Myocardial and pericardial disease

Question 1

Pericarditis causes

Answer 1

Most common- viral
- coxsackie B
- infections: TB, staph, strep, fungal, toxoplamosis

MI
- post-infarction fibrinous (1-3 days)
- dressler syndrome: weeks-monthss

Post-op

Uraemia

Radiation

Malignancy

Autoimmune
- RA, SLE, scleroderma

Truma

Question 2

Ewart sign

Answer 2

Caused by compression of the lung parenchyma by a large pericardial effusion.
- dullness at the base of the left lung, with increased vocal fremitus and bronchial breathing.

Question 3

Management of Purulent pericarditis

Answer 3

Pericardiocentesis - cultures

Empirical abx
- vancomycin, ceftriaxone, meropenem

Question 4

Myocarditis causes

Answer 4

Most common= viral
- coxsackie B1-B5 (picornavirus), - parvovirus B19
- human herpesvirus 6 (HHV6)
- adenovirus
- HCV, HIV

Bacterial:
- Group A β-hemolytic Streptococcus (acute rheumatic fever)
- Corynebacterium diphtheriae (diphtheria)
- Borrelia burgdorferi (borreliosis)
- Mycobacterium (tuberculosis)
- Mycoplasma pneumoniae

Fungal, parasites (Chagas disease, toxoplasmosis)

Non-infective
- CTD
- vasculitis
- toxins

Question 5

Medications associated with myocarditis

Answer 5

doxorubicin
anthracycline
sulfonamides