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20 Cards in this Set
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Module 4 - logbook 11: definition viral cardiomyopathy |
Dilated cardiomyopathy secondary to an infection (myocarditis) |
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Module 4 - logbook 11: aetiology |
Coxsackie B, adenovirus, parvovirus B19, enteroviruses, HIV, Epstein-Barr virus and hepatitis A and hepatitis C
Other causes of myocarditis include: immune relared, drugs and toxic |
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Module 4 - logbook 11: epidemiology |
Myocarditis: sudden cardiac death in 8.6% of cases Dilated cardiomyopathy: 2/10,000 Heart failure: 1-2% adult population has heart failure. 10% of over 70s |
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Module 4 - logbook 11: risk factors |
Myocarditis: Immunocompromised/auto-immune/medications Dilated cardiomyopathy: genetic, alcohol and hypertension Heart failure: Same as cardiomypoathy (especailly hypertension*), heart disease*, valve disease |
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Module 4 - logbook 11: common presentation |
Heart failure - symptoms: Dyspnoea and fatigue, fluid retention (inc ascities (stomach), orthopnea, PND, signs: basal crepitations, raised JVP, peripheral oedema, S3 heart sound (gallop),
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Module 4 - logbook 11: investigations |
Investigations (NICE): previous MI Doppler echocardiography < 2 weeks No previous MI: B-type natriuretic peptide - released when myocardium is stressed > 400pg/ml Doppler echo < 2 weeks. 100-300 < 6 weeks. < 100 - HF unliekly |
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Module 4 - logbook 11: pathophysiology |
Infection can cause long term damage to myocardium > dilated cardiomyopathy. Dilated cardiomyopathy prevents efficient systole > decreased SV and Ejection fraction > heart failure |
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Module 4 - logbook 11: prognosis |
50% of people with heart failure dying within four years of diagnosis |
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Module 4 - logbook 11: management (medication) |
Medication: cardiovascular co-morbidity (statin + antiplatelet/coag). ACE inhibitor/ARB, loop/thiazide diuretic, beta blocker and maybe Mineralocorticoid/aldosterone receptor antagonists and maybe Ivabradine/Digoxin/Opiod if required |
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Module 4 - logbook 11: drugs - AMITRIPTYLINE |
Tricyclic antidepressant - inhibits serotonin re-uptake > more free serotonin |
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Module 4 - logbook 11: drugs - CANDESARTAN |
ARB - stops AT II from binding to smooth muscle |
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Module 4 - logbook 11: drugs - BISOPROLOL |
Beta blocker inhibits sympathetic stimulus on beta 1 adrenergic receptors |
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Module 4 - logbook 11: drugs - BUMETANIDE |
Loop diuretic - acts on loop of henle. Na K ATPase pump - blocks reabsoprtion of sodium and potassium >>> less water retention |
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Module 4 - logbook 11: drugs - DIGOXIN |
Ionotropic - calcium influx and chronotropic - increases phase 4 depolarisation and decreases action potential - AV conduction. |
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Module 4 - logbook 11: drugs - WARFARIN |
Vitamin K antagonist, precursor of clotting facotrs |
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Module 4 - logbook 11: drugs - ZOPICLONE |
Hypnotic - benzodiazepine complex - enhancement of inhibitory effects of GABA |
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Module 4 - logbook 11: drugs - EPLERENONE |
Aldosterone antagonist - blocks aldosterone binding. Alodsterone leads to water retention and stimulates ADH (more water retention) |
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Module 4 - logbook 11: Heart failure criteria and classifaction |
Symptoms, signs and objective evidence New York Heart association: I: no symptoms on ordinary physical activity II: slight limitation of physical activity III: less than ordinary activity leads to symptoms IV: unable to do any activity without symptoms |
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Module 4 - logbook 11: management (non pharmacological) |
Relevant revascularisation/valve disease Cardiac resynchronisation therapy (CRT)/implantable cardioverter defibrillators (ICD) Heart transplant and left ventricular assist device |
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Module 4 - logbook 11: drugs - FINASTERIDE |
5-alpha reductase inhibitor. Stops 5 alpha testosterone turning into DHT - quite specific to prostate |