Myocarditis And pericardial disease Flashcards Preview

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Flashcards in Myocarditis And pericardial disease Deck (30)
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define myocarditis

- Acute inflammation of the myocardium


What are the signs and symptoms of myocarditis

- asymptomatic
- fatigue
- palpitations
- chest pain
- dyspnoea
- fulminant congestive cardiac failure


What are the causes of myocarditis

- idiopathic

- viral = coxsackievirus, adenovirus, CMV, echovirus, influenza
- parasitic - trypansoma cruzi , toxoplasma gondii
- bacterial - streptococcus, diphtheria
- fungal

- drugs - methyldopa, penicillin, sulphonamides
- radiation

- an autoimmune form with auto activated T cells and organ specific antibodies may occur
- Giant cell myocarditis

- alcohol
- hydrocarbons


What investigations do you use to diagnose myocarditis

- Chest X ray
- cardiac enzymes (elevated)
- viral antibody titres
- endomyocardial biopsy
- viral RNA


What would the chest X ray show in myocarditis

- cardiac enlargement


What would the ECG show in myocarditis

- ST changes
- T wave inversion
- Atrial arrhythmias
- AV block
- QT prolongation


How do you manage myocarditis

- bed rest in the acute phase
- avoid athletic activities for 6 months
- heart failure treated with diuretics, ACE inhibits, beta blockers or spironolactone
- antibiotics should be administered immediately
- NSAIDS are contraindicated in the acute phase but can be used in the late phase
- administration of high dose IV immunoglobulin


What is Giant cell myocarditis

- severe form of myocarditis characterised by the presence of multinucleate Giant cells within the myocardium
- associated with sarcoidosis, thymomas and autoimmune disease


What is Chagas disease

- caused by the protozoan trypanosome cruzi and is endemic in South America where upwards of 20 million people are infected
- features of myocarditis are present with fever and congestive heart failure
- progression to a dilated cardiomyopathy with a propensity towards heart block and ventricular arrhythmias


What is acute pericarditis

- Inflammation of the pericardium


What are the two types of causes of acute pericarditis

- Idiopathic
- Secondary


What are the secondary causes of acute pericarditis

- Viruses - such as coxsackie, echovirus, EBV, CMV, adenovirus
- bacteria - such as TB, Lyme disease, Q fever, pneumonia, rheumatic fever
- fungi and parasite - usually in immunocompromised
- autoimmune
- drugs - hydralazine, penicillin, isoniazid, chemotherapy
- metabolic
- trauma, surgery, malignancy


What are the symptoms of acute pericarditis

- chest pain worse on inspiration or lying flat
- chest pain relieved by sitting forward
- pericardial friction rub may be heard
- fever can occur


What does an ECG look like in acute pericarditis

- Concave ST segements elevation (saddle shaped)
- PR depression


What investigations can you carry out for acute pericarditis

- blood tests - FBC, ESR, U&E, Cardiac enzymes
- CXR - cardiomegaly
- echo - if suspected pericardial effusion


What Is the treatment for acute pericarditis

- NSAIDs or aspirin with gastric protection for 1-2 weeks
- add colchicine 500mcg for 3 months to reduce risk of recurrence
- rest until symptoms resolve
- treat the cause


What is pericardial effusion

- accumulation of fluid in the pericardial sac


What are the causes of pericardial effusion

- pericarditis
- myocardial rupture
- aortic dissection
- pericardium filling with pus
- malignancy


What are the clinical features of pericardial effusion

- dyspnoea
- chest pain
- signs of local structures being compressed - nausea due to diaphragm,
- bronchial breathing at left based
- muffled heart sounds


How do you diagnose pericardial effusion

- CXR - shows enlarged heart
- ECG - low voltage QRS complex


How do you manage pericardial effusion

- Treat underlying cause
- Pericardiocentesis may be diagnostic (infection) or therapeutic (Cardiac tamponade)


What is constrictive pericarditis

This is when the heart is encased in a rigid pericardium


What are the causes of constrictive pericarditis

- often unknown - elsewhere TB or after any pericarditis


What are the clinical features of constrictive pericarditis

- right heart failure with raised JVP
- Kussmaul's sign
- soft diffuse apex beat
- quiet heart sounds
- S3
- diastolic pericardial knock
- hepatosplenomegaly
- ascites
- oedema


What is kussmauls sign

- JVP rising paradoxically with inspiration


What investigations would you see and do for constrictive pericarditis

- CXR = small heart and pericardial calcification


How do you manage constrictive pericarditis

surgical excision


What is cardiac tamponade

- A pericardial effusion that raises intrapericaridal pressure reducing ventricular filling and dropping cardiac output


What are the signs of cardiac tamponade

- increase in pulse
- decrease in blood pressure
- pulses paradoxus
- increase in JVP
- kussmaul's sing
- muffled S1 and S2


How can you diagnose cardiac tamponade

- becks triad = falling BP, rising JVP, muffled heart sounds
- ECG - low voltage QRS