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Flashcards in Myocardial disease Deck (27):
1

What is myocarditis?

Inflammation of the mycardium

2

What is the most common cause of myocarditis in the UK

Viral infection, particularly Coxsackie virus infection

3

What are the other causes of myocarditis?

Diptheria
Rheumatic fever
Radiation injury
Some drugs- penicillin, sulfonamides, methyldopa, spironolactone

4

What are the symptoms and signs of myocarditis?

Fatigue
Dyspnoea
Chest pain
Fever
Palpitations
Tachycardia
S4 gallop

5

What investigations are done to confirm myocarditis? What may they show?

CXR: may show cardiac enlargement
ECG: shows non-specific T wave and ST changes
Diagnosis is supported by demonstrration of an increase in serum viral tires and inflammation on cardiac biopsy
In absence of MI, positive troponin confirms diagnopsis

6

How is myocarditis managed?

Bed rest
Treatment of heart failure and any underlying cause
Prognosis is good

7

What are cardiomyopathies

Cardiomyopathies are a group of disease of the myocardium that affect the mechanical or electrical function of the heart

8

What cardiomyopathies affect the mechanical function of the heart?

Hypertrophic, dilated and restrictive cardiomyopathy

9

What is the characteristic feature of hypertrophic cardiomyopathy?

Marked ventricular hypertrophy in the absence of abnormal loading conditions such as hypertension and valvular disease
The hypertrophic non-compliant ventricles impair diastolic filling so that stroke volume is reduced

10

Describe the epidemiology/prevalance of HCM

Prevalance=0.2%

Autosomal dominant inheritance

50% of cases are sporadic

70% of cases have mutations in genes encoding beta-myosin, alpha-tropomyosin and troponin T

MOST COMMON CAUSE OF SUDDEN CARDIAC DEATH IN YOUNG PEOPLE

11

What are the clinical features of HCM?

May be symptom free and detected through family screening
Symptoms include breathlessness, angina or syncope

12

What are the complications of HCM?

Sudden death
Artial and ventricular arrhythmias
Thromboembolism
IE
Heart failure

13

What clinical features may be seen O/E in HCM

Jerky carotid pulse because of rapid ejection and sudden obstruction to ventricular outflow during systole

An ejection systolic murmur occurs because of left ventricular outflow obstruction

14

What investigations are done for HCM. What do they show?

ECG: abnormal. Pattern of left ventricular hypertrophy with no discernable cause is diagnostic

Echo/MRI: Ventricular hypertrophy

15

How is HCM managed?

1. Amioderone reduces risk of arrhythmias and sudden death
2. Individuals at highest risk are fitted with an implantable cardiac defibrillator
3. Chest pain and dyspnoea are treated with beta-blockers and verapamil

16

What is dilated cardiomyopathy (DCM)

LV is dilated and contracts poorly

17

How is DCM inherited in its familial form?

autosomal dominant

18

What other conditions are associated with DCM?

Alcohol
High BP
Haemochromatosis
Viral infection
Autoimmune
Peri- or post-partum
Hyperthyroidism

19

How do patients with DCM present?

Shortness of breath is usually the first complaint
More rarely, patients present with embolism from mural thrombus or arrhythmia
Subsequently there is progressive heart failure with the symptoms and signs of biventricular failure

20

What is seen on an echo of a patient with DCM?

Globally dilated, hypokinetic heart and low ejection fraction

21

How is DCM treated?

Heart failure and arrhythmias are treated in the normal way
Cardiac resynchronization therapu and implantable cardiac defibrillators are used in patients with NYHA III/IV grading
Severe cardiomyopathy is treated with cardiac transplantation

22

What are considered poor prognostic factors for HCM?

Age <14
Syncope at presentation
Family history of HCM/sudden death

23

What is primary restrictive cardiomyopathy?

The ridgid myocardium restrictis diastolic and ventricular filling and the clinical features resemble those of constrictive pericarditis

24

What is the most common cause of restrictive cardiomyopathy in the UK? What else might cause restrictive cardiomyopathy?

Amyloidosis

Haemochromatosis
Sarcoidosis

25

How is restrictive cardiomyopathy diagnosted?

Cardiac catheterization which shows characteristic pressure changes

26

What is the treatment and prognosis of restrictive cardiomyopathy?

No specific treatment- treat the cause
Prognosis is poor

27

What is cardiac myxoma?

Rare, benign cardiac tumour. May mimic infective endocarditis (fever, weight loss, clubbing, raised ESR) or mitral stenosis (keft atrial obstruction, systemic emboli, AF)