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NU734 Acute Care I > Nu 735 Myocarditis and Pericarditis > Flashcards

Nu 735 Myocarditis and Pericarditis Flashcards

1
Q

****Acute Myocarditis : Fulminant Myocarditis

Miocardium muscular layer of heart also know as rebdo myocetes
Arrange in spide shape

A

Pathophysiology
Direct injury and invasio to myocardium
* Production of cardiotoxic substances
* Chronic inflammation w/wo infectio

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2
Q

Acute Myocarditis
Mode of Transportation

A
  • Organ Receptor specific > Coxsackie- adenovirus receptor on heart
  • Respitory > Viral > Organ receptor specific > Coxsackie- adenovirus receptor on heart.
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3
Q

Acute Myocarditis

Primary vs Secondary

A

a. **Primary Cause **

  • Acute viral infection
  • Post Viral Immune Response
  • Protozoan TRypanosoma Cruzi
  • Fulminant Myocaditis ( form acute myocarditis)

b. Secondary Cause
Non-invesive Inflammatory Response
Medicatiosn
Chemical Agents
Inflammatory Disease (loopus)

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4
Q

Acute Myocarditis

Clinica Manifestions

A

a. Young to middle age adults
Recent viral syndrome
Progressive dyspnea, weakness, fever, myalgias
b. Heart Failure
c. Chest pain that mimics pericarditis or AMI
d. Atrial or ventricular Tachyarrhythmia
e. Intracranial Thrombus (Emboli)

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5
Q

Acute Myocarditis

Fulminant Myocaditis ( form acute myocarditis) Due to Viral Invetion
Protozoan Trypanosoma Cruzi

A

*** Cardiogentic Shock **
* With Multiple organ failue
* characterized by severe LV dysfuntion
* May require Inotrops (force contraction increase CO) + Vent
* May leat ot Cadiomyopathy

**Laboratory (all non-specific)

    • Elevated WBC, CRP, ESR
      Troponin (only elevated 33% ; CK-MB only in 10%)

**Diagnositic **
**a. EKG **
i. Non-specific tachycardia or arrhythmia
Ventricular conduction abnormalties
ii Ventricular conduction abnormalities +/- ectopy
iii. presence of Q-wave (droping) or LBBB
**b. Pulmonary HTN **
Pulmonary HTN
c. Chest X/Ray: Pulmonary edema
d. Endomyocadial Biopsy: Requires dx histology

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6
Q

Acute Myocaditis :
Threatment

A

Avoid Anti-inflammatories
and Immunosuppresents
Antimicrobial THerapy - can be given only of microbes identify
Ace
BBB
Diuretics
ECMO
Limit Exercies

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7
Q

Acute Myocaditis 2/2
Parasitic Involvement aka
Chaga’s Disease

A

1. Epidemiology
* 3rd most common parasitic infecion in the word
* Most common infection cause of cadiomyopathy
*** 2. Transmission **
a. Protozoa T cruzi via reduviid bug

**3. Managment **
a. Cardiomyopathy: HF threamtent
b. AV nodal dysfunction : Pacemaker
c. DVT +PE: Heparing
d. Antiparasitic therapy: Bensnidazole+nifurtimox (only pediatric )

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8
Q

Name of Acute Miocarditis caused by Parasitic Involent

A

Chaga’s Disease

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9
Q

Acute Myocarditis:
Toxoplasmosis

A
  1. Trasmission
    a. Undercooked infected beef. pork, or feline feces
    b. Organ tranplant
    c. Blood transfusion

2. At-Risk Population
Immunocompromized pt +s/s of myocarditis
IgG +

**3. S/s : **
* Pericardial effusion
* Constrictive pericarditis
* Encephalitis
* Chorioretinitis

4. Dx
a. IgM +IgG +

5. Tx
Pyrmethamine + Sulfadiazine OR
Clindamycin

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10
Q

Test
Causes of Toxoplasmoosis?
Diagnosis ?

