Myocarditis, Pericardits, Effusions & Tamponade, Constrictve Pericarditis (pathology) Flashcards
What is myocarditis?
Acute or chronic inflammation of myocardium (can be with pericarditis) Impairs: - Myocardial function - Conduction-> arrhythmias Generally VIRAL
Inflammatory infiltrates in myocardium
- Reduced heart function= HF
- Heart block + arrhythmias
What are the symptoms of myocarditis?
- HF like symptoms
- Fatigue
- SOB
- May not have fever
What are the investigations of myocarditis?
ECG: - Usually, abnormal Elevated biomarkers but not consistent with MI Echo: - Can get Right wall motion artifacts CMRI – gold standard Viral DNA PCR Autoantibodies Strep antibodies B burgdorferi Lyme’s disease HIV
What are the treatment/management strategies for myocarditis?
- Supportive management for HF and arrhythmias
- Immunotherapy if specific cause
- Stop possible drugs/toxic agent exposure
- Recovery if responsive to immunosuppressive therapy
What is pericarditis?
Inflammation of pericardial layers with/without myocardial involvement
- Mostly viral or idiopathic
- Bacterial
- Post MI – Dressler’s syndrome
- Perforation
- Dissection of proximal aorta
- Neoplasia
What are the symptoms of pericarditis?
- Pleuritic chest pain (sitting forward improves it, worse if lying back)
- Fever if infective
What are the signs of pericarditis?
- Pyrexia
- Pericardial rub on left sternal edge
- ↑JVP
- Low BP
If muffled heart sounds+ ↑JVP= effusion/tamponade
What are the investigations of pericarditis?
ECG - PR depression - ST segment elevation Echo ↑ troponin if myocardial involvement (post MI)
What are the treatments/management for viral, idiopathic, bacterial pericarditis?
Viral
- Symptom management
Idiopathic
-colchicine and limited use of NSAIDs
Bacterial
- Drain effusion and antibiotics even if small effusion
Regardless of cause, large effusion+ haemodynamic effect-> DRAIN
What is an effusion? What is a tamponade?
Effusion= fluid accumulation overtime Tamponade= sudden fluid accumulation
What are the symptoms of effusion and tamponade?
- Fatigue
- SOB
- Dizzy with low BP
- Chest pain
What are the signs of effusion and tamponade?
- Pulsus paradoxus*
- ↑ JVP
- Low BP
- +/- rub
- +/- muffled Heart sounds
- On inspiration, the radial pulse may not be palpated but a heartbeat may still be heard on auscultation, hence the paradox. The term “pulsus paradoxus” refers to a significant fall in systolic blood pressure during inspiration.
What are the investigations for effusion and tamponade?
Echo – FIRST LINE
CXR- large cardiac shadow
Test effusion- most are exudates
ECG- V5 alternates between large and small QRS
What is the treatment for effusion and tamponade?
Drainage
Persistent effusion-> surgical pericardial window made to allow flow in abdomen
What is constrictive pericarditis?
Impaired filling although myocardium is normal
