myocarditis and pericardits Flashcards
generalized inflammation of the myocardium associated with necrosis and degeneration of myocytes
myocarditis
ischemic heart disease in myocarditis
nope
myocarditis:
- age
- incidence
- clinical presentation
- etiology
- occur at any age
- difficult to establish many are asymptomatic
- 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
- infections, immune-related or unknown
myocarditis clinical classification (3)
- acute myocarditis- self-limited
- acute, chronic active myocarditis
- fulminant
acute myocardits, self-limited
- specific organism found in 60% of the cases
- Cox B virus
- excellent prognosis
acute, chronic active myocarditis
- recent onset of HF
2. significant progression to cardiomyopathy
fulminant
- uncommon
- excellent response to immunosupresive drugs
- presumed viral
myocarditis infectious etiology
- viral
- rickettial
- bacterial
- chamydiae
- fungi
- parasites
- viral- Cox A and B, rubella, echovirus, influenza
- rickettial- typhus, rocky mountain spotted fever
- bacterial- staphylococcal, diptheria, strept, mening, borrelia (lyme)
- chamydiae- C.psittaci
- fungi- toxoplasmosis, aspergillosis, cryptococcal, candida
- parasites- chagas, echinococcus
myocarditis etiology immune related
- post-viral
- rheum. fever
- lupus
- drug hypersensitivity
- Heart transplant rejection
myocarditis etiology of unknown cause
- sarcoidosis
2. Giant cell arteritis
viral myocarditis:
- most cases of myocarditis in the US are viral due to (2)
- patients have a history of upper respiratory tract viral infection with a positive
- viruses can cause myocardial injury as a direct ________ or by a destructive _______
- recovery
- unusually severe in
- histopathology
- if there is extensive necrosis expect to see
- Cox A and B and adenovirus
- positive PCR
- a direct cytopathic effect or by a destructive host immune response
- most patients recover but a few dies of CHF or arrhythmias
- it can be unusually severe in pregnant women and children
- histopathology shows a patchy or diffuse interstitial infiltrate of T lymphocytes, macrophages and rare giant cells with focal myocyte necrosis
- extensive necrosis expect to see many PMNs followed by chronic inflammation and repair may be found
myocarditis in AIDS
- evidence of Cardiac dx.
- presentation
- what is present in addition
- symptomatic or asymptomatic
- 50% have cardiac dx.
- present with pericardial effusions, myocarditis, endocarditis or cardiomyopathy
- opportunistic infections or infection of the heart
- only a small percentage of pt. with AIDS related HD are symptomatic
epicardial surface of the heart is smooth and glistening but there are small scattered pinpoint yellowish micro abscesses due to an
infectious myocarditis
Chagas disease
- infection caused by
- incidence
- epidemiology
- myocardial involvement %
- insect- Trypanosoma
- 8 million in Latin America
- kissing bug transmits the fusiform hemoflagellate to wild and domesticated animals and humans
- myocardial involvement 10-40%
Chagas transmission
- by blood-feeding
- through transfusion with infected blood
- congenitally, from infected mother to fetus
acute stage of myocarditis
- 1-2 weeks of incubation, chagoma develops with fevers and swollen lymph nodes
- in 2-3 weeks parasitemia appears with multiorgan involvement
- myocardium is filled with thousands of parasite- filled pseudocytes, dense inflammation, and myocyte necrosis
chronic chagas
- 32% will have fatal damage to the heart and digestive tract
- cardiac dilatation, prominent ventricular outflow tract with dilatation of valve rings
- interstitial fibrosis with hypertrophies myofibers, chronic inflamation, mural thrombosis formation with embolization and apocal aneurysmal thinning
what are the 2 drugs that can be used for the early chronic phases of Chagas
nifurtimox and benznidazole
prevntion and control of chagas: (4)
- tx. with residual inseticides
- blood screening to prevent transmission through transfusion
- drug treatment for acute early indeterminate and congenital cases
- house improvement
giant cell myocarditis:
- disease is (2)
- etiology
- age
- treatment
- gross heart
- rare disease that is usually rapid and fatal
- unknown cause seen in SLE, hyperthyroidism and thymoma
- young to middle age pt.
- no effective treatment available
- heart is flabby and dilated
isolated pericardial disease is common or uncommon
very uncommon
most pericardial lesions are seen in association with diseases found in
other areas of the heart, surrounding structures or secondary to systemic diseases
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
pericardial effusions
accumulation of blood in the pericardial sac due to rupture of a heart wall by either MI, trauma, tumor infiltration or aortic rupture
hemopericardium
hemopericardium can lead to _____ and it associated with these symptoms:
lead to cardiac tamponade with rapid accumlation of blood and cardiovascular collapse symptoms include tachy, anxiety, SOB, distant hearts sounds and narrow pulse pressure
inflammation of the visceral or parietal pericardium with the formation of pericardial effusions most are due to acute rxn., chronic less common
pericarditis
etiology of pericarditis:
- infectious agents
- immunologically mediated
- miscellaneous
- infectious agents: viruses, bacteria, TB, fungi, parasites
- immuno: Rheum. fever, collagen dx., postcardiotomy, post MI
- miscellaneous- uremia, neoplasia, trauma, radiation
acute pericarditis:
- cause
- classification (5)
- viral infections
2. (i) serous (ii) fibrinous and serofibrinous (iii) purulent or suppurative (iv) hemorrhagc (v) caseous
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
serous pericarditis
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
fibrinous pericarditis
fibrinous pericarditis
- frequent or rare?
- what do we hear?
- most frequent type of pericarditis
2. loud pericardial friction rub
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
purulent pericarditis
a bloody and fibrinous exudate is present, usually secondary to alignant neoplastic involvement, TB and bleeding diathesis
hemorrhagic pericarditis
pericardial involvement by direct spread form a tuberculous foci within the tracheobroncial lymph nodes
caseous pericarditis
chronic fibrosing disease of the pericardium
constrictive pericarditis
constrictive pericarditis:
- gross heart
- usually begins with an
- progression
- what is the result
- etiology
- fibrotic, thickened, and adherent pericardium restricts diastolic filling of the heart
- begins with an episode of acute pericarditis
- 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
- uniform restriction of the filling of all heart chambers
- idiopathic, TB in 15% of the cases
myocardium is scarred, thickened with narrowed venae cava, a small, quiet heart with restricted venous inflow and low diastolic volume
constrictive pericarditis
found deep in the pericardial surface, may involve the pericardium, endocardium, and aorta
rheumatoid nodules
rheumatoid heart disease can lead to _______ in about 20%
fibrinous pericarditis
