Myocarditis And pericardial disease Flashcards
define myocarditis
- Acute inflammation of the myocardium
What are the signs and symptoms of myocarditis
- asymptomatic
- fatigue
- palpitations
- chest pain
- dyspnoea
- ## fulminant congestive cardiac failure
What are the causes of myocarditis
- 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
What investigations do you use to diagnose myocarditis
- Chest X ray
- ECG
- cardiac enzymes (elevated)
- viral antibody titres
- endomyocardial biopsy
- viral RNA
What would the chest X ray show in myocarditis
- cardiac enlargement
What would the ECG show in myocarditis
- ST changes
- T wave inversion
- Atrial arrhythmias
- AV block
- QT prolongation
How do you manage myocarditis
- 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
What is Giant cell myocarditis
- severe form of myocarditis characterised by the presence of multinucleate Giant cells within the myocardium
- associated with sarcoidosis, thymomas and autoimmune disease
What is Chagas disease
- 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
What is acute pericarditis
- Inflammation of the pericardium
What are the two types of causes of acute pericarditis
- Idiopathic
- Secondary
What are the secondary causes of acute pericarditis
- 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
What are the symptoms of acute pericarditis
- chest pain worse on inspiration or lying flat
- chest pain relieved by sitting forward
- pericardial friction rub may be heard
- fever can occur
What does an ECG look like in acute pericarditis
- Concave ST segements elevation (saddle shaped)
- PR depression
What investigations can you carry out for acute pericarditis
- ECG
- blood tests - FBC, ESR, U&E, Cardiac enzymes
- CXR - cardiomegaly
- echo - if suspected pericardial effusion
What Is the treatment for acute pericarditis
- 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
What is pericardial effusion
- accumulation of fluid in the pericardial sac
What are the causes of pericardial effusion
- pericarditis
- myocardial rupture
- aortic dissection
- pericardium filling with pus
- malignancy
What are the clinical features of pericardial effusion
- dyspnoea
- chest pain
- signs of local structures being compressed - nausea due to diaphragm,
- bronchial breathing at left based
- muffled heart sounds
How do you diagnose pericardial effusion
- CXR - shows enlarged heart
- ECG - low voltage QRS complex
How do you manage pericardial effusion
- Treat underlying cause
- Pericardiocentesis may be diagnostic (infection) or therapeutic (Cardiac tamponade)
What is constrictive pericarditis
This is when the heart is encased in a rigid pericardium
What are the causes of constrictive pericarditis
- often unknown - elsewhere TB or after any pericarditis
What are the clinical features of constrictive pericarditis
- right heart failure with raised JVP
- Kussmaul’s sign
- soft diffuse apex beat
- quiet heart sounds
- S3
- diastolic pericardial knock
- hepatosplenomegaly
- ascites
- oedema
What is kussmauls sign
- JVP rising paradoxically with inspiration
What investigations would you see and do for constrictive pericarditis
- CXR = small heart and pericardial calcification
How do you manage constrictive pericarditis
surgical excision
What is cardiac tamponade
- A pericardial effusion that raises intrapericaridal pressure reducing ventricular filling and dropping cardiac output
What are the signs of cardiac tamponade
- increase in pulse
- decrease in blood pressure
- pulses paradoxus
- increase in JVP
- kussmaul’s sing
- muffled S1 and S2
How can you diagnose cardiac tamponade
- becks triad = falling BP, rising JVP, muffled heart sounds
- ECG - low voltage QRS
