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myocarditis and pericardits Flashcards

1
Q

generalized inflammation of the myocardium associated with necrosis and degeneration of myocytes

A

myocarditis

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2
Q

ischemic heart disease in myocarditis

A

nope

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3
Q

myocarditis:

  1. age
  2. incidence
  3. clinical presentation
  4. etiology
A
  1. occur at any age
  2. difficult to establish many are asymptomatic
  3. depend on cause and severity but common symptoms are chest pains, arrhytmia, SOB, fluid retention, fatigue but we can also see symptoms associated with a viral infection
  4. infections, immune-related or unknown
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4
Q

myocarditis clinical classification (3)

A
  1. acute myocarditis- self-limited
  2. acute, chronic active myocarditis
  3. fulminant
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5
Q

acute myocardits, self-limited

A
  1. specific organism found in 60% of the cases
  2. Cox B virus
  3. excellent prognosis
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6
Q

acute, chronic active myocarditis

A
  1. recent onset of HF

2. significant progression to cardiomyopathy

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7
Q

fulminant

A
  1. uncommon
  2. excellent response to immunosupresive drugs
  3. presumed viral
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8
Q

myocarditis infectious etiology

  1. viral
  2. rickettial
  3. bacterial
  4. chamydiae
  5. fungi
  6. parasites
A
  1. viral- Cox A and B, rubella, echovirus, influenza
  2. rickettial- typhus, rocky mountain spotted fever
  3. bacterial- staphylococcal, diptheria, strept, mening, borrelia (lyme)
  4. chamydiae- C.psittaci
  5. fungi- toxoplasmosis, aspergillosis, cryptococcal, candida
  6. parasites- chagas, echinococcus
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9
Q

myocarditis etiology immune related

A
  1. post-viral
  2. rheum. fever
  3. lupus
  4. drug hypersensitivity
  5. Heart transplant rejection
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10
Q

myocarditis etiology of unknown cause

A
  1. sarcoidosis

2. Giant cell arteritis

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11
Q

viral myocarditis:

  1. most cases of myocarditis in the US are viral due to (2)
  2. patients have a history of upper respiratory tract viral infection with a positive
  3. viruses can cause myocardial injury as a direct ________ or by a destructive _______
  4. recovery
  5. unusually severe in
  6. histopathology
  7. if there is extensive necrosis expect to see
A
  1. Cox A and B and adenovirus
  2. positive PCR
  3. a direct cytopathic effect or by a destructive host immune response
  4. most patients recover but a few dies of CHF or arrhythmias
  5. it can be unusually severe in pregnant women and children
  6. histopathology shows a patchy or diffuse interstitial infiltrate of T lymphocytes, macrophages and rare giant cells with focal myocyte necrosis
  7. extensive necrosis expect to see many PMNs followed by chronic inflammation and repair may be found
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12
Q

myocarditis in AIDS

  1. evidence of Cardiac dx.
  2. presentation
  3. what is present in addition
  4. symptomatic or asymptomatic
A
  1. 50% have cardiac dx.
  2. present with pericardial effusions, myocarditis, endocarditis or cardiomyopathy
  3. opportunistic infections or infection of the heart
  4. only a small percentage of pt. with AIDS related HD are symptomatic
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13
Q

epicardial surface of the heart is smooth and glistening but there are small scattered pinpoint yellowish micro abscesses due to an

A

infectious myocarditis

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14
Q

Chagas disease

  1. infection caused by
  2. incidence
  3. epidemiology
  4. myocardial involvement %
A
  1. insect- Trypanosoma
  2. 8 million in Latin America
  3. kissing bug transmits the fusiform hemoflagellate to wild and domesticated animals and humans
  4. myocardial involvement 10-40%
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15
Q

Chagas transmission

A
  1. by blood-feeding
  2. through transfusion with infected blood
  3. congenitally, from infected mother to fetus
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16
Q

acute stage of myocarditis

A
  1. 1-2 weeks of incubation, chagoma develops with fevers and swollen lymph nodes
  2. in 2-3 weeks parasitemia appears with multiorgan involvement
  3. myocardium is filled with thousands of parasite- filled pseudocytes, dense inflammation, and myocyte necrosis
17
Q

chronic chagas

A
  1. 32% will have fatal damage to the heart and digestive tract
  2. cardiac dilatation, prominent ventricular outflow tract with dilatation of valve rings
  3. interstitial fibrosis with hypertrophies myofibers, chronic inflamation, mural thrombosis formation with embolization and apocal aneurysmal thinning
18
Q

what are the 2 drugs that can be used for the early chronic phases of Chagas

A

nifurtimox and benznidazole

19
Q

prevntion and control of chagas: (4)

