epi/pericardial disease

Question 1

myocarditis

Answer 1

inflam of muscle layer of heart
ranges from mild to lethal (discomfort to HF -> transplant)
inflam leads to degeneration and necrosis of cardiac myocytes (muscle cells)
conduction disruption is common -> dysR common

Question 2

myocarditis: etiology

Answer 2

mostly viral in US and europe
Coxsackie A + B

Question 3

myocarditis: tm

Answer 3

depends on severity of S -> anti inflam, antivirals, transplant

Question 4

pericarditis

Answer 4

inflam of pericardium causes fluid accumulation in pericardial space
normal to have fluid there just to cushion and decrease friction
example of pericardial effussion
pericardium surrounds heart and roots of major BV

Question 5

pericarditis: cardiac tamponade

Answer 5

affects ability to pump
fluid accumulates >200mL -> compress heart
heart chambers restricted by surrounding pericardial fluid -> cant stretch and fill with blood

Question 6

pericarditis: cardiac tamponade - tm

Answer 6

cardiac emergency
drain fluid -> pericardiocentesis

Question 7

pericarditis: cardiac tamponade - cm

Answer 7

beck triad: hypoT, JVD, muffled heart sounds
hypoT: d/t decreased CO -> confused, dizzy, etc.
JVD: backflow of blood
heart sounds: listening through lots of fluid
pulsus paradoxus (70-80%): decrease in SBP of 10+ with inspiration (should increase), can see with arterial line if pt has one

Question 8

pericarditis: cm

Answer 8

chest pain -> sharp, worse with deep breathing
fever (inflam), dyspnea (pain with breathing), ST elevations or depression (similar to MI on ecg but not s/s)
pericardial friction rub: scratching sound with stethoscope, can be heard during entire cardiac cycle

Question 9

pericaditis: tm

Answer 9

NSAIDs, ASA, corticosteroids (+/-, sometimes work well and sometimes dont, 2nd line if NSAIDs dont work)
colchicine: gout, 2nd line if NSAIDs dont work