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ACUTE MYOCARDITIS Flashcards

1
Q

ACUTE MYOCARDITIS

A

Acute inflammation of the cardiac muscle that is usually viral in etiology

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2
Q

ACUTE MYOCARDITIS

Common Presentations:

A 
– Often seen in young adults/children
– Fever
– Chest pain with ECG changes
– Arrhythmia
– Heart failure
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3
Q

ACUTE MYOCARDITIS- Low ejection fraction and heart failure have high mortality but some recover and others develop a _______

A

chronic dilated cardiomyopathy

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4
Q

ACUTE MYOCARDITIS- _________ have high mortality but some recover and others develop a chronic dilated cardiomyopathy

A

Low ejection fraction and heart failure

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5
Q

DILATED CARDIOMYOPATHY

A

a disease of the heart muscle, usually starting in left ventricle.

The ventricle stretches and thins (dilates) and can’t pump blood as well as a healthy heart can.

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6
Q

DILATED CARDIOMYOPATHY- PRESENTATION

A

Heart failure with a large silent heart

with impaired systolic function

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7
Q

DILATED CARDIOMYOPATHY- ETIOLOGY

A 
Usually idiopathic
Genetic
Viral
Cocaine
Chemotherapy 
Ischemic
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8
Q

DILATED CARDIOMYOPATHY

CLINICAL MANIFESTATIONS:

A

HEART FAILURE
ARRHYTHMIA
THROMBOEMBOLISM

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9
Q

The renin–angiotensin system (RAS) or the renin-angiotensin aldosterone system (RAAS) is a hormone system that regulates ________

A

blood pressure and fluid balance.

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10
Q

Enlarged Heart & Congested Lung fields on x ray indicat?

A

DILATED CARDIOMYOPATHY-

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11
Q

If renal blood flow is reduced, juxtaglomerular cells convert prorenin from the blood into renin and secrete it into circulation.

Plasma renin then carries out the conversion of angiotensinogen released by liver to angiotensin I.

A-1–> angiotensin II by the enzyme ACE found in the lungs.

A-II causes blood vessels to constrict, resulting in __________

A

increased blood pressure.

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12
Q

Activation of AT1 receptors by angiotensin II results in

A 
Vasoconstriction
Increased aldosterone release
Sodium Retention
Fibrosis
Increased Sympathetic Activity
**Hypertrophy
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13
Q

DILATED CARDIOMYOPATHY

TREATMENT

A

TREATMENT OF HEART FAILURE
ANTICOAGULATION
ANTI-ARRHYTHMIC AGENTS
ANTI-INFLAMMATORY / IMMUNO-SUPPRESSIVE

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14
Q

DILATED CARDIOMYOPATHY- TREATMENT OF HEART FAILURE

A

Diuretics, ACE Inhibitors, Beta blockers, Aldosterone

antagonists, Vasodilators, Inotropes, LVads, Transplant

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15
Q

DILATED CARDIOMYOPATHY- ANTI-ARRHYTHMIC AGENTS

A

Drugs, Implantable defibrillators

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16
Q

If renal blood flow is reduced, juxtaglomerular cells convert prorenin from the blood into renin and secrete it into circulation.

Plasma renin then carries out the conversion of angiotensinogen released by liver to angiotensin I.

A-1–> angiotensin II by the enzyme __________ found in the lungs.

A

angiotensin-converting enzyme

17
Q

HYPERTROPHIC / OBSTRUCTIVE CARDIOMYOPATHY

A

Disproportionate thickening of the intraventricular septum

18
Q

Diastolic dysfunction due to impaired diastolic relaxation & increased stiffness

Elevated LV diastolic pressure causes increased pulmonary venous & capillary
pressures

Dyspnea on exertion usual symptom

A

HYPERTROPHIC CARDIOMYOPATHY
WITHOUT AORTIC OUTFLOW
OBSTRUCTION

19
Q 
Asymmetric myocardial hypertrophy
• Diastolic dysfunction
• Enhanced systolic dysfunction
• Dynamic left ventricular outflow
obstruction
• Propensity for syncope & sudden death
A

