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paediatrics > 21. diseases of pericardium and myocardium > Flashcards

21. diseases of pericardium and myocardium Flashcards

1
Q

Myocardial disease etiology

A

Infections (Myocarditis)

Familial-Hereditary

Metabolic, Nutritional, Endocrine

Connective Tissue-Granulomatous Disease

Drugs-Toxins

Coronary Arteries

Other

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2
Q

causes of Infection (myocarditis)

A

 Viral (e.g., coxsackievirus, mumps, Epstein-Barr virus, influenza, parainfluenza, measles, varicella, HIV)

 Rickettsiae (e.g., psittacosis, Coxiella,

 Bacterial (e.g., diphtheria, Mycoplasma, meningococcus, leptospirosis, Lyme disease)

 Parasitic (e.g., Chagas disease, toxoplasmosis, Loa loa)
Familial-Hereditary

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3
Q

Familial-Hereditary examples

A 
Muscular dystrophies (Duchenne (Becker, limb girdle)
 Myotonic dystrophy

 Mitochondrial myopathy syndromes

 Friedreich ataxia

 Pompe disease (glycogen storage)

 Endocardial fibroelastosis

 Familial cardiomyopathy

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4
Q

Metabolic, Nutritional, Endocrine

A

 Beriberi (thiamine deficiency)

 Keshan disease (selenium deficiency)

 Hypothyroidism, Hyperthyroidism

 Pheochromocytoma

 Mitochondrial myopathies II

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5
Q

Connective Tissue-Granulomatous Disease

A

 SLE
 Scleroderma
 Rheumatic fever
 Dermatomyositis

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6
Q

Drugs-Toxins

A 
 Doxorubicin (Adriamycin)
 Iron overload (hemosiderosis)
 Irradiation
 Cocaine
 Amphetamines
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7
Q

Coronary Arteries

A

 Anomalous left coronary artery

 Kawasaki disease

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8
Q

Other

A

 Sickle cell anemia
 Hypereosinophilic syndrome
 Endomyocardial fibrosis
 Idiopathic

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9
Q

Myocarditis def

A

inflammation of the heart muscle.

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10
Q

Myocarditis sx depend on

A

age and the acute or chronic nature of the infection.

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11
Q

Myocarditis sx in neonates

A

initially have fever, severe heart failure, respiratory distress, cyanosis, distant heart sounds,
weak pulses, tachycardia out of proportion to the fever, mitral insufficiency caused by dilatation of the valve
annulus, a gallop rhythm, acidosis, and shock.
associated rash

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12
Q

outcome of fulminant myocarditis in neonates

A

death may occur within 1–7 days of the onset of symptoms.

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13
Q

CXR of myocarditis in neonates

A

enormously enlarged heart and pulmonary edema.

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14
Q

electrocardiogram in myocarditis in neonates

A

sinus tachycardia, reduced QRS complex voltage, and ST segment and T-wave
abnormalities. Arrhythmias may be the first clinical manifestation

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15
Q

older patient with acute myocarditis

A

initially acute congestive heart failure;

more commonly, patients have a gradual onset of congestive heart failure or a sudden onset of ventricular
arrhythmias.

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16
Q

what kind of cardiomyopathy is present in older pt w/myocarditis

A

idiopathic dilated

cardiomyopathy is present as acute infectious phase has usually passed

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17
Q

dg of myocarditis

A

elevated:
sedimentation rate, heart enzymes, and brain natriuretic
peptide (BNP)

Serum viral titers

PCR of ventricular biopsy and serum samples

Echocardiography

Endomyocardial biopsy

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18
Q

what are the cardiac ez

A

creatine phosphokinase, lactate dehydrogenase)

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19
Q

why is ventricular vcr done

A

(viral genome routinely present in cardiac samples yet absent in
peripheral blood)

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20
Q

what does echocardiography show in myocarditis

A

poor ventricular function
pericardial effusion, mitral valve regurgitation
absence of coronary artery
other congenital heart lesions.

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21
Q

rx for paediatric myocarditis

A

for severe congestive heart failure or cardiogenic shock?

