uncommon?

Answer 15

uncommon

Question 16

Name some infiltrative and and non-infiltrative causes for restrictive cardiomyopathy

Answer 16

Non infiltrative = Familiar, scleroderma, diabetic

Infiltrative = Amyloid, sarcoid

Question 17

What investigations should be done for restrictive cardiomyopathy?

Answer 17

Repeated ECG 
Bloods - FBC, U+Es 
CXR 
Echo 
CMRI
Sclerotic – auto antibodies detection 
Biopsy

Question 18

what drugs should not be used in restrictive cardiomyopathy ? and why?

Answer 18

ACEI
B blockers
Diuretics

they would reduce the BP which would increase the problem of low cardiac output

Question 19

Which drug should be given during restrictive cardiomyopathy ?

Answer 19

Anticoagulant

Question 20

Is prognosis better or worse than dilated cardiomyopathy?

Answer 20

worse

Question 21

Is hypertrophic cardiomyopathy common or uncommon?

Answer 21

very common

Question 22

In hypertrophy are the myocytes organised or unorganised?

Answer 22

unorganised (not lined up properly )

- reduces contractibility efficiency

Question 23

Is diastole or systole affected during restrictive cardiopathy?

Answer 23

diastole

Question 24

Is diastole or systole affected during hypertrophy cardiopathy?

Answer 24

diastole as the walls have been thickened so less blood can fill up the heart chamber

Question 25

Does hypertrophic heart disease run in families?

Answer 25

yes

Question 26

What differences would be seen if the apex OR septal was hypertrophied?

Answer 26

APEX - function not affected as much SEPTAL - valves can be affected and led to left ventricle outflow track (LVOT) obstruction

Question 27

Can coronary arteries be affected during hypertrophy?

Answer 27

yes which can lead to ischaemia and infarction

Question 28

What symptoms can a patient with hypertrophy have?

Answer 28

- mostly asymptomatic - fatigue, angina like chest pain, pre syncope (on excretion) - If no obstruction and have hypertrophy (abnormal myoctyes can cause AF which is a common reason for people to be syncope even when there is no obstruction) - Irregular pulse - Notched pulse pattern - Double impulse of apex

Question 29

What investigations would be done for hypertrophy?

Answer 29

``` ECG Echo ETT CMRI MRI ``` have to assess sudden cardiac death risk as the patient mat require a ICD (implantable cardioverter-defibrillator)

Question 30

Is myocarditis common or uncommon?

Answer 30

very rare

Question 31

What are five causes of myocarditis?

Answer 31

- Viral - Bacteria - Toxins - Medications - Fungi

Question 32

What four things happen if the myocarditis if left a long period of time without treatment?

Answer 32

- inflammatory response - lose of functional myocytes - results in heart failure - 3rd degree heart block and tachycardia

Question 33

What symptoms would someone with myocarditis have?

Answer 33

- fever - flu like symptoms - last a couple of weeks - signs of heart failure

Question 34

What investigations would be done for myocarditis

Answer 34

- ECG - Echo - Bloods (biomarkers - troponin) - Viral DNA PCR - Strep and auto antibodies - HIV test - CMRI

Question 35

What is the treatment for myocarditis ?

Answer 35

- ACEI, B blockers, diuretics - Immunotherapy - Treat heart failure

Question 36

What % fully recover from myocarditis?

Answer 36

30%

Question 37

What % die within the 1st year?

Answer 37

20%

Question 38

What are the symptoms of pericarditis ?

Answer 38

- Short course (1-2 weeks) - chest pain on inspiration - postural (sitting forward makes it better) - fever

Question 39

What three investigations should be done for pericarditis?

Answer 39

- Troponin - may not show MI but may be a secondary cause - ECG - ST elevation, PR depression - Echo

Question 40

What are the clinical signs of pericarditis? | 5 signs

Answer 40

- pyrexic - low BP - raised JVP - patient will be sitting forward - muffled heart sounds (like walking on snow)