Diseases of heart muscle

Causes;
o Viruses – coxsacckie, polio, HIV, Lassa fever
o Bacteria – Clostridia, diphtheria, Meningococcus Mycoplasma, Psittacosis
o Spirochaetes – Leptospirosis, syphilis, Lyme disease
o Protoszoa – Chagas disease
o Drugs
o Toxins
o Vasculitis
* Signs/symptoms
o Fatigue, dyspnoea, chest pain, palpitations, tachycardia, soft S1, S4 gallop
* Test
o ECG – ST segment elevation/depression, T wave inversion, atrial arrhythmias, transient AV block
o Serology may be helpful
* Management
o Treat underlying cause
o Patient may recover or get retractable heart failure

Dilated cardiomyopathy

* Associated with;
o Alcohol
o Hypertension
o Haemochromatosis
o Viral infection
o Autoimmune
o Peri or postpartum
o Thyrotoxicosis
o Congenital
* Presentation
o Fatigue, dyspnoea, pulmonary oedema, RVF, emboli, AF, VT
* Signs
o Raised pulse, lowered BP, raised JVP, displaced apex beat, S3 gallop, mitral or tricuspid regurgitation, pleural effusion, oedema, jaundice, hepatomegaly, ascites
* Tests
o CXR – cardiomegaly, pulmonary oedema
o ECG – tachycardia, non-specific T wave changes
o Echo – globally hypokinetic heart with low ejection fraction
* Management
o Bed rest, diuretics, digoxin, ACEI, anticoagulation, consider heart transplant
o Mortality
o Variable – 40% in 2 years

Hypertrophic cardiomyopathy

* This is LV outflow tract obstruction from an asymmetric septal hypertrophy
* Prevalence
o 0.2% – autosomal dominant inheritance by 50% are sporadic (genes include ?-myosin, ?-tropomyosin)
* Symptoms and signs
o Angina, dyspnoea, palpitaions, syncope, sudden death, a wave in JVP, harsh ejection systolic murmur
* Tests
o ECG – LVH, progressive T wave inversion, deep Q waves, AF, WPW, ventricular ectopics and VT
o Echo – asymmetrical septal hypertrophy, small LV cavity with hypercontractile posterior wall
* Management
o ?-blockers and verapamil for symptoms
o Amiodarone for arrhythmia
o Anticoagulate for paroxysmal AF of systemic emboli
o Dual chamber pacing
o Septal myomectomy

Restrictive cardiomyopathy

* Causes;
o Amyloidosis
o Haemochromatosis
o Sarcoidosis
o Scleroderma
o Loffler’s eosinophilic endocarditis
o Endomyocardial fibrosis
* Presentation
o Like constrictive pericarditis
o Features of RVF predominate, raised JVP with prominent x and Y decents, hepatomegaly, oedema, ascites

Cardiac myxoma

* Rare benign cardiac tumour
* Usually sporadic but may be familial (autosomal dominant)
* May mimic IE (fever, weight loss, clubbing, raised ESR) or mitral stenosis (left atrial obstruction, systemic emboli, AF)
* A tumour ‘plop’ may be heard
* Test
o ECHO
o Treatment
o ExcisionAcute myocarditis

* Causes;
o Viruses – coxsacckie, polio, HIV, Lassa fever
o Bacteria – Clostridia, diphtheria, Meningococcus Mycoplasma, Psittacosis
o Spirochaetes – Leptospirosis, syphilis, Lyme disease
o Protoszoa – Chagas disease
o Drugs
o Toxins
o Vasculitis
* Signs/symptoms
o Fatigue, dyspnoea, chest pain, palpitations, tachycardia, soft S1, S4 gallop
* Test
o ECG – ST segment elevation/depression, T wave inversion, atrial arrhythmias, transient AV block
o Serology may be helpful
* Management
o Treat underlying cause
o Patient may recover or get retractable heart failure

