Epi / pericardial diseases

Question 1

Define myocarditis:

Answer 1

An inflammatory disease of the myocardium that can range from mild to lethal. Causes inflammation and necrosis of the cardiac myocytes. Conduction disruption is common.

Question 2

What is the most common cause of myocarditis in the US and Europe?

Answer 2

Viruses

Question 3

What is the most common virus the causes myocarditis?

Answer 3

Coxsackie virus A and B

Question 4

What are the 3 types of treatment for myocarditis?

Answer 4

Anti-inflammatories, anti-virals, or a heart transplant

Question 5

How does pericarditis relate to pericardial effusion?

Answer 5

When the pericardium is inflamed it leads to fluid accumulation in the pericardial space (this is a pericardial effusion).

Question 6

What is cardiac tamponade?

Answer 6

Fluid accumulation past 200 mL in the pericardial space. This compresses the heart and the chambers are restricted by the surrounding pericardial fluid so they cannot stretch and fill with blood. This causes a decrease in cardiac output.

Question 7

What are the signs of acute pericarditis?

Answer 7

• Chest pain (sharp, worse when deep breathing)
• Fever
• Dyspnea
• Pericardial friction rubs
• ST elevations on EKG

Question 8

What are symptoms of cardiac tamponade?

Answer 8

The Beck Triad; hypotension, JVD, muffled heart sounds
Pulsus paradoxus

Question 9

What is pulsus paradoxus?

Answer 9

A 10 mmHg decrease with EXPIRATION
(or can think of it as a 10 mmHg increase with INSPIRATION)

Question 10

What are the treatment options for pericarditis?

Answer 10

NSAIDS (anti-inflammation)
ASA (reduce inflammation and a little pain)
Corticosteroids
Colchicine (for pericarditis that isn’t responsive to NSAIDS)
Can go and drain the fluid