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Rosen's Cardio > 72. Pericardial and myocardial disease > Flashcards

72. Pericardial and myocardial disease Flashcards

1
Q

Causes of pericarditis

A 
Infectious
- viral 
- bacterial
- fungal
- parasite
- rickettsia
Postinjury
- penetrating
- blunt
- OR
- MI
- radiation
- meds
Systemic disease
- uremia
- mets
- RA
- lupus
- sarcoid
- scleroderma
- amyloid
Primary tumors
Aortic dissection
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2
Q

Sx of pericarditis

A

Sharp, pleuritic and positional
o Worse flat
o Better seated

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3
Q

4 stages of pericarditis on ECG

A 
1. Hours to days
	 Diffuse STE and ST depressions
	PR depression
2. Normalization of ST and PR, TW flatten
3. Deep symmetrical TWI
4. Normalize

STE are concave, compared to convex in STEMI

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4
Q

MGMT pericarditis

A
  • Treat cause if found
  • NSAIDS first choice
    o Ibuprofen
  • Colchicine to reduce recurrence
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5
Q

cause of uremic pericarditis

A
  • 2/2 renal failure or dialysis
  • More common with HD
  • Often associated with occult infection
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6
Q

Dx of uremic pericarditis

A
  • ECG findings often normal
  • Look for large heart on CXR
  • Look for effusion, common cause of tamponade
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7
Q

MGMT uremic pericarditis

A
  • Intensive HD
  • NSAIDS not effective and contraindicated
  • Steroids if not responding to HD
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8
Q

Def. dressler syndrome

A

o Late post-MI

o Fever, pleuritis, fiction rub, leukocytosis, effusion

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9
Q

most common causes of neoplastic pericarditis

A

o Lung, breast, lymphoma

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10
Q

MGMT neoplastc

A
  • Pericardiocentesis with possible pericardial chemo
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11
Q

amount of fluid needed to see on CXR

A

200-250ml

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12
Q

3 most common causes of tamponade

A
  • 10% of all patients with CA will develop
  • Also common in uremic
  • Penetrating chest wounds
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13
Q

3 stages of tamponade

A

o Fluid fills recesses
o Fluid accumulates faster than pericardial stretch
o Fluid exceeds ability to support RV pressure

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14
Q

triad of tamponade

A

o Hypotension
o Distended neck veins
o Muffled heart sounds

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15
Q

ECG findings of tamponade

A
  • lowe voltage

- alternans

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16
Q

4 mechanisms of purulent pericarditis

A

o Spread from adjacent tissues
o Hematogenous spread
o Direct inoculation
o Spread from intracardiac source

17
Q

MGMT purulent pericarditis

A
  • Pericardiectomy is traditional Tx

- Possible lavage and indwelling cath to avoid surgery

18
Q

causes of pneumopericardium

A 
-	Often due to fistulas
o	Pleural space
o	Bronchial tree
o	Upper GI tract
-	Trauma, FB, caustic substances, invasive procedures
-	Possible due to baro trauma
19
Q

causes of constrictive pericarditis

A
  • Late consequence of any type of pericarditis
  • Fibrous reaction of pericardium
  • Impaired diastolic filling
20
Q

mgmt restrictive pericarditis

A

pericardiectomy

21
Q

3 stages of myocarditiis

A

Acute – Viral cytotoxicity
Subacute – increase in humoral factors
Chronic – diffuse myocardial fibrosis
 Leads to dilated cardiomyopathy

22
Q

common causes of myocarditis

A 
Chagas most common
- adeno
- coxsackie
- chamydia
- CMV
=H1N1
-Heps
-herpes
-Flu
- mono
- mumps
- rabies
- rubeola
- rubella
- strep
23
Q

ECG for myocarditis

A

o Sinus tach
o Wide QRS
o Low voltages

24
Q

MGMT myocarditis

A
  • Supportive and aimed at preserving LV function
  • Can range from limiting activity to ECMO
  • Tx is stage specific
    o Acute
     Anti virals
    o No evidence for immunosuppression
    o Chronic
     CHF mgmt.
25
Q

what is chagas

A
  • Trypasosome cruzi
  • Insect vectors
  • Many never have Sx
  • Fever, HSM,
  • CP, arryhtmias, embolic episodes, ST changes
26
Q

mgmt chagas

A
  • Antiparasitic
    o Benzidazole
  • Amio for V tach
  • ACE may help for CHF
27
Q

define dilated cardiomyopathy

A
  • Spectrum of disorders that lead to dilated and failing heart
  • Myocarditis most common cause in children
  • Causes
    o Primary
     Cytokines
     Macrophages
     NK cells
28
Q

ECG for dilated cardiomyopathy

A
  • ECG non specific
    o Poor R wave progression
    o Blocks
    o LBBB
29
Q

MGMT dilated cardiomyopathy

A

o LV dilation
o Variable wall motion abnormalities
o Must have EF <45% to Dx

30
Q

mech of hypertrophic cardiomyopathy

A
  • Hypertrophied LV in absence of other causes
  • Ventricular thickening
  • Possible outflow obstruction
31
Q

ECG of HOCM

A

o LV hypertrophy
o ST alterations
o TWI
o LA enlargement

32
Q

MGMT HOCM

A
  • BB is mainstay of therapy
  • CCB may also help
  • Avoid nitro as deceases LV volume
  • Amio if any arrythmia
33
Q

mech of ARVC

A
  • Genetic disease of ventricle scarring
  • Replaced with fatty tissue
  • Dysrhythmias, syncope and sudden death
34
Q

ECG of ARVC

A

o Wide QRS
o LBBB
o Inverted TW

35
Q

RFs for peripartum cardiomyopathy

A 
o	Myocarditis
o	Tocolytics
o	Preeclampsia
o	Advance maternal age
o	Twins
o	Obesity
o	Cocaine use
o	Genetics
36
Q

mgmt perpartum cardiomyoapthy

A
  • Limit Ph activity
  • BB therapy
  • Afterload reduction
  • Avoid ACEi and ARB
  • Common recurrence and higher mortality with next pregnancy

Rosen's Cardio (6 decks)

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