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Z Year3 Cardio Conditions > Myocarditis > Flashcards

Myocarditis Flashcards

1
Q

What is myocarditis?

A

inflammation of myocardium – inflammatory cardiomyopathy

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2
Q

What are the risk factors for myocarditis?

A
  1. HIV + other infections
  2. Smallpox vaccination
  3. Autoimmune/immune mediated disease
  4. Peri-partum and postnatal periods
  5. <50 years
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3
Q

What are some signs and symptoms for myocarditis?

A
  • More Acute
    1. Flu-like prodrome
    2. Chest pain (worse when lying down)
    3. SOB
    4. Palpitations
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4
Q

What are possible differential diagnosis for myocarditis?

A
  1. Acute coronary syndrome
  2. Dilate cardiomyopathy
  3. Pericarditis
  4. Stress-induced cardiomyopathy
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5
Q

What imaging should you order for myocarditis?

A
  1. 12 lead ECG
  2. CXR
  3. 2D echo
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6
Q

What would a 12 lead ECG show in myocarditis?

A
  • non-specific ST-segment and T-wave abnormalities

- ST-segment elevation and depression frequently occur

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7
Q

What could a CXR for myocarditis show?

A

bilateral pulmonary infiltrates in the setting of myocarditis-induced CHF

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8
Q

What would a 2D echo for myocarditis show?

A

global and regional left ventricular motion abnormalities and dilatation

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9
Q

What blood would you order for suspected myocarditis?

A
  1. serum ck
  2. serum ck-mb
  3. serum troponin
  4. serum B type natriuretic peptide
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10
Q

What would serum ck show in myocarditis?

A

midly elevated

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11
Q

What would serum ck-mb show in myocarditis?

A

midly elevated

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12
Q

What are some causes of myocarditis?

A
  1. Infectious
  2. Drugs (cocaine)
  3. Metals
  4. Radiation
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13
Q

What is most common cause of myocarditis?

A

Coxscakie B virus is most common cause of myocarditis in Europe

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14
Q

What are signs for myocarditis?

A
  1. Palpitations
  2. Rales
  3. Elevated neck veins
  4. S3 gallop
  5. Sinus tachycardia
  6. Atrial and ventricular arrhythmias
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15
Q

What is diagnostic for myocarditis?

A

endomyocardial biopsy: diagnostic but not routinely performed – if myocarditis treatment isn’t helping

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16
Q

What would serum troponin be like in myocarditis?

A

elevated

17
Q

What would serum B type natriuretic peptide show in myocarditis?

A

elevated in response to ventricular distention, such as occurs in CHF due to myocarditis

18
Q

What is the acute treatment of myocarditis with no evidence of left ventricular systolic dysfunction?

A

1st line: supportive care ± treatment of underlying cause – methylprednisolone

19
Q

What is the acute treatment of myocarditis with evidence of left ventricular systolic dysfunction?

A

1st line: ACE inhibitors or Angiotensin II receptor blockers
Plus: treatment of underlying cause

20
Q

What adjuncts may be used in treatment for myocarditis?

A
  1. Beta blockers
  2. oral vasodilators/nitrates
  3. diuretics
  4. aldosterone antagonists
  5. long-term anticoagulation therapy
21
Q

What is the treatment of myocarditis in haemodynamically unstable patient?

A

1st line: IV arterial vasodilator + invasive haemodyanmic monitoring e.g. nitroprusside
Plus: treatment of underlying cause

22
Q

What adjunct is used in haemodynimcially unstable patients with myocarditis?

A

Adjunct:

  • IV glyceryl trinitrate
  • IV inotropes or vasopressors e.g. dobutamine
23
Q

How do you treat refractory cardiogenic shock in myocarditis?

A

Refractory cardiogenic shock: adult patients
Plus: intra-aortic ballow pump
Adjunct: left ventricular assist device

24
Q

What is 1st and 2nd line for ongoing myocarditis (end stage heart failure or refractory life-threatening arrhythmias)?

A

1st line: heart transplantation + existing heart failure medication
2nd line: destination left ventricular assist device therapy + anticoagulation + existing heart failure therapy e.g. warfarin

25
Q

What criteria is used for myocarditis?

A

Dallas

26
Q

What are possible complications of myocarditis?

A
  1. Atrial fibrillation
  2. Ventricular tachyarrhythmias
  3. Dilated cardiomyopathy
  4. Sudden cardiac death
  5. Multisystem organ failure

Z Year3 Cardio Conditions (22 decks)

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