Myocarditis and Pericarditis Flashcards
What is myocarditis?
Inflammation of the myocardium
What is the most common cause of myocarditis?
in general, viral infections; specifically coxsackievirus
What are causes of myocarditis?
Infectious:
-coxsackievirus (most common)
- HIV
- Borrelia (Lyme disease)
- T. cruzi (Chagas disease)
Immune-mediated:
- rheumatic fever
- SLE
- drug-induced
What drugs are associated with myocarditis?
- sulfonamides
- doxorubicin/daunorubicin (chemotherapeutics)
- methyldopa
What is the clinical presentaiton of myocarditis?
often asymptomatic and preceeded by flu-like illness
variable symptomatic presentation:
- CHF
- CP (mimicing MI)
- palpitations
- syncope
What are complications of myocarditis?
- arrhythmia
- sudden cardiac death
- AV block
- dilated cardiomyopathy
What developmental form of T. cruzi is found in the heart?
amastigotes
What are the histologic types of myocarditis?
What are the causes of each?
Lymphocytic:
- lymphocytic infiltrate
- viral, autoimmune, and idiopathic myocarditis
Eosinophilic:
- eosinophil infiltrate
- drug reaction and parasitic
What is idiopathic giant cell myocarditis?
an aggressive myocarditis characterized by pressence of giant cells
-poor prognosis, typically less than 3 mo
What is myocardial sarcoidosis?
myocarditis characterized by non-necrotizing granulomas
What is a pericardial effusion?
accumulation of fluid in the pericardial space
What is the normal fluid found in the pericardial space?
What fluids may be found in pericardial effusion?
Normal:
-thin, clear, straw-colored
Effusion:
- serous
- blood (hemopericardium)
- pus (purulent pericarditis)
What are causes of pericardial effusion?
Serous:
- idiopathic
- viral pericarditis
- autoimmune
Purulent:
-bacterial pericarditits
Hemopericardium:
- cardiac wall rupture
- aortic dissection
- trauma
What is cardiac tamponade?
pericardial effusion resulting in enough pressure to compress the heart and restrict heart function
-typically either from rapid accumulation of fluid (may require less fluid) or gradual accumulation of a large amount of fluid
How does pericardial effusion present?
typically asymptomatic
may present with:
- CP
- orthopnea
How does cardiac tamponade present?
Beck triad:
- hypotension
- distended neck veins
- muffled heart sounds
additional:
- tachycardia
- pulsus paradoxus (decrease in pulse pressure >10mmHg during inspiration)
- heart failure (biventricular)
- shock
What is pericarditis?
inflammation of the pericardium
How does acute pericarditis present?
Presentation:
- pleuritic chest pain; positionally dependent (improves with sitting and leaning forward)
- fever
Exam:
-pericardial friction rub
What EKG changes can be seen with pericarditis?
- ST elevation (concave)
- PR depression
What are the types of pericarditis?
(most common?)
- serous
- fibrinous/serofibrinous (most common)
- purulent
- caseous
- hemorrhagic
- constrictive
What is serous pericarditis?
(cause)
pericarditis resulting in an isolated serous exudate
-lymphocytic inflammatory infiltrate
may be associated with viruses and noninfectious inflammatory conditions however both are more likely to produce serofibrinous exudate
What is fibrinous/serofibrinous pericarditis?
(cause)
pericarditis resulting in mixed serous and fibrinous exudate
-most common
-inflammatory infiltrate (lymphocytic?)
causes:
- MI
- Dressler’s syndrome (post-MI autoimmune condition)
- uremia
What is purulent pericarditis?
(cause)
pericarditis resulting in fibropurulent exudate
-neutrophilic infiltrate, with possible bacteria
Causes:
-bacterial infection (surrounding tissues, bacteremia, or post-surgical_
What is caseous pericarditis?
(cause)
pericarditis resulting in caseous exudate
-necrotizing granuloma
cause:
- tuberculosis
- occasionally fungal
What is hemorrhagic pericarditis?
(cause)
pericarditis resulting in mixed blood and fibrinous exudate
Cause:
- pericardial metastasis (breast, lung, and esophageal)
- trauma/surgery
- bacterial
How does chronic pericarditis present?
as fluid overload and reduced cardiac output
- JVD (w/ Kussmaul sign, increased distention with inspiration)
- peripheral edema
- hepatomegaly/ascites
- dyspnea
- tachycardia
- pulsus paradoxus
What is constrictive pericarditits?
chronic pericarditis resulting in a rigid, fibrinous pericardium that restricts cardiac function
-mimics restrictive cardiomyopathy
Cause:
-secondary to acute pericariditis