HYPERTROPHIC OBSTRUCTIVE

CARDIOMYOPATHY

20
Q

HYPERTROPHIC OBSTRUCTIVE
CARDIOMYOPATHY

CLINICAL MANIFESTATIONS
Variable: Asymptomatic to severe symptoms

A
  • DYSPNEA
  • ANGINA
  • SUDDEN DEATH
21
Q

If renal blood flow is reduced, juxtaglomerular cells convert prorenin from the blood into renin and secrete it into circulation.

Plasma renin then carries out the conversion of ___________

A

angiotensinogen released by liver to angiotensin I.

A-1–> angiotensin II by the enzyme ACE found in the lungs. A-II causes blood vessels to constrict, resulting in increased blood pressure.

22
Q

Relation of Neurohumoral Activation to Development and Reversal of Remodeling:

Myocyte dysfunction
Structural alteration

A

Cardiac adrenergic
RAAS signaling
–>
Remodeled Ventricle (hypertrophic)

23
Q

Relation of Neurohumoral Activation to Development and Reversal of Remodeling:

Improved function
Reverse remodeling

A 
ACE Inhibitors and
β-blocker therapy
-->
Relatively normal
chamber size and
geometry
24
Q

BNP Levels of Patients W/ CHF is?

A

Often elevated

25
Diuretics, ACE Inhibitors, Beta blockers, Aldosterone | antagonists, Vasodilators, Inotropes, LVads, Transplant
TREATMENT OF HEART FAILURE in DILATED CARDIOMYOPATHY
26
Vasodilators can cause?
hypotension not tolerated by all people (TREATMENT OF HEART FAILURE in DILATED CARDIOMYOPATHY)
27
Disproportionate thickening of the intraventricular septum
HYPERTROPHIC / OBSTRUCTIVE | CARDIOMYOPATHY
28
HYPERTROPHIC CARDIOMYOPATHY vasodilators fx
Vasodilator decreases ventricular volume - increases outflow obstruction BAD!
29
Drugs that reduce preload (eg, nitrates, diuretics, ACE inhibitors, angiotensin II receptor blockers) decrease chamber size and worsen symptoms and signs of
HYPERTROPHIC CARDIOMYOPATHY
30
HYPERTROPHIC CARDIOMYOPATHY can easily cause sudden death:
In younger people | usually athletes training
31
___________ increase the outflow tract gradient and cause a reflex tachycardia that further worsens ventricular diastolic function in HCM
Vasodilators
32
Inotropic drugs (eg, digitalis glycosides, catecholamines) worsen outflow tract obstruction, do not relieve the high end-diastolic pressure, and may induce __________ in HCM
arrhythmias.
33
By decreasing myocardial contractility, these drugs dilate the heart. By slowing the heart rate, they prolong the diastolic filling period. Both effects decrease outflow obstruction, thus improving ventricular diastolic function. GOOD for HCM!
β-Blockers and rate-limiting Ca channel blockers with a lower arterial dilation capacity (usually verapamil), alone or combined,
34
HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY TREATMENT
* Avoid extreme exertion * Decrease contractility – Beta blockers/Verapamil * Surgical myomectomy or Alcohol ablation * Automatic Implantable Cardiac Defibrillator
35
RESTRICTIVE CARDIOMYOPATHY
Most commonly infiltrative: | amyloidosis, sarcoidosis
36
Impaired ventricular filling due to stiff (noncompliant) ventricles Systolic function often normal and ventricles usually not dilated Diagnosed by echocardiography with Doppler assessment of ventricular filling
RESTRICTIVE CARDIOMYOPATHY This rare entity has a poor prognosis. Intractable failure and fatal arrhythmias may occur
37
HYPERTROPHIC OBSTRUCTIVE | CARDIOMYOPATHY is only caused by
GENETICS!

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