Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CARDIOLOGY > Acute myocarditis > Flashcards

Acute myocarditis Flashcards

1
Q

Diagnosis of acute myocarditis

Myocarditis definition

A

Inflammation +/- myocardial necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes

A

Infectious
Autoimmune
Toxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MRI

A

Bcz myocardial edema (green) and in the other scar

Only MRI capacity of tissue characterisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Echo

A
  • no pathognomonic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MRI

A

Edema + scar pathognomonic aspect -> sub epicardial topography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The most commmon scenario - the pseudo-infarction presentation
24yobold man ,GI viral pro drone and then chest pain
Heart attack - like enzyme dynamics ( CKMB180 )

A

Occluded artery

Treated as ST elevation MI -> send angiography as soon as possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pericardial pain

A

In expiration

Irradiates to trapezius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Differential diagnosis

A

myocardial infarction to some -> transmural
Takotsubo cardiomyopathy -> stress induced cardiomyopathy in which we have reversable hypokinesia + inflammation of myocardial muscle but its secondary to stress
Paripartum cardiomyopathy
Arrhythmogenic cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Specific imaging aspects

A

Sarcoidosis
Hypereosinophilic myocarditis -> sub endocardial scar ,high number of eosinophils in blood

Chagas myocarditis - inflammation,aneurysm image in LV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Evolution and prognostic

Clinical presentation

A

Acute :

  • spontaneous remission in 50% of cases after 2-4 weeks
  • 25% cases - persistent cardiac dysfunction
  • 12-25% cases - unfavourable evolution => death or heart transplant

Fulminant evolution:

  • Cardiogenic shock => reserved prognostic
  • Recovery > 80%
  • Uterior good prognostic on long term

Subacute/chronic =>Dilated cardiomyopathy and heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Treatment In Acute myocarditis

NO ANTIINFLAMMATORY

A 
Supportive 
- Rest , no effort 
Treatment of complications 
Cardiogenic shock 
Malignant arrhythmias + conduction disorders 
HF

Pathogenic
Immunomodulators
Immunosuppressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Supportive treatment in acute myocarditis

Cardiogenic shock

A

1.Transfer in specialised units capable of :

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Malignant arrhythmias + conduction disorders

A

Continuous EKG monitoring
Treatment of malignant arrhythmias
External electrical shock
Antiarrhythmic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HF - hemodynamically stable

A 
Medical treatment 
Diuretics 
aCE inhibitors 
Beta blockers 
Anti aldosterone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

NSAIDS harmful to myocarditis?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pericarditis + myocarditis

A

NSAIDS

17
Q

Only myocarditis

A

No NSAIDS

18
Q

Acute myocarditis - Clinical presentation of acute coronary syndrome

A
  • Prodrom : viral infection (respiratory or gastrointestinal) - 1 to 4 weeks before debut
  • Chest pain - frequently severe and recurrent
  • ECG : ST -T changes
  • Imagistic : with/without contractile dysfunction
  • Biologic changes : with /without enzymatic dinamic changes suggestive of myocardial necrosis
  • Angiography : normal coronary arteries
19
Q

Sarcoidosis

A

is a specific type of myocarditis
we should think about it when we see lymph nodes enlargement or mediastinal lymph nodes enlargement typical for sarcoidosis, scar
distributed everywhere in the ventricle

20
Q

Hypereosinophilic myocarditis

A

subendocardial hyper enhanchement,subendocardial scar but this scar is diffused,its not located only in one coronary artery , high number of eosinophils in the peripheral blood

21
Q

Chagas myocarditis

A

Aneurysmal formation in the LV

22
Q

Gold standard

A

MRI

23
Q

Symptoms/physical exam

the clinical presentation is broad

A 
asymptomatic
heart failure findings
e.g., dyspnea on exertion, fatigability, and volume overload
arrhythmia findings
e.g., palpitations and lightheadedness
chest pain fever
24
Q

Complications

A

Dilated cardiomyopathy
Heart failure
Sudden cardiac death

25
Q

Treatment in acute myocarditis

A 
Supportive:
Rest , no effort 
Treatment of complications:
- Cardiogenic shock 
- Malignant arrhythmias and conduction disorders
- Heart failure

Pathogenic

  • Immunomodulator
  • Immunosuppresive
26
Q

Supportive treatment in acute myocarditis

Cardiogenic shock

A

Transfer in sprecialized units capable of :

  • Invasive hemodynamic monitoring
  • Cardiac catheterism
  • Myocardial biopsy
Hemodynamic support 
-Vasopressor : A,NA
-Mechanic:
IV aasist device
ECMO

Emergency heart transplant

27
Q

Supportive treatment in acute myocarditis

Malignant arrhythmias and conduction disorders

A
  • Continuous EKG monitoring
  • Treatment of malignant arrhythmias
    External electrical shock
    Antiaarhythmic : Amiodarone
    Treatment - bradycardia :
    Temporary pacing
28
Q

Supportive treatment in acute myocarditis

Heart failure - hemodynamically stable

A 
Medical treatment 
Diuretics 
ACE inhibitors / angiotensin receptor blockers
beta blockers
antialdosteronic +/-
29
Q

Contraindications

A

Physical effort
AINS !
Especially aspirine

30
Q

Pathogenic treatment in acute myocarditis

Immunomodulator therapies

A

Antiviral therapies

  • Vaccines
  • Herpes : aciclovir , valaciclovir
  • Entero/adeno viruses : interferon

IV imunoglobulines
Immuno-absorbtion

31
Q

Myocarditis treatment

A

Acute phase

  • Rest
  • Supportive - complications treatment

Chronic phase
Heart failure treatment

Immunomodulary/immunosupression treatment:

  • Extremely limited role
  • Indication based on the result of the endomyocardial biopsy

CARDIOLOGY (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions