Myocardial and Pericardial Disorders

Question 1

What is a major cause of sudden death in adults <40?

Answer 1

Myocarditis

Question 2

What is the MCC of acute myocarditis in the US?

Answer 2

VIRUSES

Adenovirus (most common)
Group B Cox

Question 3

What are other microbial pathogenic causes of myocarditis?

Answer 3

1. Parasites (trypanosoma, trichinella, toxoplasma)
2. Bacteria (borrelia burgdorferia, mycoplasma, rickettsia rickettsia)
3. Fungi (Candida, Mucor, Aspergillus)

Question 4

What are other non-microbial causes of myocarditis?

Answer 4

1. RF
2. Toxins
3. Drugs (cocaine)
4. Systemic and collagen vascular diseases (SLE, systemic sclerosis, Kawasaki disease, radiation)
5. Sarcoidosis

Question 5

What happens in myocarditis?

Answer 5

Global ENLARGEMENT of the heart and DILATION of the champers

Question 6

What is highly predictive of a viral myocarditis?

Answer 6

Lymphocytic infiltrate w/ focal areas of necrosis

Question 7

A pt comes to you with SOB, fever, chest pain, an arrhythmia, pericardial friction rub, biventricular CHF and MV regurgitaiton. What do they have?

Answer 7

Myocarditis

Question 8

What are common lab findings of myocarditis?

Answer 8

Increased CK-MB
Increased troponin (normal value doesn’t exclude myocarditis)
Detection of Abs of a specific pathogen

Question 9

How do you treat myocarditis?

Answer 9

Tx the underlying cause

50% of pts die w/in 5 yrs

Question 10

What is pericarditis?

Answer 10

Inflammation of the pericardium

Question 11

What is the most common cause of pericarditis?

Answer 11

Idiopathic (>40%)
Infectious
Drugs
SLE

Question 12

What happens in pericarditis?

Answer 12

Fibrinous pericardial exudate>
dense scar tissue w/ dystrophic calcification>
constrictive pericarditis

Question 13

What are the most common clinical findings associated with pericarditis?

Answer 13

Precordial friction rub

Pain relieved by leaning forward and is worsened by leaning back

Question 14

Pericarditis is often accompanied by…

Answer 14

pericardial effusion>

Question 15

How does pericardial effusion affect normal heart sounds?

Answer 15

Effusion makes heart sounds difficult to hear

Question 16

Why is neck vein distention on inspiration commonly seen in pericarditis?

Answer 16

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)

Question 17

How do you diagnose myocarditis?

Answer 17

1. Xray- shows “water bottle” configuration (if effusion present)
2. Echocardiogram (pericardial effusion)
3. ECG- can identify changes that occur in different phases of pericarditis

Question 18

How do you treat pericarditis?

Answer 18

1. Tx aimed at the cause

2. Pericardiocentesis is required for an effusion

Question 19

What is constrictive pericarditis?

Answer 19

Incomplete filling of chambers d/t thickening of parietal pericardium.

Question 20

What is the most common cause of constrictive pericarditis world wide?

Answer 20

TB

Question 21

What causes constrictive pericarditis in the US?

Answer 21

Idiopathic

Post open heart surgery

Question 22

What is a pericardial knock?

Answer 22

A common finding associated with constrictive pericarditis

d/t ventricles hitting the thickened parietal pericardium

Question 23

What is seen on a xray of contrictive pericarditis?

Answer 23

Calcification of the pericardium