Intravenous immunoglobulin (IVIG) 2 g/kg

prednisone (2 mg/kg daily, tapered to 0.3 mg/kg daily over a period of 3 mo)

antiviral drugs- enterovirus (pleconaril), Epstein-Barr virus (acyclovir)

22
Q

cardiomyopathy

A

chronic disease of the heart muscle that can be

  1. dilated
  2. hypertrophic
  3. restrictive
23
Q

dilated cardiomyopathy causes

A 
Infectious 
Sporadic 
Infiltrative
Toxic 
Idiopathic
24
Q

haemodynamics in dilated cardiomyopathy

A

Decreased systolic

function

25
Q

Treatment in dilated cardiomyopathy

A 
Positive inotropes 
Diuretics
Afterload reduction  Corticosteroids
β-Blockers 
Antiarrhythmics
Anticoagulants
Cardiac transplantation
26
Q

Hypertrophic cardiomyopathy causes

A

sporadic

inherited

27
Q

Hypertrophic cardiomyopathy haemodynamics

A 
Diastolic dysfunction
(impaired ventricular filling)
28
Q

rx in cardiomyopathy haemodynamics

A

β-Blockers

Calcium channel blockersation

29
Q

Restrictive cardiomyopathy causes

A

infiltrative

myocardial hypertrophy

myocardial fibrosis

idiopathic

30
Q

haemodynamics in Restrictive cardiomyopathy

A 
Diastolic dysfunction
(impaired ventricular filling)
31
Q

rx in Restrictive cardiomyopathy

A

diuretics

anticoagulants

corticosteroids

cardiac transplantation

32
Q

pericarditis def

A

inflammation of the pericardium

33
Q

pericarditis etio

A

 Idiopathic (Presumed Viral)

 Infectious Agents

 Collagen Vascular-Inflammatory and Granulomatous Diseases

 Traumatic

 Contiguous Spread-

 Metabolic-

 Neoplastic-

 Others-

34
Q

examples of Infectious Agents causing pericarditis

A

Group A streptococcus, Staphylococcus aureus, Mycobacterium tuberculosis, Coxsackievirus
(group A, B),

35
Q

examples of Collagen Vascular-Inflammatory and Granulomatous Diseases causingg pericarditis

A

Systemic lupus erythematosus (idiopathic and
drug-induced),

vasculitis,

familial Mediterranean fever,

36
Q

examples of Traumatic causes of pericarditis

A

cardiac contusion (blunt trauma),

penetrating trauma,

postpericardiotomy syndrome

radiation,

37
Q

example of a Contiguous Spread causing pericarditiss

A

pleural disease

pneumonia

38
Q

Metabolic causes of pericarditis

A

hypothyroidism,

uremia,

chylopericardium,

39
Q

Neoplastic causes of pericarditis

A

primary, contiguous (lymphoma), metastatic, infiltrative

40
Q

sx of pericarditis

A

Chest pain: (worsened if lying down or with inspiration)

Dyspnea

Malaise

Patient assumes sitting position

Dry: sharp pain due to rubbing of the layers

Large effusion: dull heavy pain

41
Q

types of pericarditis

A

non constrictive

tamponade

constrictive

42
Q

sx of non constrictive

A

 Fever
 Tachycardia
 Friction rub (accentuated by inspiration, body position)
 Enlarged heart by percussion and x-ray examination
 Distant heart sounds

43
Q

sx of tamponade

A 
 Distended neck veins
 Hepatomegaly
 Pulsus paradoxus (greater than 10 mm Hg with inspiration)
 Narrow pulse pressure
 Weak pulse
 Poor peripheral perfusion
44
Q

sx of constrictive

A 
 Distended neck veins
 Kussmaul sign (inspiratory increase of jugular venous pressure)
 Distant heart sounds
 Pericardial knock
 Hepatomegaly
 Ascites
 Edema
 Tachycardia
45
Q

dg of pericarditis

A

ECG

CXR

ECHO

pericardiocentesis

blood test

46
Q

ECG evidence for pericarditis

A

Elevated ST segments, T wave inversion (late), tachycardia,
reduced QRS voltage,??
electrical alternans (variable
QRS amplitudes)

47
Q

CXR evidence for pericarditis

A

Cardiomegaly (water bottle heart)

48
Q

ECHO evidence for pericarditis

A

Pericardial fluid

49
Q

pericardiocentesis evidence for pericarditis

A 
Gram and acid-fast stains,
culture, 
PCR (virus, bacteria,
mycobacteria, fungus), cytology, 
cell count, 
glucose,
protein, 
pH
50
Q

Blood tests evidence for pericarditis

A 
ESR, 
viral titers,
ANA, 
ASO titers, 
EBV titers
51
Q

rx pf pericarditis

A
  • Pericardiocentesis

* Anti-inflamatory drugs

paediatrics (34 decks)

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