Pericardial Disease & Myocarditis Flashcards
What is myocarditis?
Acute or chronic Inflammation of the myocardium
Describe the histopathology of myocarditis.
There is infiltration of inflammatory cells into the myocardium layers
What is the main causes of myocarditis?
Bacterial Fungal Protozoan Parasitic Toxins Hypersensitivity Autoimmune activation
What are the symptoms of myocarditis?
Symptoms of Heart failure
Fatigue
Dyspnoea
Chest pain (in minority)
What are the investigations for myocarditis?
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
What is pericarditis?
Inflammation of the pericardial layers
May or may not have myocardial involvement
What are the main causes of pericarditis?
Bacterial Post MI Perforation Proximal aortic dissection Neoplasia
What are the symptoms of pericarditis?
Chest pain
Pyrexia
Describe the chest pain experienced in pericarditis.
Pleuritic and postural features
Leaning forwards makes it better
Lying back makes it worse
What are the investigations for pericarditis?
ECG
Echo
Troponin
(Elevated if myocardial involvement)
What is constrictive pericarditis?
Impaired filling although myocardium is normal most of the time
What are the causes of constrictive pericarditis?
Idiopathic Radiation Post surgery Autoimmune Renal failure Sarcoidosis
What is a pericardial effusion?
Accumulation of fluid in the pericardial space.
May be haemodynamically significant (tamponade) or not
What are the causes of pericardial effusion?
Usually the same as pericarditis Bacterial Post MI Perforation Proximal aortic dissection Neoplasia
Where tamponade is present what are the symptoms?
Fatigue
Dyspnoea
Dizzy with low BP
Occasionally chest pain
What are the signs of a cardiac tamponade?
Pulses paradoxes Elevated JVP Low be Pleural rub Muffled heart sounds Pulmonary edema (very rare)
What investigations are used to detect a tamponade?
Echo
CXR
What is the treatment for a tamponade?
Drainage
Persistent effusion - surgical pericardial window is made to allow flow to the abdomen
What pericardial disease is heart failure found in?
Constrictive pericarditis.
What investigation determines restrictive cardiomyopathy from constrictive pericarditis?
Right heart catheterisation
What procedure is carried out to treat a cardiac tamponade?
Pericardiocentesis
Name a few pathogens which can be responsible for myocarditis
Coxsackie B virus Epstein Barr virus Cytomegalo virus HIV Treponema Streptococcal Staphylococcal Chlamydia Herpes Borrelia (Lyme disease) Mycoplasm
What does the ECG show in pericarditis?
PR depression
ST changes
If pericarditis is idiopathic, what drugs must be in limited use?
Colchine and NSAIDS
What is pericarditis?
Inflammation of the pericardial layers
May have myocardial involvement
How would you know if pericarditis has myocardial involvement?
Raised troponin levels
What is constrictive pericarditis?
Chronic inflammation of the pericardium / pericardial layers of the heart which lead to scarring, thickening and muscle tightening.
This results in impaired filling
What disease can renal failure cause?
Constrictive pericarditis
