Myocardial and Pericardial Disorders Flashcards
What is a major cause of sudden death in adults <40?
Myocarditis
What is the MCC of acute myocarditis in the US?
VIRUSES
Adenovirus (most common)
Group B Cox
What are other microbial pathogenic causes of myocarditis?
- Parasites (trypanosoma, trichinella, toxoplasma)
- Bacteria (borrelia burgdorferia, mycoplasma, rickettsia rickettsia)
- Fungi (Candida, Mucor, Aspergillus)
What are other non-microbial causes of myocarditis?
- RF
- Toxins
- Drugs (cocaine)
- Systemic and collagen vascular diseases (SLE, systemic sclerosis, Kawasaki disease, radiation)
- Sarcoidosis
What happens in myocarditis?
Global ENLARGEMENT of the heart and DILATION of the champers
What is highly predictive of a viral myocarditis?
Lymphocytic infiltrate w/ focal areas of necrosis
A pt comes to you with SOB, fever, chest pain, an arrhythmia, pericardial friction rub, biventricular CHF and MV regurgitaiton. What do they have?
Myocarditis
What are common lab findings of myocarditis?
Increased CK-MB
Increased troponin (normal value doesn’t exclude myocarditis)
Detection of Abs of a specific pathogen
How do you treat myocarditis?
Tx the underlying cause
50% of pts die w/in 5 yrs
What is pericarditis?
Inflammation of the pericardium
What is the most common cause of pericarditis?
Idiopathic (>40%)
Infectious
Drugs
SLE
What happens in pericarditis?
Fibrinous pericardial exudate>
dense scar tissue w/ dystrophic calcification>
constrictive pericarditis
What are the most common clinical findings associated with pericarditis?
Precordial friction rub
Pain relieved by leaning forward and is worsened by leaning back
Pericarditis is often accompanied by…
pericardial effusion>
How does pericardial effusion affect normal heart sounds?
Effusion makes heart sounds difficult to hear
Why is neck vein distention on inspiration commonly seen in pericarditis?
Blood can’t enter RA on inspiration b/c of fluid surrounding the heart (effusion)>
blood refluxes back into the jugular vein on inspiration>
distension (kussmaul sign)
How do you diagnose myocarditis?
- Xray- shows “water bottle” configuration (if effusion present)
- Echocardiogram (pericardial effusion)
- ECG- can identify changes that occur in different phases of pericarditis
How do you treat pericarditis?
- Tx aimed at the cause
2. Pericardiocentesis is required for an effusion
What is constrictive pericarditis?
Incomplete filling of chambers d/t thickening of parietal pericardium.
What is the most common cause of constrictive pericarditis world wide?
TB
What causes constrictive pericarditis in the US?
Idiopathic
Post open heart surgery
What is a pericardial knock?
A common finding associated with constrictive pericarditis
d/t ventricles hitting the thickened parietal pericardium
What is seen on a xray of contrictive pericarditis?
Calcification of the pericardium
