Lecture 2 Flashcards
Acute Pericarditis
1- Acute inflammation of the pericardium (< 2 Weeks)
Acute Pericarditis causes
1- Infection by viral, bacterial or fungal
2- Autoimmune disease
3- Trauma
4- Drug Toxicity
Acute Pericarditis Symptoms
1- Triad of chest pain
2- Friction rub (inflamed pericardial surface)
3- ECG changes
Pericardial Effusion
accumulation of excess fluid (exudate) int he pericardial sac
Effect that determine the severity of Pericardial Effusion on cardiac function
1- Rapidity of fluid accumulation
2- Elasticity of pericardium
Types of Pericarditis
1- Serous Pericarditis
2-Fibrinous Pericarditis
Serous Pericarditis associated with
1- Systemic lupus erythematous (SLE)
2- Rheumatic Fever
Serous Pericarditis characterized by
-production of clear, straw-colored, protein rich exudate containing small numbers of inflammatory cells
Fibrinous Preicarditis characterized
-Fibrin-rich exudate
Fibrinous Pericarditis cause by
1- Uremia
2- Myocardial infraction
3- Acute rheumatic fever
Types of Pericarditis
1- Purulent Pericariditis
2- Hemorrhagic pericarditis
Purulent Pericariditis is characterized by
-grossly cloudy exudate
Purulent pericarditis causes
bacterial infection
Hemorragic pericarditis characterized by
bloody exudate
Hemorragic pericarditis results from
1- Tumor invasion of the pericardium
2- Tuberculosis
3- Other bacterial infections
Cardiac Tamponade
- Increase in pericardial sac pressure
- Medical Emergency
Cardiac Tamponade caused by
accumulation of fluid or blood in the pericardial sac
Cardiac Tamponade results in
reduced ventricular filling and subsequent hemodynamic compromise
Cardiac Tamponade risk
1- death depends on the speed of the diagnosis, treatment provided and the underlying cause of the tamponade
Pericardiocentesis
- performed in response to cardiac tamponade
- can be done using a subxiphoid approach or parasternal approach
Myocardial Disease
disorders originating from within the myocardium, but not from cardiovascular disease
Two types of Myocardial disease
1- Myocarditis
2- Primary cardiomyopathies
Myocarditis
- inflammation of the heart muscles (and conduction system) without evidence of myocardial infraction
- Myocardium becomes thick and swollen
Myocardium casuses
1- Viral (#1 cause)
2- drug toxicity (cocaine)
3-Autoimmune diseases
Myocardium presents as
biventricular heart failure in young persons who do not have valvular, rheumatic or congenital heart disease
Primary Cardiomyopathies
disease of the heart muscles that are non-inflammatory and are not assocaited with hypertension, congenital heart disease, valvular disease or coronary artery disease
Primary Cardiomyopathies onset
Often is silent and symptoms do not occur until disease is well advances
Primary Cariomyopathies my be detected
with PE (Particularly in athletes)
Primary Cardiomyopathies diagnosis
when a young, previously healthy, normotensive person experiences cardiomegaly and heart failure
Dilated Cardiomyopathy
1- Most common form
2- progressive cardia hypertrophy and dilation
3- impaired pumping ability in one or both ventricles
4- Mural Thrombi are common and may be a source of thrromboemboli
Dilated Cardiomyopathy causes
1- idiopathic
2- Infectious myocarditis
3- Alcohol
Most common initial manifestations of Dilated cardiomyopathy
-Related to heart failure
Hypertrophic Cardiomyopathy characterized
- Ventricular hypertrophy
- Impaired diastolic ventricular filling
Hypertrophic Cardiomyopathy is often inherited as
1- autosomal dominant
2- several genes have been implicated in the genesis of this disorder
Hypertrophic Cardiomyopathy manifestations are
1- remain stable for many years and gradually acquire more symptoms
2- May result IN LEFT VENTRICULAR OUTFLOW OBSTRUCTION
Left ventricular outflow obstruction
-places patient in danger of syncope and even sudden death, which often occurs unexpectedly in young athletes
Restrictive Cardiomyopathy
1- least common of the primary cardiomyopathies
2- Ventricular filling is restricted due to excessive rigidity and stiffness of the ventricular walls
Restrictive Cardiomyopathy causes
- unknown
- may be associated with various infiltrations
Infected Endocarditis (Bacterial Endocarditis)
- Relatively uncommon
- life threatening conditions of the endocardial surface of the heart and valves
Infected Endocarditis require 2 independent factors
1- Damaged endocardial surface
2- A portal of entry by which the organism gains access to the vasculature. STAPHYLOCOCCUS AUREUS IS THE PATHOGEN 50% OF CASES.
3- Can also occur in normal hearts of IV drug abusers
Infected Endocarditis characteristic
1- large, soft, friable, easily detached vegetations consisting of fibrin and intermeshed inflammatory cells and bacteria
Infected Endocarditis may cause
1- Ulceration, often with perforation, of valve cusps or rupture of one of the chordae tendineae
2- mitral valve most frequently involved
Distal embolization occurs
1- when vegetation fragment
2- can occur almost anywhere in the body and can result in septic infracts in the brain or in other organs
Infective endocarditis antibiotic
Amoxicillin Patients that are allergic can be treated with 1- cephalexin 2- azithromycin 3- clarithromycin
