Inflammatory Heart Diseases Flashcards
Define myocarditis
Inflammatory disease of the myocardium w/a wide range of clinical presentations in an otherwise healthy person, ranging from subtle to devistating
T or F: once the infection is over, myocarditis goes away
False - it continues to influence the heart long after the infection and may cause chest pain and lead to heart failure or transplant if left untreated
What is the etiology of myocarditis
Majority = idiopathic
- viruses
- bacteria
- fungi
- protozoa
- rheumatic fever
- autoimmune disorders
What is the clinical presentation of myocarditis
- flu-like symptoms (arthralgia, malasie, fever)
- pharyngitis/tonsilitis/upper respiratory tract infection
- chest pain, sweats, dyspnea, palpitations
- HF signs
- cardiogenic shock
- syncope or sudden death
What medical tests are done for myocarditis?
- Blood work
- ECG
- MRI
- Endomyocardial biopsy
To rule out other causes
- Echo (TTE)
- Coronary angiogram
What is the medical intervention for myocarditis
- Standard HF treatment (Pharm & implanted devices)
- Avoid physical stress (several months)
- Immunosuppression if autoimmune cause
What pharmacological interventions are used for myocarditis
Standard HF treatment:
Ace inhibitors
Beta Blockers
ARBs
Diuretics
Inotropics
What is the prognosis for myocarditis
- Good if fulminant (unknown cause)
- if mild symptoms = complete recovery
- 30% develop dilated cardiomyopathy
What is endocarditis
It is induced by an infection of the endocardium or inner lining of the heart resulting in pronounced inflammation
What are pre-disposing factors to developing endocarditis
- prosthetic valves
- elderly patients w/degenerated valves
- IV Drug users
- IV catheters, pacemaker electrodes
What are non-surgical or drug causes of endocarditis
- Rheumatic valvular disease
- congenital heart disease
- mitral valve prolapse
- degenerative heart disease
What are treatments for endocarditis?
- Antibiotics
- Surgery is serious enough
What one symptom of endocarditis is present 95% of the time?
Fever
What are possible clinical presentations of endocarditis?
- sudden weight loss
- Joint and muscular pain
- fever and chills
- visible purple or red spots
- heart murmurs
- constant coughing
- blood in the urine
- edema
- fatigue and unusual tiredness
- night sweats
- tenderness below the rib cage
- a pale face or complexion
- SOB or difficulty breathing
What diagnostic tests do you do for endocarditis
- Blood cultures
- Echo (TTE = low sensitivity, TEE = high sensitivity)
- ECG
- X-ray
- MRI
- CT
- WBC
What is acute pericarditis
Inflammation of the pericardium characterized by chest pain, pericardial friction rub, and serial ECG changes
What is the main sign of acute pericarditis compared to the other itis’s?
Pain!
Pericardially or retrosternal w/referred pain and intensity varies w/it worse during inflammation
Etiology of acute pericarditis
-Idiopathic (50%)
- Infections
- Inflammatory disorders
- Metabolic conditions
- Cardiovascular disorders
- Iatrogenic
- Neoplasms
- Drugs/irradiation
- trauma
- pneumonia
- pulmonary infarction
What is the clinical presentation of pericarditis?
- chest pain
- intermittent fever
- dyspnea/tachypnea
- cough, dysphagia
- effusion
What are the medical tests done for pericarditis?
- stethoscope
- ECG
- Echo - TEE
- MRI
- Chest x-ray
- Ultrasound imaging
- Lab values
Rule out:
- CT
Which lab values are tested for pericarditis?
- CBC
- Inflammatory markers
- Electrolytes
- BUN
- Creatinine
- Thyroid hormones
- Cardiac enzyme levels
What is the pharmacological management of pericarditis?
- antibiotic if indicated
- Anti-inflammatory meds such as NSAIDs or corticosteroids
- morphine // narcotics
What is the surgical management of pericarditis?
- pericardiocentesis for large effusions
- pericardial window
- pericardiectomy in constrictive pericarditis
What pericardial effusion develop into?
- Tamponade where you get decreased ventricular filling leading to a lesser SV, CO and pulse pressure with a higher venous pressure and high heart rate