Dilated cardiomyopathy

* Associated with;
o Alcohol
o Hypertension
o Haemochromatosis
o Viral infection
o Autoimmune
o Peri or postpartum
o Thyrotoxicosis
o Congenital
* Presentation
o Fatigue, dyspnoea, pulmonary oedema, RVF, emboli, AF, VT
* Signs
o Raised pulse, lowered BP, raised JVP, displaced apex beat, S3 gallop, mitral or tricuspid regurgitation, pleural effusion, oedema, jaundice, hepatomegaly, ascites
* Tests
o CXR – cardiomegaly, pulmonary oedema
o ECG – tachycardia, non-specific T wave changes
o Echo – globally hypokinetic heart with low ejection fraction
* Management
o Bed rest, diuretics, digoxin, ACEI, anticoagulation, consider heart transplant
o Mortality
o Variable – 40% in 2 years

Hypertrophic cardiomyopathy

* This is LV outflow tract obstruction from an asymmetric septal hypertrophy
* Prevalence
o 0.2% – autosomal dominant inheritance by 50% are sporadic (genes include ?-myosin, ?-tropomyosin)
* Symptoms and signs
o Angina, dyspnoea, palpitaions, syncope, sudden death, a wave in JVP, harsh ejection systolic murmur
* Tests
o ECG – LVH, progressive T wave inversion, deep Q waves, AF, WPW, ventricular ectopics and VT
o Echo – asymmetrical septal hypertrophy, small LV cavity with hypercontractile posterior wall
* Management
o ?-blockers and verapamil for symptoms
o Amiodarone for arrhythmia
o Anticoagulate for paroxysmal AF of systemic emboli
o Dual chamber pacing
o Septal myomectomy

Restrictive cardiomyopathy

* Causes;
o Amyloidosis
o Haemochromatosis
o Sarcoidosis
o Scleroderma
o Loffler’s eosinophilic endocarditis
o Endomyocardial fibrosis
* Presentation
o Like constrictive pericarditis
o Features of RVF predominate, raised JVP with prominent x and Y decents, hepatomegaly, oedema, ascites

Cardiac myxoma

* Rare benign cardiac tumour
* Usually sporadic but may be familial (autosomal dominant)
* May mimic IE (fever, weight loss, clubbing, raised ESR) or mitral stenosis (left atrial obstruction, systemic emboli, AF)
* A tumour ‘plop’ may be heard
* Test
o ECHO
o Treatment
o ExcisionAcute myocarditis

* Causes;
o Viruses – coxsacckie, polio, HIV, Lassa fever
o Bacteria – Clostridia, diphtheria, Meningococcus Mycoplasma, Psittacosis
o Spirochaetes – Leptospirosis, syphilis, Lyme disease
o Protoszoa – Chagas disease
o Drugs
o Toxins
o Vasculitis
* Signs/symptoms
o Fatigue, dyspnoea, chest pain, palpitations, tachycardia, soft S1, S4 gallop
* Test
o ECG – ST segment elevation/depression, T wave inversion, atrial arrhythmias, transient AV block
o Serology may be helpful
* Management
o Treat underlying cause
o Patient may recover or get retractable heart failure

Dilated cardiomyopathy

* Associated with;
o Alcohol
o Hypertension
o Haemochromatosis
o Viral infection
o Autoimmune
o Peri or postpartum
o Thyrotoxicosis
o Congenital
* Presentation
o Fatigue, dyspnoea, pulmonary oedema, RVF, emboli, AF, VT
* Signs
o Raised pulse, lowered BP, raised JVP, displaced apex beat, S3 gallop, mitral or tricuspid regurgitation, pleural effusion, oedema, jaundice, hepatomegaly, ascites
* Tests
o CXR – cardiomegaly, pulmonary oedema
o ECG – tachycardia, non-specific T wave changes
o Echo – globally hypokinetic heart with low ejection fraction
* Management
o Bed rest, diuretics, digoxin, ACEI, anticoagulation, consider heart transplant
o Mortality
o Variable – 40% in 2 years

Hypertrophic cardiomyopathy

* This is LV outflow tract obstruction from an asymmetric septal hypertrophy
* Prevalence
o 0.2% – autosomal dominant inheritance by 50% are sporadic (genes include ?-myosin, ?-tropomyosin)
* Symptoms and signs
o Angina, dyspnoea, palpitaions, syncope, sudden death, a wave in JVP, harsh ejection systolic murmur
* Tests
o ECG – LVH, progressive T wave inversion, deep Q waves, AF, WPW, ventricular ectopics and VT
o Echo – asymmetrical septal hypertrophy, small LV cavity with hypercontractile posterior wall
* Management
o ?-blockers and verapamil for symptoms
o Amiodarone for arrhythmia
o Anticoagulate for paroxysmal AF of systemic emboli
o Dual chamber pacing
o Septal myomectomy

