Myocardial and pericardial disease

Question 1

Myocarditis?

Answer 1

myocardium is inflamed and has dec cardiac function

Question 2

2 phases of myocardial cell damage in myocarditis

Answer 2

Myocardial cells are damaged from viral infection
Myocardial cells are damaged from hosts immune response
Lymphocytic myocarditis- MC

Question 3

Can be “focal”- in just one part of the heart so we like to get 4-6 biopsies

Answer 3

myocarditis

Question 4

cause of myocarditis

Answer 4

MCC coxsackievirus and echovirus
Hypersensitivity of eosinophils and leukocytes
GAS Rheumatic carditis
Lyme carditis from borrelia burgdorferi

Question 5

sx of myocarditis

Answer 5

Chest pain, joint pain, myalgia, fatigue, palpitations, CHF, syncope, SCD, fluid retention/edema

Question 6

PE myocarditis

Answer 6

Fever over 100.4, pericardial friction rub, diminished CO

If serious, tachycardia, weak pulses, cool extremities, muffled heart tones, S3, JVD, edema

Question 7

trmt myocarditis

Answer 7

Endocardial biopsy for if you have acute deterioration of cardiac function, unknown cause, and unresponsive to therapy
If due to Rheumatic carditis, give PCN
If from hypersensitivity of eosinophils and leukocytes, remove agent and give corticosteroids
If from lyme carditis, give corticosteroids and tetracycline

Question 8

dilated CMP?

Answer 8

Heart is weak and enlarged

Walls are thin and cant contract well

Question 9

MC in men 20-60 yo

Answer 9

dilated CMP

Question 10

dilated CMP sx

Answer 10

CHF (orthopnea, PND, edema, weight gain, low output state)
SCD (sudden cardiac death)
Atrial Arrhythmias 
Syncope
Chest pain

Question 11

dilated CMP exam

Answer 11

JVD, rales, S3, hepatomegaly, pitting edema, displaced PMI, murmur

Question 12

dilated CMP trmt

Answer 12

ICD
Beta blockers
Afterload reduction- ACE, ARB, Entresto
Aldactone
Anticoag- LV thrombus

Question 13

“jet MR” in mid-late systole

Answer 13

hypertrophic CMP

Question 14

Genetic, autosomal dominant
Leading cause of CDS in athletes less than 35 yo
MC Asymmetric hypertrophy of septum and anterior wall

Answer 14

HOCM

Question 15

exam HOCM

Answer 15

Prominent Q wave, rapid upstroke carotid pulse, lateral PMI, s4, systolic ejection murmur, mitral regurg murmur, sinus tach

Question 16

restrictive CMP

Answer 16

Systemic disease involving myocardium
Classification:
Non Infiltrative- idiopathic, familial, scleroderma
Infiltrative- amyloidosis, sarcoidosis
Storage disease- hemochromatosis
Endocardial fibrosis
Carcinoid
Malignant infiltration

Question 17

Constrictive CMP

Answer 17

Acute pericarditis, cardiac surgery, radiation, chest trauma, systemic disease inv. pericardium

Question 18

restrictive CMP exam

Answer 18

s3

Question 19

Constrictive CMP exam

Answer 19

pericardial knock

Question 20

XCR restrictive CMP

Answer 20

no Ca

Question 21

echo restrictive CMP

Answer 21

both atria dilated, normal or small LV, diastolic dysfunction

Question 22

ECG restrictive CMP

Answer 22

BBB, AV block

Question 23

CT/MRI restrictive CMP

Answer 23

normal pericardium

Question 24

biopsy restrictive CMP

Answer 24

fibrosis, hypertrophy, infiltration

Question 25

hemodynamics restrictive CMP

Answer 25

unequal diastolic pressures

Question 26

Constrictive CMP XCR

Answer 26

pericardial calcification

Question 27

Constrictive CMP echo

Answer 27

normal atria and ventricles/ effusion

Question 28

Constrictive CMP ecg

Answer 28

abnormal repolarization

Question 29

Constrictive CMP CT/MRI

Answer 29

pericardial thickening/effusion

Question 30

Constrictive CMP biopsy

Answer 30

normal

Question 31

Constrictive CMP hemodynamics

Answer 31

normal diastolic pressures

Question 32

trmt hypertrophic CMP

Answer 32

Reassurance Screen if genetic via echo No competitive athletics Exercise testing 48 hr holter- looks for silent arrhythmias Antiarrhythmic Beta blocker- slows HR to inc diastolic filling CCB (Verapamil) Surgery- transplant or remove septal muscle NSRT (nonsurgical septal reduction therapy)- occlude septal artery with catheter and ETOH Antigoag- bc they have inc risk for AFib and thromboembolism

Question 33

Amyloidosis?

Answer 33

Interstitial amyloid protein deposits on organs usually the heart Causes restrictive CMP

Question 34

Amyloidosis dx

Answer 34

Echo- granular/sparkling myocardium in a patchy distribution Impaired LV relaxation Serum and protein electrophoresis is diagnostic Fat pad biopsy or RV endomyocardial biopsy

Question 35

Amyloidosis trmt

Answer 35

No cure- limit production of amyloid proteins | Steroids, immunosuppressives, hemodialysis, SCT, chemo, support

Question 36

Constrictive pericarditis | dx

Answer 36

BNP, echo, CXR, CT, MRI, LFT, ECG | All show thick pericardium

Question 37

Trmt Constrictive pericarditis

Answer 37

pericardial stripping/pericardiectomy

Question 38

Pericardial effusions?

Answer 38

Pericardial cavity normally contains 50 mL of plasma infiltrate Exudative, transudative, or blood in pericardial sac

Question 39

dx Pericardial effusions

Answer 39

Echo is the best but can do CT or MRI

Question 40

Tamponade sx

Answer 40

Hypotension, dyspnea, chest pain, tachycardia JVD- kussmaul's sign Rise in JVD with inspiration suggests inpaired filling of RV

Question 41

Tamponade dx

Answer 41

EKG- Low voltage QRS | CXR- inc cardiac silhouette

Question 42

Tamponade trmt

Answer 42

Emergent removal of fluid Pericardiocentesis- remove fluid, determine if its exudate or transudate, culture, cytology, smear Surgical drainage- pericardial window, tube pericardiostomy, pericardiectomy

Question 43

Acute pericarditis | cause

Answer 43

``` T- trauma, tumor U- uremia M- MI O- other infections MCC coxsackie A and B R- rheumatoid, radiation ```

Question 44

Acute pericarditis | sx/exam

Answer 44

Retrosternal chest pain, fever, SOB | Friction rub, paradoxical pulse, distant heart sounds, JVD

Question 45

Acute pericarditis | dx

Answer 45

Classic: ST elevation and PR depression CXR- enlarged cardiac silhouette; possible pleural effusion Labs: CBC, ESR, CRP, troponin, CM-MB, uremia Echo- evaluate if effusion present for tamponade (NOT good)

Question 46

Acute pericarditis | trmt

Answer 46

Hospitalization Relieve pain with NSAIDS, ASA, Colchicine (not well treated for GI), corticosteroids, GI prophylaxis Pericardiocentesis Rarely pericardiectomy NO steroids… it will make the virus shed more

Question 47

Dressler Syndrome/postmyocardial infarction syndrome?

Answer 47

Secondary form of pericarditis that occurs 4-6 wks post MI | Autoimmune

Question 48

Dressler Syndrome/postmyocardial infarction syndrome | sx

Answer 48

Triad: fever, pleuritic pain, pericardial effusion

Question 49

Dressler Syndrome/postmyocardial infarction syndrome | trmt

Answer 49

NSAIDS, colchicine