Myocardial and Pericardial Disease Flashcards
1
Q
treatment of myocarditis?
A
- rest and if signs of heart failure, same treatment as other causes of heart failure. If arrhythmias present also use standard therapy
- avoid NSAIDs and alcohol
- anti-inflammatory medications of unclear benefit cases should be individulized including cases of covid
2
Q
- Preserved systolic function
- abnormal diastolic function: Reduced extent filling due to increased stiffness, reduced rate of filling in early diastole
- infiltrative or fibrotic cause most common, some may be famiial
- heart failure caused by inability to fill at low pressure
A
Restrictive cardiomyopathy
3
Q
- May present at any age
- elevated filling pressures and diastolic dysfunction
- atrial enlargement
- typical symptoms of CHF
- near normal systolic ventricular function
- poor long term prognosis
A
Idiopathic restrictive cardiomyopathy
4
Q
- Innappropriate hypertrophy of the LV/RV
- hypertrophy most frequently involves the septum
- reduced LV volume
- Hemodynamic abnormalities of systole (outflow tract obstruction in about 50% of patients) and distole (abnormal filling and mitral regurgitation (myocardial fiber disarray)
Sudden death possible at all ages
A
Hypertrophic cardiomyopathy
5
Q
symptoms of hypertrophoic cardiomyopathy?
A
- most commonly as young of middle-aged adults
- dyspnea on exertion and other heart failure symptoms
- exertional angina or other chest pains
- exertional syncope
- sudden death
- palpitations
6
Q
Treatment of hypertrophic cardiomyopathy?
A
Diastolic dysfunction
- maintenance of adequate fluid balance
- calcium channel blockers and beta blockers
Syncope
- outflow gradient reduction
- pacemakers
Sudden death: screening for higher risk with holter monitors, stress testing, degree of LVH and LV scar (ICD placement)
7
Q
- thick fibrous material that surrounds the heart and great proximal vessels
- reduces cardiac motion and friction
- prevents excessive filling of the chambers
- prevents excessive myocyte stretch
A
Pericardium
8
Q
- localized inflammation of the pericardium
- causes: viral, TB, renal failure, neoplasm, prior mycoardial infarction, prior heart surgery, radiation exposure
- may cause chest pain
- usually self limiting
A
pericarditis
9
Q
what are clincial findings in pericarditis?
A
- Sharp pleuritic (sharp, worse with inspiration) chest pain, positional(worse when supine & improved when sitting forward)
- pericardial friction rub
- ECG changes of ST and T waves with PR depression (diffuse ST elevations in the precordial leads with associated PR depressions)
- Pericardial effusion
10
Q
initial treatment of pericarditis?
A
- NSAIDs in high doses (ibuprofen 800mg 3x/day, ASA 650mg 3x/day) PPP: NSAIDs or asprin x7-14 days
- colchicine 0.6-1.2 twice a day for 3 months
- steroids if above not possible or not working or if a systemic disease is involved
11
Q
- loss of pericardial elasticity
- smoldering pericarditis
- chronic fibrosis and thickening of the pericardium
- limits ability of the heart to fill (restriction of ventricular diastolic filling)
- increases filling pressures and reduces output response to exercise
- surgical removal may be necessary
A
constrictive pericarditis
12
Q
- Collection of fluid in the pericardial space
- rapid fluid accumulation: medical emergency
- gradual onset of large fluid collection from an inflammatory or neoplastic cause
A
Pericardial Effusion
13
Q
what is the size ranges of pericardial effusion?
A
- minimal: small echo free space in the AV groove < 5mm in diastole (50-100ml)
- small: 5-10mm of posterior pericardial echo free space with or without accumulation in other parts of the pericardium (100-250ml)
- Moderate: 10-20mm of posterior echo free space with fluid elsewhere but usually still asymmetric with less echo free space elsewhere (250-500ml)
- large: more than 20mm of echo free space wiht fluid almost always surrounding the heart (>500m)
14
Q
what are symptoms of cardiac tamponade? what would you see on physical examination?
A
- symptoms: dyspnea, fatigue, cough, agitation and restlessness, syncope, shock, anuria
- physical exam: Pulse paradoxus, tachycardia, increase jugualr venous pressure, hypotension, distant muffled heart sounds
15
Q
Exaggerated (>10mmHg) cyclic decrease in systolic BP during normal inspiration
- inspiration: increased venous return, increased RV volume and increased pooling in lungs, BP drops.
- Interventricular septum shifts left, decreased LV volume decreased stroke volume and systolic pressure falls
- expiration: Blood flows to the left side out of the lungs and stroke volume then BP rises
- not detected by automatic BP cuff
A
Pulsus paradoxus
16
Q
how does myocarditis clinically present?
A
- nonspecific URI or viral syndrome that may not cause cardiac symptoms, yet the patient may have subclinical cardiac involvement
- acute chest pain for 1-4 weeks following a viral illness
- subacute onset of heart failure symptoms
- cardiogenic shock
17
Q
- systolic dysfunction leading to a dilated, weak heart
- idopathic is the most common cause
- infections: Viral most common (especially enteroviruses-coxsackie B)
- echocardiogram: diagnostic test of choice- left ventricular dilation, decreased ejection fraction
- chest radiograph: cardiomegaly
A
dilated cardiomyopathy
18
Q
what are clinical manifestations of dilated cardiomyopathy?
A
- systolic heart failure
- left-sided: L for lung symptoms- dyspnea, fatigue
- right-sided: peripheral edema, jugular venous distention, hepatomegaly, GI symptoms
- S3 gallop hallmark (due to filling of a dilated ventricle)
19
Q
Treatment of dilated cardiomyopathy?
A
- standard systolic heart failure treatment: mortality reduction with ACEi, beta blockers, symptom control with diuretics
20
Q
clinical manifestations of contrictive pericarditis?
A
- dyspnea most common symptom, fatigue, orthopnea
- right sided heart failure signs: increased jugular venous distention, peripheral edema, nausea, Kussmaul’s sign
- pericardial knock high pitched diastolic sound similar to S3
