Module 4 Logbooks - Viral Cardiomyopathy

Front 1

Module 4 - logbook 11: definition viral cardiomyopathy

Back 1

Dilated cardiomyopathy secondary to an infection (myocarditis)

Front 2

Module 4 - logbook 11: aetiology

Back 2

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

Front 3

Module 4 - logbook 11: epidemiology

Back 3

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

Front 4

Module 4 - logbook 11: risk factors

Back 4

Myocarditis: Immunocompromised/auto-immune/medications

Dilated cardiomyopathy: genetic, alcohol and hypertension

Heart failure: Same as cardiomypoathy (especailly hypertension*), heart disease*, valve disease

Front 5

Module 4 - logbook 11: common presentation

Back 5

Heart failure - symptoms: Dyspnoea and fatigue, fluid retention (inc ascities (stomach), orthopnea, PND, signs: basal crepitations, raised JVP, peripheral oedema, S3 heart sound (gallop),

Front 6

Module 4 - logbook 11: investigations

Back 6

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

Front 7

Module 4 - logbook 11: pathophysiology

Back 7

Infection can cause long term damage to myocardium > dilated cardiomyopathy. Dilated cardiomyopathy prevents efficient systole > decreased SV and Ejection fraction > heart failure

Front 8

Module 4 - logbook 11: prognosis

Back 8

50% of people with heart failure dying within four years of diagnosis

Front 9

Module 4 - logbook 11: management (medication)

Back 9

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

Front 10

Module 4 - logbook 11: drugs - AMITRIPTYLINE

Back 10

Tricyclic antidepressant - inhibits serotonin re-uptake > more free serotonin

Front 11

Module 4 - logbook 11: drugs - CANDESARTAN

Back 11

ARB - stops AT II from binding to smooth muscle

Front 12

Module 4 - logbook 11: drugs - BISOPROLOL

Back 12

Beta blocker inhibits sympathetic stimulus on beta 1 adrenergic receptors

Front 13

Module 4 - logbook 11: drugs - BUMETANIDE

Back 13

Loop diuretic - acts on loop of henle. Na K ATPase pump - blocks reabsoprtion of sodium and potassium >>> less water retention

Front 14

Module 4 - logbook 11: drugs - DIGOXIN

Back 14

Ionotropic - calcium influx and chronotropic - increases phase 4 depolarisation and decreases action potential - AV conduction.

Front 15

Module 4 - logbook 11: drugs - WARFARIN

Back 15

Vitamin K antagonist, precursor of clotting facotrs

Front 16

Module 4 - logbook 11: drugs - ZOPICLONE

Back 16

Hypnotic - benzodiazepine complex - enhancement of inhibitory effects of GABA

Front 17

Module 4 - logbook 11: drugs - EPLERENONE

Back 17

Aldosterone antagonist - blocks aldosterone binding. Alodsterone leads to water retention and stimulates ADH (more water retention)

Front 18

Module 4 - logbook 11: Heart failure criteria and classifaction

Back 18

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

Front 19

Module 4 - logbook 11: management (non pharmacological)

Back 19

Relevant revascularisation/valve disease

Cardiac resynchronisation therapy (CRT)/implantable cardioverter defibrillators (ICD)

Heart transplant and left ventricular assist device

Front 20

Module 4 - logbook 11: drugs - FINASTERIDE

Back 20

5-alpha reductase inhibitor. Stops 5 alpha testosterone turning into DHT - quite specific to prostate