Pericardial Disease & Myocarditis

Question 1

What is myocarditis?

Answer 1

Acute or chronic Inflammation of the myocardium

Question 2

Describe the histopathology of myocarditis.

Answer 2

There is infiltration of inflammatory cells into the myocardium layers

Question 3

What is the main causes of myocarditis?

Answer 3

Bacterial
Fungal
Protozoan
Parasitic
Toxins
Hypersensitivity
Autoimmune activation

Question 4

What are the symptoms of myocarditis?

Answer 4

Symptoms of Heart failure
Fatigue
Dyspnoea
Chest pain (in minority)

Question 5

What are the investigations for myocarditis?

Answer 5

ECG
Bio markers (elevated by not same pattern as an MI)
Echo
Cardiac MRI
Biopsy
Viral DNA PCR
Auto antibodies
Strep antibodies
Lyme B burgdorferi
HIV

Question 6

What is pericarditis?

Answer 6

Inflammation of the pericardial layers

May or may not have myocardial involvement

Question 7

What are the main causes of pericarditis?

Answer 7

Bacterial
Post MI
Perforation
Proximal aortic dissection
Neoplasia

Question 8

What are the symptoms of pericarditis?

Answer 8

Chest pain

Pyrexia

Question 9

Describe the chest pain experienced in pericarditis.

Answer 9

Pleuritic and postural features
Leaning forwards makes it better
Lying back makes it worse

Question 10

What are the investigations for pericarditis?

Answer 10

ECG
Echo
Troponin
(Elevated if myocardial involvement)

Question 11

What is constrictive pericarditis?

Answer 11

Impaired filling although myocardium is normal most of the time

Question 12

What are the causes of constrictive pericarditis?

Answer 12

Idiopathic
Radiation
Post surgery
Autoimmune
Renal failure
Sarcoidosis

Question 13

What is a pericardial effusion?

Answer 13

Accumulation of fluid in the pericardial space.

May be haemodynamically significant (tamponade) or not

Question 14

What are the causes of pericardial effusion?

Answer 14

Usually the same as pericarditis
Bacterial
Post MI
Perforation
Proximal aortic dissection
Neoplasia

Question 15

Where tamponade is present what are the symptoms?

Answer 15

Fatigue
Dyspnoea
Dizzy with low BP
Occasionally chest pain

Question 16

What are the signs of a cardiac tamponade?

Answer 16

Pulses paradoxes
Elevated JVP
Low be
Pleural rub
Muffled heart sounds
Pulmonary edema (very rare)

Question 17

What investigations are used to detect a tamponade?

Answer 17

Echo

CXR

Question 18

What is the treatment for a tamponade?

Answer 18

Drainage

Persistent effusion - surgical pericardial window is made to allow flow to the abdomen

Question 19

What pericardial disease is heart failure found in?

Answer 19

Constrictive pericarditis.

Question 20

What investigation determines restrictive cardiomyopathy from constrictive pericarditis?

Answer 20

Right heart catheterisation

Question 21

What procedure is carried out to treat a cardiac tamponade?

Answer 21

Pericardiocentesis

Question 22

Name a few pathogens which can be responsible for myocarditis

Answer 22

Coxsackie B virus
Epstein Barr virus
Cytomegalo virus
HIV
Treponema
Streptococcal
Staphylococcal
Chlamydia
Herpes
Borrelia (Lyme disease)
Mycoplasm

Question 23

What does the ECG show in pericarditis?

Answer 23

PR depression

ST changes

Question 24

If pericarditis is idiopathic, what drugs must be in limited use?

Answer 24

Colchine and NSAIDS

Question 25

What is pericarditis?

Answer 25

Inflammation of the pericardial layers

May have myocardial involvement

Question 26

How would you know if pericarditis has myocardial involvement?

Answer 26

Raised troponin levels

Question 27

What is constrictive pericarditis?

Answer 27

Chronic inflammation of the pericardium / pericardial layers of the heart which lead to scarring, thickening and muscle tightening.
This results in impaired filling

Question 28

What disease can renal failure cause?

Answer 28

Constrictive pericarditis