Acute Myocarditis Flashcards
Primary myocarditis
acute viral infection, post viral response , protozan
typonsoma cruzi
fulminant myocardis ( require ionotrops , cardiomyopathy)
cardiomyopathy
Secondary myocarditis
noninfectious inflammatory response
medication, chemical agents, inflammatory disease ( lupus)
Injury to myocardium
direct invasion
production of cardiotoxic substance
chronic inflammation with or without infection
mode of entry
respiratory or GI tract
Organ receptor specific
coxasackie adenovirus receptor on heart
young to middle aged adults
recent viral syndrome
progressive dyspnea weakness , fever , myalgias
Heart failure
rales , gallop ect
chest pain
mimic pericarditis or AMI
EKG/ECG
atrial or ventricular tachyarrthymia
Intracardiac thrombi
pulmonary or systemic thrombus
fulminant myocarditis
cardiogenic shock
multiorgan failure
acute myocarditis diagnostic studies
EKG /ECG
nonspecific with tachycardia or arrhythmias
ventricular conduction abnormalities and ectopy
presence of a Q wave or LBBB
prognostic concern
echocardiogram
pulmonary hypertension
chest xray
pulmonary edema and cardiomegaly
Laboratory
elevated WBC CRP and ESR
endomyocardial biopsy
required for biopsy
treatment of myocarditis
NSAIDS and Colchicine
myopericarditis chest pain and pericarditis predominate
: avoid if in acute inflammation
underlying cardiomyopathy treatment
ACE i , BB , diuretic (if needed)
IABP or LvAD
cardiogenic shock
ECMO
severe pulm infiltrates
limit exercise
antimicrobial therapy specific only when the infective agent is identified
parasitic involvement
Chaga’s disease
3rd most common parasitic infection in the world
most common infectious cause of cardiomyopathy
protozoa t cruzi transmitted by reduvid bug
manage of cardiomyopathy
heart failure rx
Manage AV node dysfunction and arrhythmias
pacemaker /defib
high risk for dvt and pe
anticouag
antiparasitic therapy
benznidazole & nifurtimox ( only helps with peds)
acute myocarditis toxoplasmosis
contracted through various insults
undercooked infected beef or pork products
organ transplant or transfusion
suspect toxoplasmosis in immunocompromised
present with ss of myocarditis
IgG positive
Presentation:
pericardial effusion or constrictive pericarditis
encephalitis, chorioretinitis
Diagnosis;
IgM-positive and IgG-positive
Treatment:
Pyrimethamine and sulfadiazine or clindamycin
bacterial myocarditis acute
rare
direct invasion or abscess formation
corynebacterium diphtheria
cardiac involvement in 1/2 cases
toxin release affecting the conduction system
cause of death in infection is cardiac involvement
treatment
diphtheria antitoxin therapy
antitoxin prioritizes over antibiotics
acute myocarditis noninfective involvement
Causes of :
cardiac transplant rejection
cardiac sarcoidosis
giant cell myocarditis
presentation
rapid onset HF
vent tachy
conduction blocks
chest pain syndromes
diagnostic finding
chest CT with pulmonary lymphadenopathy
cardiac MRI with inflammatory areas
acute myocarditis dx and treatment
high suspicion;
v tach or conduction blocks without CAD
diagnosis;
enlarge lymph node bx suspecting sarcoid
endomyocardial bx for giant cell
treatment
high dose glucocorticoid for sarcoid
additional immunosuppressant for giant cell
treatment for
high dose glucocorticoids for sarcoid
additional immunosuppressant giant cell
