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Cardiology Exam IV > Micro: Myocarditis and Epicarditis > Flashcards

Micro: Myocarditis and Epicarditis Flashcards

1
Q

Myocarditis

A

Inflammatory disease of cardiac muscle

Dx on endomyocardial biopsy by established histological, immunological and immunohistochemical criteria

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2
Q

Dx of Myocarditis

A

Dx on endomyocardial biopsy by established histological, immunological and immunohistochemical criteria

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3
Q

Fulminant myocarditis

A

Viral prodrome
Distinct onset of illness
Severe cardiovascular compromise with ventricular dysfunction
Multiple foci of active myocarditis
Resolution range from spontaneous clearing to death

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4
Q

Acute Myocarditis

A

Less distinct onset of illness
Ventricular dysfunction
May progress to dilated cardiomyopathy

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5
Q

Are you more likely to recover from acute of fulminant myocarditis ?

A

Fulminant

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6
Q

In which patients should you rule in Myocarditis ?

A

Young person with Unexplained heart failure or arrhythmias with history of:
Systemic febrile illness
URTI

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7
Q

Major causes of mycarditis include

A

Infection: Viral, bacterial, fungal, parasitic
Autoimmune
Drug Rxns

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8
Q

Mechanism of Damage to myocytes

A

Direct damage to cells

Damage to myocytes from generalized cytokine or cell-mediated immune response

Cytotoxicity caused by viral antigen-specific immune reaction against infected cell

Cytotoxic caused by circulating toxin

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9
Q

Major viruses associated with myocarditis

A

Enteroviruses (Coxsackie, Polio etc)
Adenovirus
Parvovirus B19
Human Herpes Virus 6

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10
Q

gold standard of diagnosis for myocarditis

A

biopsy

pcr becoming more useful however

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11
Q

By what route are Enteroviruses transmitted ?

A

fecal oral

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12
Q

Which serotype of Coxsackie B is dangerous to neonates leading to febrile illness and sudden unexplained heart failure ?

A

B3

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13
Q

What mediates entry of Cox. B into myocytes ?

A

CAR – Coxsackie-adenovirus receptor

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14
Q

What is the mechanism by which coxsackie B causes myocarditis ?

A

Viral Protease A2 cleaves dystrophin leading to decreased myocyte contractility

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15
Q

Describe the disease caused by Parvovirus B19 ?

A

Erythema infectiosum (5th disease) aka Slapped cheek fever

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16
Q

How does Parvovirus B19 cause myocarditis ?

A

Infection of the myocyte endothelial cells leads to decreased endothelial integrity

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17
Q

List the primary bacteria that cause myocarditis

A 
Borelia burgdorferi (causitive agent of lyme disease)
Corynebacterium diphtheriae
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18
Q

List the bacterial agents which cause myocarditis by spreading from a previous endocardial infection

A 
Streptococci (Enterococcus)
Staphylococci
Bartonella
Brucella
Leptospira
Salmonella
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19
Q

Late changes in bacterial myocarditis resemble what other disease ?

A

dilated cardiomyopathy

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20
Q

How does C.diptheriae cause myocarditis ?

A

bacterial toxin directly kills myocytes by inhibiting EF-2 via ADP ribosylation

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21
Q

How will you treat a patient with C.diptheriae caused myocarditis ?

A

Anti-toxin

22
Q

Describe symptoms/findings of an individual who has diptheria that may be causing myocarditis

A 
Bull Neck (swollen)
Grey pseudomembrane on the back of the throat
Conjunctivitis
23
Q

What family of bacteria does Borellia burgdorferi fall into ?

A

Spirochetes

24
Q

What percentage of patients with Borellia burgdorferi develop myocarditis ?

A

10%

25
Q

What is the most common cardiac manifestation of borrelia infection and what is the prognosis ?

A

AV nodal block

Spontaneous recovery ! (unlike neurologic findings)

26
Q

What leads to cardiac damage in myocarditis associated with borellia ?

