72. Pericardial and myocardial disease

Question 1

Causes of pericarditis

Answer 1

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

Question 2

Sx of pericarditis

Answer 2

Sharp, pleuritic and positional
o Worse flat
o Better seated

Question 3

4 stages of pericarditis on ECG

Answer 3

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

Question 4

MGMT pericarditis

Answer 4

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

Question 5

cause of uremic pericarditis

Answer 5

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

Question 6

Dx of uremic pericarditis

Answer 6

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

Question 7

MGMT uremic pericarditis

Answer 7

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

Question 8

Def. dressler syndrome

Answer 8

o Late post-MI

o Fever, pleuritis, fiction rub, leukocytosis, effusion

Question 9

most common causes of neoplastic pericarditis

Answer 9

o Lung, breast, lymphoma

Question 10

MGMT neoplastc

Answer 10

• Pericardiocentesis with possible pericardial chemo

Question 11

amount of fluid needed to see on CXR

Answer 11

200-250ml

Question 12

3 most common causes of tamponade

Answer 12

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

Question 13

3 stages of tamponade

Answer 13

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

Question 14

triad of tamponade

Answer 14

o Hypotension
o Distended neck veins
o Muffled heart sounds

Question 15

ECG findings of tamponade

Answer 15

• lowe voltage

- alternans

Question 16

4 mechanisms of purulent pericarditis

Answer 16

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

Question 17

MGMT purulent pericarditis

Answer 17

• Pericardiectomy is traditional Tx

- Possible lavage and indwelling cath to avoid surgery

Question 18

causes of pneumopericardium

Answer 18

-	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

Question 19

causes of constrictive pericarditis

Answer 19

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

Question 20

mgmt restrictive pericarditis

Answer 20

pericardiectomy

Question 21

3 stages of myocarditiis

Answer 21

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

Question 22

common causes of myocarditis

Answer 22

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

Question 23

ECG for myocarditis

Answer 23

o Sinus tach
o Wide QRS
o Low voltages

Question 24

MGMT myocarditis

Answer 24

• 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.

Question 25

what is chagas

Answer 25

- Trypasosome cruzi - Insect vectors - Many never have Sx - Fever, HSM, - CP, arryhtmias, embolic episodes, ST changes

Question 26

mgmt chagas

Answer 26

- Antiparasitic o Benzidazole - Amio for V tach - ACE may help for CHF

Question 27

define dilated cardiomyopathy

Answer 27

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

Question 28

ECG for dilated cardiomyopathy

Answer 28

- ECG non specific o Poor R wave progression o Blocks o LBBB

Question 29

MGMT dilated cardiomyopathy

Answer 29

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

Question 30

mech of hypertrophic cardiomyopathy

Answer 30

- Hypertrophied LV in absence of other causes - Ventricular thickening - Possible outflow obstruction

Question 31

ECG of HOCM

Answer 31

o LV hypertrophy o ST alterations o TWI o LA enlargement

Question 32

MGMT HOCM

Answer 32

- BB is mainstay of therapy - CCB may also help - Avoid nitro as deceases LV volume - Amio if any arrythmia

Question 33

mech of ARVC

Answer 33

- Genetic disease of ventricle scarring - Replaced with fatty tissue - Dysrhythmias, syncope and sudden death

Question 34

ECG of ARVC

Answer 34

o Wide QRS o LBBB o Inverted TW

Question 35

RFs for peripartum cardiomyopathy

Answer 35

``` o Myocarditis o Tocolytics o Preeclampsia o Advance maternal age o Twins o Obesity o Cocaine use o Genetics ```

Question 36

mgmt perpartum cardiomyoapthy

Answer 36

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