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Year 3 - CR > Myocarditis And pericardial disease > Flashcards

Myocarditis And pericardial disease Flashcards

1
Q

define myocarditis

A
  • Acute inflammation of the myocardium
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2
Q

What are the signs and symptoms of myocarditis

A
  • asymptomatic
  • fatigue
  • palpitations
  • chest pain
  • dyspnoea
  • ## fulminant congestive cardiac failure
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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
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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
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5
Q

What would the chest X ray show in myocarditis

A
  • cardiac enlargement
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6
Q

What would the ECG show in myocarditis

A
  • ST changes
  • T wave inversion
  • Atrial arrhythmias
  • AV block
  • QT prolongation
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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
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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
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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
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10
Q

What is acute pericarditis

A
  • Inflammation of the pericardium
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11
Q

What are the two types of causes of acute pericarditis

A
  • Idiopathic

- Secondary

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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
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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
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14
Q

What does an ECG look like in acute pericarditis

A
  • Concave ST segements elevation (saddle shaped)

- PR depression

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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
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16
Q

What Is the treatment for acute pericarditis

A
  • NSAIDs or aspirin with gastric protection for 1-2 weeks
  • add colchicine 500mcg for 3 months to reduce risk of recurrence
  • rest until symptoms resolve
  • treat the cause
17
Q

What is pericardial effusion

A
  • accumulation of fluid in the pericardial sac
18
Q

What are the causes of pericardial effusion

A
  • pericarditis
  • myocardial rupture
  • aortic dissection
  • pericardium filling with pus
  • malignancy
19
Q

What are the clinical features of pericardial effusion

A
  • dyspnoea
  • chest pain
  • signs of local structures being compressed - nausea due to diaphragm,
  • bronchial breathing at left based
  • muffled heart sounds
20
Q

How do you diagnose pericardial effusion

A
  • CXR - shows enlarged heart

- ECG - low voltage QRS complex

21
Q

How do you manage pericardial effusion

A
  • Treat underlying cause

- Pericardiocentesis may be diagnostic (infection) or therapeutic (Cardiac tamponade)

22
Q

What is constrictive pericarditis

A

This is when the heart is encased in a rigid pericardium

23
Q

What are the causes of constrictive pericarditis

A
  • often unknown - elsewhere TB or after any pericarditis
24
Q

What are the clinical features of constrictive pericarditis

A
  • right heart failure with raised JVP
  • Kussmaul’s sign
  • soft diffuse apex beat
  • quiet heart sounds
  • S3
  • diastolic pericardial knock
  • hepatosplenomegaly
  • ascites
  • oedema
25
Q

What is kussmauls sign

A
  • JVP rising paradoxically with inspiration
26
Q

What investigations would you see and do for constrictive pericarditis

A
  • CXR = small heart and pericardial calcification
27
Q

How do you manage constrictive pericarditis

A

surgical excision

28
Q

What is cardiac tamponade

A
  • A pericardial effusion that raises intrapericaridal pressure reducing ventricular filling and dropping cardiac output
29
Q

What are the signs of cardiac tamponade

A
  • increase in pulse
  • decrease in blood pressure
  • pulses paradoxus
  • increase in JVP
  • kussmaul’s sing
  • muffled S1 and S2
30
Q

How can you diagnose cardiac tamponade

A
  • becks triad = falling BP, rising JVP, muffled heart sounds
  • ECG - low voltage QRS

Year 3 - CR (44 decks)

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