296.2 🩺 國考版

296.2.1 高頻考點

296.2.1.1 Autoimmune Cardiac Manifestations

  • SLE: pericarditis (#1), myocarditis, Libman-Sacks, premature CAD
  • RA: pericarditis (often subclinical), CAD equivalent
  • Scleroderma: PAH + myocardial fibrosis
  • APS: thrombosis + valve abnormalities
  • PM/DM: myocarditis

296.2.1.2 Vasculitis Cardiac

  • Takayasu: aortitis + coronary ostia + AR + HTN
  • GCA: aortic + thoracic aneurysm
  • PAN: coronary aneurysms (HBV)
  • Churg-Strauss: myocarditis + Löffler endomyocardial fibrosis (ANCA, eosinophil)
  • Kawasaki: coronary aneurysms (pediatric); IVIG + ASA

296.2.1.3 Infiltrative

  • AL amyloid: plasma cell; daratumumab + CyBorD (ANDROMEDA)
  • ATTR-wild type: elderly HFpEF; tafamidis (ATTR-ACT)
  • ATTR-hereditary: TTR mutation; tafamidis + patisiran (gene silencer)
  • Sarcoid: AV block + HFrEF; CMR + PET + EMB
  • Hemochromatosis: DCM; phlebotomy / chelation
  • Fabry: HCM mimic + renal/neuropathy; ERT
  • Glycogen storage: Pompe HCM; ERT

296.2.1.4 Endocrine

  • Hyperthyroidism: AF, HF
  • Hypothyroidism: bradycardia, pericardial effusion
  • Acromegaly: LVH, HF
  • DM: cardiomyopathy + CAD

296.2.1.5 Infectious

  • Syphilis: tertiary aortitis + AR + aneurysm
  • TB: pericarditis (constrictive risk)
  • HIV: cardiomyopathy + accelerated atherosclerosis
  • Chagas: late cardiomyopathy + apical aneurysm
  • Lyme: AV block (acute)
  • Endocarditis (Ch297-298)

296.2.1.6 Genetic/Neuromuscular

  • Friedreich’s: HCM
  • Duchenne: DCM
  • Myotonic dystrophy: AV block, sudden death
  • Emery-Dreifuss: DCM + AV block (LMNA)

296.2.2 易混淆比范

Disease Most Common Cardiac Issue Key Treatment
SLE Pericarditis HCQ + steroids + IS
Scleroderma PAH + myocardial fibrosis PAH-specific therapy
Takayasu Aortitis + coronary ostia Steroids + biologics
AL amyloid HF + conduction Daratumumab + CyBorD
ATTR-wild type HFpEF in elderly Tafamidis
Sarcoid AV block + HFrEF Steroids + ICD
Hemochromatosis DCM + arrhythmia Phlebotomy / chelation
Fabry HCM + renal ERT (agalsidase)
Syphilis tertiary Aortitis + AR Penicillin + surgery
Chagas Apical aneurysm + DCM Anti-T. cruzi + ICD
HIV Cardiomyopathy + premature CAD ART + statin

296.2.3 Special Topics

296.2.3.1 Lake Louise CMR Criteria for Myocarditis

  • T2 hyperintensity + LGE (modified 2018)
  • Useful in any myocarditis (viral, autoimmune, ICI)

296.2.3.2 Endomyocardial Biopsy Indications

  • Suspected sarcoid
  • Giant cell myocarditis
  • Unexplained HFrEF with arrhythmia
  • Amyloid (PYP first, biopsy if non-diagnostic)
  • ICI myocarditis (gold standard)

296.2.3.3 Treat the Underlying Disease First

  • Many cardiac manifestations improve with disease control
  • Coordinate with rheumatology, hematology, endocrinology, etc.