ACUTE MYOCARDITIS Flashcards
ACUTE MYOCARDITIS
Acute inflammation of the cardiac muscle that is usually viral in etiology
ACUTE MYOCARDITIS
Common Presentations:
– Often seen in young adults/children – Fever – Chest pain with ECG changes – Arrhythmia – Heart failure
ACUTE MYOCARDITIS- Low ejection fraction and heart failure have high mortality but some recover and others develop a _______
chronic dilated cardiomyopathy
ACUTE MYOCARDITIS- _________ have high mortality but some recover and others develop a chronic dilated cardiomyopathy
Low ejection fraction and heart failure
DILATED CARDIOMYOPATHY
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.
DILATED CARDIOMYOPATHY- PRESENTATION
Heart failure with a large silent heart
with impaired systolic function
DILATED CARDIOMYOPATHY- ETIOLOGY
Usually idiopathic Genetic Viral Cocaine Chemotherapy Ischemic
DILATED CARDIOMYOPATHY
CLINICAL MANIFESTATIONS:
HEART FAILURE
ARRHYTHMIA
THROMBOEMBOLISM
The renin–angiotensin system (RAS) or the renin-angiotensin aldosterone system (RAAS) is a hormone system that regulates ________
blood pressure and fluid balance.
Enlarged Heart & Congested Lung fields on x ray indicat?
DILATED CARDIOMYOPATHY-
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 __________
increased blood pressure.
Activation of AT1 receptors by angiotensin II results in
Vasoconstriction Increased aldosterone release Sodium Retention Fibrosis Increased Sympathetic Activity **Hypertrophy
DILATED CARDIOMYOPATHY
TREATMENT
TREATMENT OF HEART FAILURE
ANTICOAGULATION
ANTI-ARRHYTHMIC AGENTS
ANTI-INFLAMMATORY / IMMUNO-SUPPRESSIVE
DILATED CARDIOMYOPATHY- TREATMENT OF HEART FAILURE
Diuretics, ACE Inhibitors, Beta blockers, Aldosterone
antagonists, Vasodilators, Inotropes, LVads, Transplant
DILATED CARDIOMYOPATHY- ANTI-ARRHYTHMIC AGENTS
Drugs, Implantable defibrillators
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.
angiotensin-converting enzyme
HYPERTROPHIC / OBSTRUCTIVE CARDIOMYOPATHY
Disproportionate thickening of the intraventricular septum
Diastolic dysfunction due to impaired diastolic relaxation & increased stiffness
Elevated LV diastolic pressure causes increased pulmonary venous & capillary
pressures
Dyspnea on exertion usual symptom
HYPERTROPHIC CARDIOMYOPATHY
WITHOUT AORTIC OUTFLOW
OBSTRUCTION
Asymmetric myocardial hypertrophy • Diastolic dysfunction • Enhanced systolic dysfunction • Dynamic left ventricular outflow obstruction • Propensity for syncope & sudden death
HYPERTROPHIC OBSTRUCTIVE
CARDIOMYOPATHY
HYPERTROPHIC OBSTRUCTIVE
CARDIOMYOPATHY
CLINICAL MANIFESTATIONS
Variable: Asymptomatic to severe symptoms
- DYSPNEA
- ANGINA
- SUDDEN DEATH
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 increased blood pressure.
Relation of Neurohumoral Activation to Development and Reversal of Remodeling:
Myocyte dysfunction
Structural alteration
Cardiac adrenergic
RAAS signaling
–>
Remodeled Ventricle (hypertrophic)
Relation of Neurohumoral Activation to Development and Reversal of Remodeling:
Improved function
Reverse remodeling
ACE Inhibitors and β-blocker therapy --> Relatively normal chamber size and geometry
BNP Levels of Patients W/ CHF is?
Often elevated
Diuretics, ACE Inhibitors, Beta blockers, Aldosterone
antagonists, Vasodilators, Inotropes, LVads, Transplant
TREATMENT OF HEART FAILURE in DILATED CARDIOMYOPATHY
Vasodilators can cause?
hypotension
not tolerated by all people
(TREATMENT OF HEART FAILURE in DILATED CARDIOMYOPATHY)
Disproportionate thickening of the intraventricular septum
HYPERTROPHIC / OBSTRUCTIVE
CARDIOMYOPATHY
HYPERTROPHIC CARDIOMYOPATHY vasodilators fx
Vasodilator decreases ventricular volume - increases outflow obstruction
BAD!
Drugs that reduce preload (eg, nitrates, diuretics, ACE inhibitors, angiotensin II receptor blockers) decrease chamber size and worsen symptoms and signs of
HYPERTROPHIC CARDIOMYOPATHY
HYPERTROPHIC CARDIOMYOPATHY can easily cause sudden death:
In younger people
usually athletes training
___________ increase the outflow tract gradient and cause a reflex tachycardia that further worsens ventricular diastolic function in HCM
Vasodilators
Inotropic drugs (eg, digitalis glycosides, catecholamines) worsen outflow tract obstruction, do not relieve the high end-diastolic pressure, and may induce __________ in HCM
arrhythmias.
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,
HYPERTROPHIC OBSTRUCTIVE
CARDIOMYOPATHY
TREATMENT
- Avoid extreme exertion
- Decrease contractility – Beta blockers/Verapamil
- Surgical myomectomy or Alcohol ablation
- Automatic Implantable Cardiac Defibrillator
RESTRICTIVE CARDIOMYOPATHY
Most commonly infiltrative:
amyloidosis, sarcoidosis
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
HYPERTROPHIC OBSTRUCTIVE
CARDIOMYOPATHY is only caused by
GENETICS!
