Myocarditis Flashcards
What is Myocarditis?
is an inflammation of the myocardium, or heart muscle
Why is myocarditis uncommon and poorly understood inflammation of the myocardium?
because at least several weeks (in some cases, a decade) elapse between exposure to the causative agent and the development of symptoms.
What usually causes Myocarditis?
INFECTIONS
- viral
- bacterial
- protozoal
- fungal
What bacteria usually causes Myocarditis?
- Corynebacterium diphtheriae
- Staphylococcus aureus
- Lyme disease
- Chlamydia
- Mycoplasma
- Streptococcus
What viral infections usually cause Myocarditis?
- influenza
- coxsackie
- cytomegalovirus
- adenovirus
- hepatitis C
- herpes
- HIV
- parvovirus
In myocarditis what can damage the heart muscle?
- Organisms
- blood cells
- toxins
- immune substances
Other causes of Myocarditis may include?
- allergic reactions
- chemical exposure
- radiation
- inflammatory disorders (rheumatoid arthritis or sarcoidosis).
What are the inflammatory disorders that may cause Myocarditis?
- Rheumatoid arthritis
- Sarcoidosis
The result in muscle fiber dysfunction and degeneration that can impair contractility and conduction are?
(what penetrates into the myocardium)
Penetration of organisms, blood cells, toxins, and immune substances.
What are some complications of Myocarditis?
- heart failure
- cardiomyopathy
- dysrhythmias
- thrombus development
This cardiac condition occurs/affects mostly what population?
Most often effects young atheletic with age group puberty- 30 yo, males > females
The clinical manifestations of myocarditis include?
Myocarditis can also be asymptomatic
IF PRESENT
- flulike symptoms (fever, chills, myalgia)
- Pericarditis symptoms (chest pain, friction rub)
- Heart failure symptoms (dyspnea, edema, activity intolerance, or pale, cool skin)
- dyspnea
- dysrhythmia
- palpitations
- tachycardia
- heart murmurs
- chest discomfort
- cardiomegaly
- pale and cool extremities
- syncope
- decreased urine output
- joint pain/swelling
What are the classification systems to aid in the diagnosis of acute myocarditis?
- Possible subclinical acute myocarditis
- Probable acute myocarditis
- Definite myocarditis
What is a diagnosis based on in”Possible subclinical acute myocarditis”?
- without specific symptoms that can be inferred based on transient increases in troponin or EKG changes after a viral illness, adverse drug reaction, or vaccination (rarely).
What is a diagnosis based on in “Probable acute myocarditis?
the presence of one of four clinical syndromes associated with myocarditis:
- chest pain
- acute heart failure
- presyncope or syncope
- myopericarditis (myocarditis with pericarditis).
What is a diagnosis based on in “Definite myocarditis”?
confirmed by histological analysis of heart tissue.
Describe Myocarditis resembling a MI (myocardial infarction)?
Myocarditis can present with:
- Chest pain
- Reversible occlusion
When resembling a MI, Myocarditis can present with chest pain because?
The inflammation of the coronary arteries.
When resembling a MI, Myocarditis can present with “Reversible occlusion” because?
Due to vasospasm can result from an influx of inflammatory cells.
When resembling a MI, Myocarditis can present with chest pain that worsens with?
leaning backward
When resembling a MI, Myocarditis can present with chest pain that improves with?
leaning forward; this condition is classically associated with pericarditis, which often accompanies myocarditis of the outer layers of the myocardium.
What are the symptoms of pericarditis?
- chest pain
- friction rub
What are the symptoms of Heart Failure?
- dyspnea
- edema
- activity intolerance
- pale
- cool skin
How long can it take for symptoms to develop in myocarditis?
Can be weeks to decade btwn exposures and symptoms development
How is Myocarditis Diagnosed?
- history
- physical examination
- blood cultures
- EKG
- cardiac biomarkers
- CBC
- ESR
- chest X-rays
- echocardiogram
- endomyocardial biopsy
what cardiac biomarkers are used for the diagnosis of Myocarditis?
troponin and creatinine kinase
What is the GOLD standard for diagnosing Myocarditis?
- endomyocardial biopsy
risky and should only be done if absolutely necessary
What can be given in treating the causative agent (in myocarditis)?
antibiotics for bacterial infections
The treatment for Myocarditis is?
- resolve the underlying cause
- antipyretics
- anticoagulants
- antidysrhythmics
- diuretics
- immunosuppressants
- rest/activity restriction
- fluid limitation
What treatments are given in myocarditis to reduce cardiac workload?
- increasing bed rest
- restricting activity
- limiting fluids
In the treatment of myocarditis which immunosuppressants are used to treat symptoms or complications?
corticosteroids or nonsteroidal anti-inflammatory drugs
