Epicardial + Pericardial Disease

Question 1

Myocarditis

Answer 1

Inflammatory disease of the myocardium. Can range from a mild disorder to a lethal condition

• Inflammation with degeneration and necrosis of cardiac myocytes (Loss of myocytes)
• Conduction disruption is common

Question 2

Myocarditis Causes

Answer 2

Viruses are the most common causes of myocarditis in the US and Europe

Coxsackie viruses A and B account for a large proportion of cases

Question 3

Pericarditis

Answer 3

When the pericardium undergoes inflammation, fluid accumulates in the pericardial space.

The fluid is called PERICARDIAL EFFUSION and it surrounds the heart

Question 4

How much fluid must accumulate to cause CARDIAC TAMPONADE in pericarditis?

Answer 4

200 mL or Greater

• It can compress the heart
• The heart chambers are restricted by the surrounding pericardial fluid so they cannot stretch and fill with blood

Reduction in CO

Question 5

Signs of Acute Pericarditis

Answer 5

• Chest pain: sharp worsens w/ deep breathing
• Fever
• Dyspnea
• Pericardial Friction rub
• EKG: ST elevations (multiple leads
• Cardiac Tamponade
• Pulsus Paradoxus: 70-80% of Pt’s w/cardiac tamponade

Question 6

Symptoms of Cardiac Tamponade

Answer 6

(Beck Triad)

1. Hypotension (low CO)
2. JVD
3. Muffled Heart sounds

Question 7

Pericarditis ECG Changes

Answer 7

Global ST depression/elevation (depends on lead)

Question 8

Pulsus Paradoxus

Answer 8

Decrease in SYSTOLIC BP of 10 mm Hg or more w/ INSPIRATION

Increase in Systolic BP of 10 mm Hg or less w/ EXPIRATION? (IE)

Question 9

Pericarditis Treatment

Answer 9

(NACC)

NSAID's
ASA
Corticosteroids
Colchicine
-usually for gout
-recently for pericarditis refractory to NSAID's

Pericardiocentesis