cardio day 2 pp3 Flashcards
myocarditis?
Heart is inflamed and has dec cardiac function
2 phases of myocardial cell damage
in myocarditis and MCC
Myocardial cells are damaged from viral infection
Myocardial cells are damaged from hosts immune response
Lymphocytic myocarditis- MC
Ongoing inflammation in myocarditis causes_________
myocardial inflammation, dilated CMP, restrictive CMP, acute LV failure
Can be “focal”- in just one part of the heart so we like to get 4-6 biopsies
myocarditis
myocarditis cause
MCC coxsackievirus and echovirus
Hypersensitivity of eosinophils and leukocytes
GAS Rheumatic carditis
Lyme carditis from borrelia burgdorferi
myocarditis sx
Chest pain, joint pain, myalgia, fatigue, palpitations, CHF, syncope, SCD, fluid retention/edema
myocarditis pe
fever over 100.4, pericardial friction rub, diminished CO
If serious, tachycardia, weak pulses, cool extremities, muffled heart tones, S3, JVD, edema
myocarditis dx
ECG- T wave inversion, ST elevation, Q waves, BBB, prolonged QT, high grade AV block, AFib, ventricular arrhythmias
CXR- cardiomegaly, pleural effusion
Labs: CBC, blood cultures, cardiac enzymes, LDH, ESR, CRP, IgM serologies, anticardio IgG and IgM
Leukocytosis, high troponin and CKMB, high inflammatory markers, eosinophilia
Echo- LV EF, wall motion abnormalities, in filling pressures, left pleural effusion
MRI- inflammation, delayed enhancement of gadolinium
myocarditis trmt
Endocardial biopsy for if you have acute deterioration of cardiac function, unknown cause, and unresponsive to therapy
If due to Rheumatic carditis, give PCN
If from hypersensitivity of eosinophils and leukocytes, remove agent and give corticosteroids
If from lyme carditis, give corticosteroids and tetracycline
Dilated CMP?
Heart is weak and enlarged
Walls are thin and cant contract well
causes Dilated CMP
Nonischemic- toxic, metabolic, infectious, autoimmune, ETOH, adriamycin, herceptin, PVC, pregnancy peripartum
Ischemic- MI, CAD
Idiopathic- genetic
MC in men 20-60 yo
sx Dilated CMP
CHF (orthopnea, PND, edema, weight gain, low output state) SCD (sudden cardiac death) Atrial Arrhythmias Syncope Chest pain
exam Dilated CMP
JVD, rales, S3, hepatomegaly, pitting edema, displaced PMI, murmur
dx Dilated CMP
X ray, echo, cath, cardiac MRI, genetic testing
ECG- LBBB, atrial or ventricular arrhythmias
trmt Dilated CMP
ICD Beta blockers Afterload reduction- ACE, ARB, Entresto Aldactone Anticoag- LV thrombus
Hypertrophic CMP
pathyphys
Pathophys:
R or L ventricular hypertrophy
LVOT obstruction
Diastolic dysfunction
Myocardial ischemia
Mitral regurg
Arrhythmias
LVOT gradient- increased with dec preload or afterload or inc contractility
Venturi effect- dec in pressure when blood flows through a stenosis at high venosity
Dec in pressure causes anterior leaflet of mitral valve to go in that direction
Chordal SAM- anterior mitral valve leaflet and chordae get sucked into outflow tract causing a “jet MR” in mid-late systole
HOCM causes
Genetic, autosomal dominant
Leading cause of SCD in athletes less than 35 yo
MC Asymmetric hypertrophy of septum and anterior wall
mcc hypertrophic CMP
HOCM
sx hypertrophic CMP
SOB, CP, palpitations, LH, fatigue, syncope, SCD
LVOT obstruction can cause acute hemodynamic collapse
PE hypertrophic CMP
Prominent Q wave, rapid upstroke carotid pulse, lateral PMI, s4, systolic ejection murmur, mitral regurg murmur, sinus tach
dx hypertrophic CMP
ECG- no changes pathognomonic; LVH and repolarization changes
Echo- asymmetric septal hypertrophy, systolic anterior motion of MV, thick LV wall and small LV cavity, diastolic dysfunction
Obstructive vs nonobstructive
Obstructive- resting LVOT gradient over 30 mmHg
Nonobstructive- resting LVOT gradient less than 30 mmHg
Cardiac cath- ischemia
Brochenbrough response- after PVC you have inc LV SBP, dec aortic SBP, inc gradient between LV and AoV
trmt hypertrophic CMP
Reassurance
Screen if genetic via echo
No competitive athletics
Exercise testing
48 hr holter- looks for silent arrhythmias
Antiarrhythmic
Beta blocker- slows HR to inc diastolic filling
CCB (Verapamil)
Surgery- transplant or remove septal muscle
NSRT (nonsurgical septal reduction therapy)- occlude septal artery with catheter and ETOH
Antigoag- bc they have inc risk for AFib and thromboembolism
Restrictive CMP?
Systemic disease involving myocardium Classification: Non Infiltrative- idiopathic, familial, scleroderma Infiltrative- amyloidosis, sarcoidosis Storage disease- hemochromatosis Endocardial fibrosis Carcinoid Malignant infiltration
exam
Restrictive CMP
S3
