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clin med > Myocardial and pericardial disease > Flashcards

Myocardial and pericardial disease Flashcards

1
Q

Myocarditis?

A

myocardium is inflamed and has dec cardiac function

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2
Q

2 phases of myocardial cell damage in myocarditis

A

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

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3
Q

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

A

myocarditis

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4
Q

cause of myocarditis

A

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

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5
Q

sx of myocarditis

A

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

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6
Q

PE myocarditis

A

Fever over 100.4, pericardial friction rub, diminished CO

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

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7
Q

trmt myocarditis

A

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

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8
Q

dilated CMP?

A

Heart is weak and enlarged

Walls are thin and cant contract well

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9
Q

MC in men 20-60 yo

A

dilated CMP

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10
Q

dilated CMP sx

A 
CHF (orthopnea, PND, edema, weight gain, low output state)
SCD (sudden cardiac death)
Atrial Arrhythmias 
Syncope
Chest pain
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11
Q

dilated CMP exam

A

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

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12
Q

dilated CMP trmt

A 
ICD
Beta blockers
Afterload reduction- ACE, ARB, Entresto
Aldactone
Anticoag- LV thrombus
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13
Q

“jet MR” in mid-late systole

A

hypertrophic CMP

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14
Q

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

A

HOCM

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15
Q

exam HOCM

A

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

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16
Q

restrictive CMP

A 
Systemic disease involving myocardium
Classification:
Non Infiltrative- idiopathic, familial, scleroderma
Infiltrative- amyloidosis, sarcoidosis
Storage disease- hemochromatosis
Endocardial fibrosis
Carcinoid
Malignant infiltration
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17
Q

Constrictive CMP

A

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

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18
Q

restrictive CMP exam

A

s3

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19
Q

Constrictive CMP exam

A

pericardial knock

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20
Q

XCR restrictive CMP

A

no Ca

21
Q

echo restrictive CMP

A

both atria dilated, normal or small LV, diastolic dysfunction

22
Q

ECG restrictive CMP

A

BBB, AV block

23
Q

CT/MRI restrictive CMP

A

normal pericardium

24
Q

biopsy restrictive CMP

A

fibrosis, hypertrophy, infiltration

25
Q

hemodynamics restrictive CMP

A

unequal diastolic pressures

26
Q

Constrictive CMP XCR

A

pericardial calcification

27
Q

Constrictive CMP echo

A

normal atria and ventricles/ effusion

28
Q

Constrictive CMP ecg

A

abnormal repolarization

29
Q

Constrictive CMP CT/MRI

A

pericardial thickening/effusion

30
Q

Constrictive CMP biopsy

A

normal

31
Q

Constrictive CMP hemodynamics

A

normal diastolic pressures

32
Q

trmt hypertrophic CMP

A

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

33
Q

Amyloidosis?

A

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

34
Q

Amyloidosis dx

A

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

35
Q

Amyloidosis trmt

A

No cure- limit production of amyloid proteins

Steroids, immunosuppressives, hemodialysis, SCT, chemo, support

36
Q

Constrictive pericarditis

dx

A

BNP, echo, CXR, CT, MRI, LFT, ECG

All show thick pericardium

37
Q

Trmt Constrictive pericarditis

A

pericardial stripping/pericardiectomy

38
Q

Pericardial effusions?

A

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

39
Q

dx Pericardial effusions

A

Echo is the best but can do CT or MRI

40
Q

Tamponade sx

A

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

41
Q

Tamponade dx

A

EKG- Low voltage QRS

CXR- inc cardiac silhouette

42
Q

Tamponade trmt

A

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

43
Q

Acute pericarditis

cause

A 
T- trauma, tumor
U- uremia
M- MI
O- other infections MCC coxsackie A and B
R- rheumatoid, radiation
44
Q

Acute pericarditis

sx/exam

A

Retrosternal chest pain, fever, SOB

Friction rub, paradoxical pulse, distant heart sounds, JVD

45
Q

Acute pericarditis

dx

A

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)

46
Q

Acute pericarditis

trmt

A

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

47
Q

Dressler Syndrome/postmyocardial infarction syndrome?

A

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

Autoimmune

48
Q

Dressler Syndrome/postmyocardial infarction syndrome

sx

A

Triad: fever, pleuritic pain, pericardial effusion

49
Q

Dressler Syndrome/postmyocardial infarction syndrome

trmt

A

NSAIDS, colchicine

clin med (35 decks)

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