A

Damage result of macrophage attacking spirochete

27
Q

How do you treat borellia associated myocarditis ?

A

Ceftriaxone or pennicilin

temporary pacemaker for individuals with AV block

28
Q

What is the causative agent of Chagas Disease , which involves myocarditis ?

A

Trypanosoma cruzi (protozoa, not a bacteria !)

29
Q

How is T. cruzi transmitted to humans ?

A

Bite/feces of reduviid kissing bug or triamids

30
Q

What is a ‘Chagonoma’ ?

A

Erythematous and indurated area at site of bug bite

31
Q

Describe ‘Romanas Sign’ (associated with Chagas Disease)

A

Rash and edema around eyes and face

Other symptoms of Chagas include: Fever, chills, malaise, myalgia, fatigue

32
Q

How does T. Cruzi cause myocarditis ?

A

Parasites multiply in the Myocytes –> cell damage (marked cellular infiltrate)

Mechanism for cell damage :
Cell Lysis
T-Cell mediated

33
Q

Describe the prognosis for an individual with Chagas associated myocarditis

A

Usually resolve spontaneously. Some mortality associated with severe cases.
In chronic phase of infection parasites enter organs of the body: Liver , Heart, esopahgus and colon leading to inflammation. (Granulomas in the brain)

34
Q

Describe the chronic phase of Chagas Disease

A

Can be 20 years later
Associated w/poor survival
Left ventricular apical aneurysm is typical presentation
Megacardia, electrocardiographic changes

35
Q

The C’s of Chagas Disease

A

Children
Chagoma
Cardiac
Cruzi

36
Q

How is Chagas Disease diagnosed in the lab ?

A

Thick and thin blood films – early acute phase
Biopsy may show amastigote stage
Complement-fixation
Xenodiagnosis ( giving uninfected reduviid bugs blood from suspected patients and see if T. cruzi appears)
PCR

37
Q

Pharmacologic treatment of T.cruzi (Chagas Disease)

A

Nifurtimox
Active against acute phase
Little activity against amastigotes (dividing
stage in tissues)

38
Q

Pericarditis

A

Inflammation of the preicardium

Can be infectious or noninfectious

39
Q

What are the main pathogens associated with Pericarditis ?

A

Viruses (similar to those that cause myocarditis)

40
Q

What are the bacteria that typically cause myocarditis

A

M. tuberculosis
Pyogenic Bacteria
Pneumococci
Staphylococci

41
Q

How does pericarditis present on examination ?

A

Pleuritic chest pain
High fever
Pericardial friction rub
ECG abnormalities

42
Q

What is the most common cause of subacute or chronic purulent pericarditis ?

A

M.Tuberculosis

43
Q

List areas in which tuberculosis may have spread to the pericardium from..

A

Lung/tracheobronchial tree
Adjacent lymph nodes
Spine, sternum or miliary spread

44
Q

Is pericarditis due to tuberculosis often due to new infection or reactivation of older infection ?

A

Reactivation

45
Q

Dx of tuberculosis

A

TB in smear or culture of pericardial fluid
Histologic examination of caseating granuloma
PCR may become useful

46
Q

Tx of tuberculosis

A

Isoniazid
Rifampin (Rifadin, Rimactane)
Ethambutol (Myambutol)
Pyrazinamide

47
Q

Purulent pericarditis

A

Gross puss in pericardium or microscopic purulence

very rare in this age of antibiotics

48
Q

Sources of purulent pericarditis causing bacteria ?

A

Direct spread from intrathoraci foci
Hematogenous spread
Extension from subdiaphragmatic suppurative focus

49
Q

Organisms associated with direct intrathoracic spread leading to purulent pericarditis ?

A

Strep pneumoniae

50
Q

Organisms associated with hematogenous spread leading to purulent pericarditis ?

A

Staphylococcus aureus

Streptococci

51
Q

Organisms associated with extension of myocardial focus spread leading to purulent pericarditis ?

A

S. aureus
Salmonella
Those which also cause infective endocarditis

Cardiology Exam IV (9 decks)

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