Cardiomyopathy, Myocarditis and Pericarditis

dilated cardiomyopathy is usually the left ventricle, very large and dilated, hypertrophic left ventricles, cardiomyocytes on histology and contraction band necrosis

some causes reversible, treated underlying issues e.g. haemotopomosis

symptoms:

SOB, fatigue, orthopnea, paroxysmal nocturnal dyspnoea, weight gain, peripheral oedema

any systemic illnesses - viral illness could cause affected cardiomyopathy

examination - breathless, thready pulse, more likely to get Atrial fibrillation, as ventricles dilate atria more likely to dilate?, JVP elevated, displaced apex, 3rd or 4th heart sound, pan systolic murmur - mitral regurgitation (not primary cause), pulmonary oedema, fine crepitations

tests and medications:

ECG, CXR, BNP, Bloods - FBC, U&E, Echo, CMRI (cardiac MRI) to see areas of fibrosis and distribution, Coronary angiogram, sometimes biopsy depending on time course of cardiomyopathy

if people anemic correct anaemia

remove any unideal drugs eg NSAIDs

correct hypo/hyperthyroidism - endocrine disturbance

reduce salt

managing weight, keep record, if weight changes changing diet

ACEi, ATII blockers, diuertics, sac/val

beta blockers

spironolactone

anticogulants

SLE II inhibitors

risk of cardiac death

prognosis generally poor but improved a little

restrictive and infiltrative cardiomyopathy - don’t relax so blood less likely to fill

seen in younger patients

restrictitve and infiltrative cardiomyopathy:

diuretics mostly

beta blockers

anticoagulants

SCD risk

cardiac transplant

endomyocardial fibrosis less specific treatment

hypertrophic cardiomyopathy:

impaired relaxation common feature and systolic function adequate

most common form is myocyte hypertrophy and disarray

impaired relaxation so behaves in a restrictive manner

asymptomatic

can be breathless, can have raised JVP, palpitations, syncope, anginal like chest pain

ECG abnormal, LV hypertrophy pattern on ECG on lateral leads

echo

CMRI, conclusive for hypertrophic phenotype or not, patterns of fibrosis

Exercise Treadmill test for hypertrophic cardiomyopathy score

avoid dehydration- at least 3L, avoid heavy masses

explore family member history if they have kids for genetic testing

beta blockers, verapamil (CCB- non DHP), disopyrimide (sodium channel blocker), mavocantan (myosin inhibitor) - causes drastic reversibility in myocardium sickness, only used in small number of patients

myocarditis = acute or chronic inflammation of the myocardium, can be in association with pericarditis

can get VT or even complete heart block

heart failure, fatigue, SOB, CP

may not have fever, present very acutely

ECG usually abnormal, biomarkers often elevated -troponin, don’t fall in pattern with MI, elevated troponin that stays persistently elevated for a long time

observe until biomarkers fall as high risk of VT or VF

Echo, can get RWMA

CMRI can see oedema in certain images

biopsy is unsure, infiltration of immune cells

treatment generally supportive - analgesia, painkillers, amiodarone to suppress arrhythmias, stop any toxic agent exposure or drugs

pericardial disease

pericarditis - inflammation of pericardial layer with or without myocardial involvement

pneumonia, post MI, perforation or dissection- main things of pericarditis

short duration, chest pain, runny nose, temperature, JVP if large pericardial effusion

high fever and very unwell despite no effusion may suggest bacterial

ECG-PR elevation, echo

troponin may be raised if myocardial involvement

paracetamol, ibuprofen, alotrasine? if viral

idiopathic colchicine and NSAIDs

pericardial effusion

may be haemodynamically significant

-drainage main treatment

ECG large QRS, small QRS large QRS …

PE= pericardial effusion

constrictive pericarditis is rare, reoccurring, idiopathic, radiation, post surgery, autoimmune, renal failure, sarcoid

impaired filling but myocardium usually normal

fatigue, SOB, cough

signs similar to right heart failure

diuretics and pericardectomy-treatment