Restrictive cardiomyopathy

* Causes;
o Amyloidosis
o Haemochromatosis
o Sarcoidosis
o Scleroderma
o Loffler’s eosinophilic endocarditis
o Endomyocardial fibrosis
* Presentation
o Like constrictive pericarditis
o Features of RVF predominate, raised JVP with prominent x and Y decents, hepatomegaly, oedema, ascites

Cardiac myxoma

* Rare benign cardiac tumour
* Usually sporadic but may be familial (autosomal dominant)
* May mimic IE (fever, weight loss, clubbing, raised ESR) or mitral stenosis (left atrial obstruction, systemic emboli, AF)
* A tumour ‘plop’ may be heard
* Test
o ECHO
o Treatment
o ExcisionAcute myocarditis

* Causes;
o Viruses – coxsacckie, polio, HIV, Lassa fever
o Bacteria – Clostridia, diphtheria, Meningococcus Mycoplasma, Psittacosis
o Spirochaetes – Leptospirosis, syphilis, Lyme disease
o Protoszoa – Chagas disease
o Drugs
o Toxins
o Vasculitis
* Signs/symptoms
o Fatigue, dyspnoea, chest pain, palpitations, tachycardia, soft S1, S4 gallop
* Test
o ECG – ST segment elevation/depression, T wave inversion, atrial arrhythmias, transient AV block
o Serology may be helpful
* Management
o Treat underlying cause
o Patient may recover or get retractable heart failure

Dilated cardiomyopathy

* Associated with;
o Alcohol
o Hypertension
o Haemochromatosis
o Viral infection
o Autoimmune
o Peri or postpartum
o Thyrotoxicosis
o Congenital
* Presentation
o Fatigue, dyspnoea, pulmonary oedema, RVF, emboli, AF, VT
* Signs
o Raised pulse, lowered BP, raised JVP, displaced apex beat, S3 gallop, mitral or tricuspid regurgitation, pleural effusion, oedema, jaundice, hepatomegaly, ascites
* Tests
o CXR – cardiomegaly, pulmonary oedema
o ECG – tachycardia, non-specific T wave changes
o Echo – globally hypokinetic heart with low ejection fraction
* Management
o Bed rest, diuretics, digoxin, ACEI, anticoagulation, consider heart transplant
o Mortality
o Variable – 40% in 2 years

Hypertrophic cardiomyopathy

* This is LV outflow tract obstruction from an asymmetric septal hypertrophy
* Prevalence
o 0.2% – autosomal dominant inheritance by 50% are sporadic (genes include ?-myosin, ?-tropomyosin)
* Symptoms and signs
o Angina, dyspnoea, palpitaions, syncope, sudden death, a wave in JVP, harsh ejection systolic murmur
* Tests
o ECG – LVH, progressive T wave inversion, deep Q waves, AF, WPW, ventricular ectopics and VT
o Echo – asymmetrical septal hypertrophy, small LV cavity with hypercontractile posterior wall
* Management
o ?-blockers and verapamil for symptoms
o Amiodarone for arrhythmia
o Anticoagulate for paroxysmal AF of systemic emboli
o Dual chamber pacing
o Septal myomectomy

Restrictive cardiomyopathy

* Causes;
o Amyloidosis
o Haemochromatosis
o Sarcoidosis
o Scleroderma
o Loffler’s eosinophilic endocarditis
o Endomyocardial fibrosis
* Presentation
o Like constrictive pericarditis
o Features of RVF predominate, raised JVP with prominent x and Y decents, hepatomegaly, oedema, ascites

Cardiac myxoma

* Rare benign cardiac tumour
* Usually sporadic but may be familial (autosomal dominant)
* May mimic IE (fever, weight loss, clubbing, raised ESR) or mitral stenosis (left atrial obstruction, systemic emboli, AF)
* A tumour ‘plop’ may be heard
* Test
o ECHO
o Treatment
o Excision