Heart muscle diseases

Question 1

what is the possible aetiology of dilated cardiomyopathy?

Answer 1

often idiopathic

alcohol, endocrine disorders, genetic (gene mutations), inflammation, infection, trauma

Question 2

what are the possible signs of dilated cardiomyopathy?

Answer 2

same as heart failure:
raised JVP
murmur (MR)
peripheral/sacral/pulmonary oedema
pleural effusion
peripheral cyanosis
hepatomegaly 
displaced apex beat

Question 3

what are some possible symptoms of dilated cardiomyopathy?

Answer 3

same as heart failure:
SoB/orthopnea/PND
chest pain
exertional fatigue
cough
ankle swelling

Question 4

what are possible investigations for dilated cardiomyopathy?

Answer 4

bloods (FBC, U&E, CRP, BNP)
ECG
CXR
echo
MRI (ideally)
CT angiogram

Question 5

what are the non-pharmacological treatments of dilated cardiomyopathy?

Answer 5

weight loss
exercise
diet
salt and water intake

Question 6

what are the pharmacological treatment options for dilated cardiomyopathy?

Answer 6

erythropoietin if anaemic
treat underlying cause (endocrine, alcoholism etc)
ACEi/ARB, beta blockers, spironolactone
Anticoagulants

Question 7

What is the aetiology if restrictive and infiltrative cardiomyopathy?

Answer 7

Half the time due to other diseases, otherwise unknown

Question 8

What investigations should be done for restrictive/infiltrative cardiomyopathy?

Answer 8

Bloods (FBC, CRP, U&E)
ECG
CXR
Echo
MRI ideally

Question 9

What are the treatments for restrictive cardiomyopathy?

Answer 9

Limited
Anticoagulants
Heart transplant

Question 10

What is the aetiology of hypertrophic cardiomyopathy?

Answer 10

Can be caused by diseases causing hypertrophy, genetic abnormalities, or idiopathic

Question 11

What is the pathology of hypertrophic cardiomyopathy?

Answer 11

Disarray of myocytes, impaired relaxation on diastole

Question 12

What are the signs of hypertrophic cardiomyopathy?

Answer 12

Can be none

May be raised JVP, irregular pulse, double apex beat

Question 13

What are the symptoms of hypertrophic cardiomyopathy?

Answer 13

Can cause sudden cardiac death
Can have no symptoms
Fatigue, SoB (on exertion), palpitations
Left ventricular outflow obstruction

Question 14

What are the non-pharmacological and pharmacological measures for hypertrophic cardiomyopathy?

Answer 14

Nonpharmacology:
Light exercise, avoid dehydration, genetic testing

Pharmacology: drugs to aid relaxation (beta blockers, vasodilating CCB’s)
internal defibrillator
Anticoagulants

Question 15

What investigations can be done for hypertrophic cardiomyopathy?

Answer 15

Bloods
ECG
Echo
MRI

Question 16

What can be some causes of myocarditis?

Answer 16

Virus 
Bacteria 
Toxins 
Autoimmune
Inflammation

Question 17

What are some symptoms of myocarditis?

Answer 17

Heart failure symptoms
SoB
Chest pain
Fatigue

Question 18

What are some investigations for myocarditis?

Answer 18

Bloods (biomarkers, troponin)
ECG
Echo
MRI

Question 19

What is the difference between troponin levels with MI and with myocarditis?

Answer 19

MI - troponin levels rise then fall

Myocarditis - troponin levels stay high

Question 20

What treatment options are available for myocarditis?

Answer 20

Supportive treatment, relieve symptoms
Treat underlying cause
Immunotherapy

Question 21

What is PR depression on an ECG specific for?

Answer 21

Pericarditis

Question 22

What is pericarditis and what is it caused by?

Answer 22

Inflammation of only pericardium

Can be bacterial, viral, post MI, cancer, dissection

Question 23

What are symptoms of pericarditis?

Answer 23

Fever

Specific pericardial pain

Question 24

What are some signs of pericarditis?

Answer 24

Potentially raised JVP
Pericardial rub
Low blood pressure
Muffled heart sounds

Question 25

What investigations should be done for pericarditis?

Answer 25

ECG Bloods (troponin) Echo

Question 26

What is the treatment of pericarditis?

Answer 26

Viral - conservative treatment Bacterial - antibiotics, but high mortality Idiopathic - colchicine + NSAIDs Drain if necessary

Question 27

What are some signs and symptoms of pericardial effusion?

Answer 27

Often same as pericarditis: | Fatigue, SoB, cough, raised JVP, low BP

Question 28

What are the investigations of pericardial effusion?

Answer 28

ECG | Echo

Question 29

What are some signs of constrictive pericarditis?

Answer 29

Cough SoB Right heart failure

Question 30

What are some investigations for constrictive pericarditis?

Answer 30

Cardiac catheter | Echo

Question 31

What are possible causes of constrictive pericarditis?

Answer 31

It’s rare, normally idiopathic | Post surgery, radiation, autoimmune