A

**Causes **
Uncook meat
Organ Transplant
Blood Transfusion
**DX: **
IGM +IgG positive

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11
Q

Tx for Toxoplasmosis

A

Pyrimethamine + Sulfadiazine
or
Clindamycin

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12
Q

Acute Myocarditis : Bacterial Involvement

A

Epidemiology
a. Rare
b. Corynebacterium Diphtheria bacteria (50% of cases ) > Toxin released affecting cardiac conduction
c. At-risk: Non immune children ; Older adults no longer immune
**Pathology: **
Direct Invasion
Abcess formation

TX: Diphtheria Antitoxin therapy (DAT)
Antitoxintoxin Prioritized > Antibiotics

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13
Q

Name of Bacteria caused Acute Myocarditis

A

Corhnebaterium Diphtheriae

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14
Q

Acute Myocarditis :
Noninfective Involvement

A

**Etiology: **
a. **Cardiac Transpalant Rejection **
b. Cardiac Sarcoidosis
Tiny collections of immune cells that form granulomas in the heart
Interferes with mechanial function

c.** Giant cell myocarditis **
i. rare and Idiopathic disease
ii. Characterized by rapid onset HF + VT

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15
Q

Non-Invesive Myocarditis

A

S/s
Rapid onset HF
VT
Conduction block
Chest pain syndrome
**High Suspicious
V-tac or conduction blocks
rapid onset

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16
Q

Pericarditis

A
17
Q

Acute Pericarditis

A

** Epidemiology **
a. Viral > Bacterial
b. Male <age 50 most affected

18
Q

Acute Pericarditis
Classifiction

A

Acute: <6 weeks fibrinous (exudative) or effusion
Subacute Pericarditis: 6 wks to 6 month a/w effusion or contrictive
Chronic pericarditis > 6 moth a/w constrictive or adhesive

19
Q

Acute Pericarditis S/s

A

a.** Chest pain**
* Pleuritic and postural
* * Susternal w/radiation > neck, Shoulder, back
* epigastrium
* Dyspnea and Fever
*
* **b. Pericardial fricion rub
**occur w/wo accumulation +/- restriction **
Highly specific Findings

	**c. Diffuse non-specific ST elevation **
	
	d. Pericardial effusion
20
Q

Acute Pericarditis
DX

A
  1. Viral :
    Clinical diagnosis w/leukocytosis
    TTE: typicaly normal and r/o effusion
    2. Bacterial
    Dx pericardiocentesis
    3. Uremic Pericarditis
    Correlates wit BUN/Cr
    Perigadium is Shaggy
    Effusion is hemorrhagic and exudative
21
Q

Pericaditis TX

A
  • ASA 1 g Q 8 rhs w/taper +
  • NSAID 600 to 800 mg TID
  • PPI: cover NSAID
    * Colchicine :
    i. enhanced response of ASA
    ii. dosing: <70g > 0.5 to 0.6
    >701g > BID

*** Post MI: **
ASA and colchicine
Containidcated : NSAIDs and Corticosteroids
CRP: Prednisone 1mg /mg /day for 2 to 4 days then tapper

22
Q

Cardiac Tamponade
Overview

A
  • Accumulation fluids in Pericardium Space
  • Fluids 200ml -2L to produce tamponate
  • Elevated Intercranial Pressure >15 mmHG
    i. IP Normal: -5 -5 mmHg
  • Obstruction LVOT
23
Q

Tamponade
Etiology

A

i. Idiopathic Pericarditis
Pericarditis 2/2 Neoplastic disease, TB, or Hemorrhage

24
Q

Fluids/Bloody

A

Neoplastic
Renal Failure
Cardiac Injury

25
Q

Fluid Exudative w/wo blood

A

Cloudy, high cell count, High count of protein, or albumin
Due to :
* HIV
* TB (Adonosin Deaminasa ) elveted TB

26
Q

Cloudy Thick

A

Infection

27
Q

Transudate

A

clear
Yellow
Low protein
Low albumin

28
Q

Pericadial Glucose

A

i. Typically, similar to Serum
II low in settigns of infectio

29
Q
A

NU734 Acute Care I (25 decks)

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