A
  1. tx. with residual inseticides
  2. blood screening to prevent transmission through transfusion
  3. drug treatment for acute early indeterminate and congenital cases
  4. house improvement
20
Q

giant cell myocarditis:

  1. disease is (2)
  2. etiology
  3. age
  4. treatment
  5. gross heart
A
  1. rare disease that is usually rapid and fatal
  2. unknown cause seen in SLE, hyperthyroidism and thymoma
  3. young to middle age pt.
  4. no effective treatment available
  5. heart is flabby and dilated
21
Q

isolated pericardial disease is common or uncommon

A

very uncommon

22
Q

most pericardial lesions are seen in association with diseases found in

A

other areas of the heart, surrounding structures or secondary to systemic diseases

23
Q

accumulation of excess fluid transudate or exudate within the pericardial cavity thus producing friction between the visceral and parietal layers during contraction and compresses the heart

A

pericardial effusions

24
Q

accumulation of blood in the pericardial sac due to rupture of a heart wall by either MI, trauma, tumor infiltration or aortic rupture

A

hemopericardium

25
Q

hemopericardium can lead to _____ and it associated with these symptoms:

A

lead to cardiac tamponade with rapid accumlation of blood and cardiovascular collapse symptoms include tachy, anxiety, SOB, distant hearts sounds and narrow pulse pressure

26
Q

inflammation of the visceral or parietal pericardium with the formation of pericardial effusions most are due to acute rxn., chronic less common

A

pericarditis

27
Q

etiology of pericarditis:

  1. infectious agents
  2. immunologically mediated
  3. miscellaneous
A
  1. infectious agents: viruses, bacteria, TB, fungi, parasites
  2. immuno: Rheum. fever, collagen dx., postcardiotomy, post MI
  3. miscellaneous- uremia, neoplasia, trauma, radiation
28
Q

acute pericarditis:

  1. cause
  2. classification (5)
A
  1. viral infections

2. (i) serous (ii) fibrinous and serofibrinous (iii) purulent or suppurative (iv) hemorrhagc (v) caseous

29
Q

inflammatory reaction of the epicardial and pericardial surfaces with scant inflammatory cells and slow accumulation of fluid

  • susually non-infectious causes, Rheum. fever, SLE, scleroderma, tumors , uremia
A

serous pericarditis

30
Q

inflammatory reaction of the epicardial and pericardial surfaces in the form of an exudate with ot w/out resolution

  • MI, post MI, uremia, chest radiation, Rheum. fever, SLE, trauma
A

fibrinous pericarditis

31
Q

fibrinous pericarditis

  1. frequent or rare?
  2. what do we hear?
A
  1. most frequent type of pericarditis

2. loud pericardial friction rub

32
Q

inflammatory rxn. in the form of an exudate usually secondary to microorganisms in the pericardial space by direct extension, blood or lymphatics

  • usually no resolution with organzation
  • friction rub
A

purulent pericarditis

33
Q

a bloody and fibrinous exudate is present, usually secondary to alignant neoplastic involvement, TB and bleeding diathesis

A

hemorrhagic pericarditis

34
Q

pericardial involvement by direct spread form a tuberculous foci within the tracheobroncial lymph nodes

A

caseous pericarditis

35
Q

chronic fibrosing disease of the pericardium

A

constrictive pericarditis

36
Q

constrictive pericarditis:

  1. gross heart
  2. usually begins with an
  3. progression
  4. what is the result
  5. etiology
A
  1. fibrotic, thickened, and adherent pericardium restricts diastolic filling of the heart
  2. begins with an episode of acute pericarditis
  3. progression: (a) progresses slowly to a subacute stage of organization and resorption of effusion (b) leading to fibrous scarring and thickening of the pericardium with obliteration of the pericardial space
  4. uniform restriction of the filling of all heart chambers
  5. idiopathic, TB in 15% of the cases
37
Q

myocardium is scarred, thickened with narrowed venae cava, a small, quiet heart with restricted venous inflow and low diastolic volume

A

constrictive pericarditis

38
Q

found deep in the pericardial surface, may involve the pericardium, endocardium, and aorta

A

rheumatoid nodules

39
Q

rheumatoid heart disease can lead to _______ in about 20%

A

fibrinous pericarditis

Cardio (26 decks)

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