myocardial and pericardial dz Flashcards
inflammation of heart muscle resulting in myocardial necrosis and degeneration
myocarditis
variable clinical presentation including
- viral prodrome
- acute chest pain 1-4wks after viral or GI infection
- subacute HF sx onset
- cardiogenic shock
- abnormal vital signs
myocarditis
has positive inflammatory markers, cardiac biomarkers and biopsy
myocarditis
- Echo: normal to mildly reduced LV fxn to severe ventricular dysfxn
- MRI– ventricular dysfunction and signs of inflammation
myocarditis findings
biopsy shows evidence of myocardial tissue necrosis and increased inflammatory cellular infiltrates
myocarditis biopsy findings
when do you do biopsy with myocarditis?
severe or refractory cases after other causes hae been excluded
3 tx of myocarditis
- rest & tx signs of HF
- avoid NSAIDs, alcohol, exercise, digoxin
- routine f/u
name the condition
normal systolic function + diastolic dysfunction in non-dilated, rigid ventricle which impedes ventricular filling (reduced extent & rate)
restrictive cardiomyopathy
3 most common causes of restrictive cardiomyopathy
- Amyloidosis
- sarcoidosis
- hemochromatosis
all are infiltrative causes
3 most common causes of restrictive cardiomyopathy
- Amyloidosis
- sarcoidosis
- hemochromatosis
all are infiltrative causes
this describes the pathophys of what condition
stiff myocardium leads to decreased compliance, increased effort to fill ventricles cause elevated ventricular filling pressures & atria dilation
RCMP pathophysiology
can cause sx of L or RHF and nonspecific sx like palpitations, fatigue, malaise, weakness, anorexia, nausea, nocturia
RCMP
most common sx of both RCMP & HCM is
dyspnea
cardiomyopathy with kissmaul sign
RCMP
describe kussmaul sign
increased JVP with inspiration
normal is decreased
ventricular and atria finding on ECHO in RCM vs HCM
- RCM– normal ventricle thickness + bilateral atrial dilation
- HCM– asymmetric wall thickness
has no specific treatment but heart transplant is the only definitive treatment; can also treat the underlying d/o
RCMP tx
what can you do to identigy or r/o specific causes of RCMP
endomyocardial biopsy
differentiate RCM from constrictive pericarditis
- RCM: S3, high BNP, biatrial enlargement
- CP: pericardial knock, calcifications/thickining, low BNP
autosomal dominant; inappropriate LVH or RVH resulting in left ventricular outflow obstruction, diastolic dysfunction d/t hypercontractile ventricles and myocardial ischemia
HCM
what is this called
left ventricular outflow tract (LVOT) obstructed d/t asymmetrical septal hypertrophy and systolic anterior motion (SAM) of the mitral valve
subaortic outflow obstruction
what worsens subaortic outflow obstruction (2)
- increased contractility (exercise, digoxin)
- decreased LV volume (dehydration, maneuvers)
most are asymptomatic but the ones w/ sx are dyspnea on exertion, palpiations, chest pain, exertional syncope
HCM sx
2 tx of HCM
- reduce outflow gradient w/ BB, non-DHP CCBs, disopyramide
- ICD placement for secondary prevention of sudden death in hx of Vfib or sustained VT, syncope or holter monitor events
4 things ppl w/ HCM should avoid
- dehydration
- exertion & strenous exercise
- digoxin
- vasodilators, diuretics, ACE/ARB, nitrates
inflammation of the pericardium
pericarditis
dresslers syndrome
post MI pericarditis + fever
5 (technically 4) Ps of pericarditis
- Pleuritic pain (sharp pain worse w/ inspiration)
- Postural (worse supine)
- Persistent chest Pain
- Pericardial friction rub
- diffuse ST elevations (concave up) + PR depressions in precordial leads
- ST depression & PR elevation in avR
pericarditis ECG findings
normal echo but still done to r/o effusion and look for associated myocarditis
ECHO findings in pericarditis
1st, 2nd, 3rd line tx of pericarditis
- NSAIDs or aspirin
- colchicine
- steroids if refractory (sx >48hrs)
loss of ventricular elasticity (fibrosis, calcification) leading to restriction of diastolic filling; caused by acute pericarditis and chronic inflammation
constrictive pericarditis
these are symptoms of?
- dyspnea is main sx
- R sided heart failure sx
- Pericardial knock
constrictive pericarditis
what is high pitched 3rd heart sound from sudden cessation of ventricular filling & what condition is it associated with
pericardial knock
associated with constrictive pericarditis
which two pericardial diseases have both pulsus paradoxus and kussmauls sign
- pericardial tamponade
- constrictive pericarditis
which pericardial dz would show diastolic collapse of cardiac chambers, hemodynamic compromise on an echo?
pericardial tamponade
which pericardial dz would show pericardial thickening and calcification on an echo?
constrictive pericarditis
which surgical procedure is done to definitively treat constrictive pericarditis?
pericardiectomy
which procedure is done to treat pericardial tamponade?
pericardiocentesis
name the condition
increased fluid in the pericardial space
pericardial effusion
t/f, pericardial effusion shares the same etiologies as acute pericarditis
true
sx of pericarditis + distant/muffled heart sounds is associated with which two pericardial dz?
pericardial effusion
pericardial tamponade
these diagnostic test results is associated with which condition
- ECG: low QRS complex, electrical alternans
- Echo: increased pericardial fluid with NO hemodynamic compromise
pericardial effusion
name the condition
pericardial effusion causing pressure on heart which limits ventricular diastolic filling
pericardial tamponade
sx include: becks triad, pulsus paradoxus, kussmauls sign
pericardial tamponade
name the phenomenon
pulses disappear or SBP drops more than 10 w/ inspiration
pulsus paradoxus
what is becks traid (list the 3 things)
- distant heart sounds
- increased JVP
- systemic HYPOtension
definitive management for recurrent pericardial tamponade is ___
pericardial window
name the condition
systolic dysfunction causing ventricular dilation; decreased LVEF < 40%
dilated cardiomyopathy
* mostly in 20-60 yo males
can be caused by infectious, infiltrative dz, pregnancy, alcohol abuse, etc but the most common cause is idiopathic; makes up majority of all cardiomyopathies
dilated cardiomyopathy
which cardiomyopathy has these clinical findings
- S3 gallop
- lateral PMI displacement
- other heart failure signs
dilated cardiomyopathy
which cardiomyopathy fits this finding
- Echo: LV dilation, reduced EF, LV hypokineses
- CXR shows cardiomegaly, pulmonary edema
dilated cardiomyopathy
T or F: you treat dilated cardiomyopathy the same way you treat HFrEF
true
