Myocarditis And pericardial disease Flashcards
1
Q
define myocarditis
A
- Acute inflammation of the myocardium
2
Q
What are the signs and symptoms of myocarditis
A
- asymptomatic
- fatigue
- palpitations
- chest pain
- dyspnoea
- ## fulminant congestive cardiac failure
3
Q
What are the causes of myocarditis
A
- idiopathic
Infective
- viral = coxsackievirus, adenovirus, CMV, echovirus, influenza
- parasitic - trypansoma cruzi , toxoplasma gondii
- bacterial - streptococcus, diphtheria
- fungal
Toxic
- drugs - methyldopa, penicillin, sulphonamides
- radiation
Autoimmune
- an autoimmune form with auto activated T cells and organ specific antibodies may occur
- Giant cell myocarditis
- alcohol
- hydrocarbons
4
Q
What investigations do you use to diagnose myocarditis
A
- Chest X ray
- ECG
- cardiac enzymes (elevated)
- viral antibody titres
- endomyocardial biopsy
- viral RNA
5
Q
What would the chest X ray show in myocarditis
A
- cardiac enlargement
6
Q
What would the ECG show in myocarditis
A
- ST changes
- T wave inversion
- Atrial arrhythmias
- AV block
- QT prolongation
7
Q
How do you manage myocarditis
A
- bed rest in the acute phase
- avoid athletic activities for 6 months
- heart failure treated with diuretics, ACE inhibits, beta blockers or spironolactone
- antibiotics should be administered immediately
- NSAIDS are contraindicated in the acute phase but can be used in the late phase
- administration of high dose IV immunoglobulin
8
Q
What is Giant cell myocarditis
A
- severe form of myocarditis characterised by the presence of multinucleate Giant cells within the myocardium
- associated with sarcoidosis, thymomas and autoimmune disease
9
Q
What is Chagas disease
A
- caused by the protozoan trypanosome cruzi and is endemic in South America where upwards of 20 million people are infected
- features of myocarditis are present with fever and congestive heart failure
- progression to a dilated cardiomyopathy with a propensity towards heart block and ventricular arrhythmias
10
Q
What is acute pericarditis
A
- Inflammation of the pericardium
11
Q
What are the two types of causes of acute pericarditis
A
- Idiopathic
- Secondary
12
Q
What are the secondary causes of acute pericarditis
A
- Viruses - such as coxsackie, echovirus, EBV, CMV, adenovirus
- bacteria - such as TB, Lyme disease, Q fever, pneumonia, rheumatic fever
- fungi and parasite - usually in immunocompromised
- autoimmune
- drugs - hydralazine, penicillin, isoniazid, chemotherapy
- metabolic
- trauma, surgery, malignancy
13
Q
What are the symptoms of acute pericarditis
A
- chest pain worse on inspiration or lying flat
- chest pain relieved by sitting forward
- pericardial friction rub may be heard
- fever can occur
14
Q
What does an ECG look like in acute pericarditis
A
- Concave ST segements elevation (saddle shaped)
- PR depression
15
Q
What investigations can you carry out for acute pericarditis
A
- ECG
- blood tests - FBC, ESR, U&E, Cardiac enzymes
- CXR - cardiomegaly
- echo - if suspected pericardial effusion