Pericardial Disease + Myocarditis Flashcards
What is myocarditis
Inflammation of the myocardium
Acute or chronic
Causes reduced function and conduction
Often associated with pericarditis
What causes myocarditis
Idiopathic = 50% Viral Bacterial Fungal Parasitic Toxins Hypersensitivity Autoimmune
What are viral causes
Adenovirus Enterovirus Coxsackie CMV Influenza EBV HSV Hepatitis Mumps Rubella HIV
What are bacterial causes
Staph and strep Chlamydia Mycoplasma pneumoniae TB Meninigococcus Treponema pallidum (syphillis) Brucellosis Psittacosis
What are fungal causes
Aspergillus
Candida
What are parasitic causes
Schistosomiasis
Toxoplasmosis
Lyme’s
Leptospirosis
What toxins can cause
Alcohol
Lithium
Cocaine
What other drugs can cause
Cephalosporin TCA Penicillin Sulphonamide Cyclophosphamide Spirnolactone Carbamazepine Clozapine
What autoimmune can cause
SLE Sarcoid Churg-Strauss Sjogren Microscopic Macroscopic Kawasai
How does myocarditis present
ACS HF Arrythmia Palpitation Fatgiue Chest pain -pleuritic SOB Fever Tachycardia
How do you Dx myocarditis
ECG Cardiac biomarkers consistent with MI ECHO = diastolic dysfunction / effusion Bloods - raised ESR / CRP MRI if stable Biopsy = diagnostic Serology for cause
What does ECG show
Persistent ST elevation >3 hours - would evolve if ischaemia
T wave inversion
AV block
Prolonged QT
How do you treat myocarditis
Treat cause
Support HF
What are the complications of myocarditis
Impaired function
Impaired conduction
Arrythmia
DCM
What is pericarditis
Inflammation of pericardium (lining of heart) with or without myocardial involvement
What causes pericarditis
POST MI MYOCARDIAL RUPTURE Post viral - cocksackie Aortic dissection Same causes as myocarditis Cancer Hypothyroid
What are the symptoms of pericarditis
Pleuritic chest pain Worse lying flat Better sitting forward Fever Cough SOB Flu like symptoms prior Pericardial rub Pericardial effusion - JVP / low BP Cardiac tamponande
How do you Dx pericarditis
ECG ECHO if suspect to look for fluid Bloods - FBC, U+E, LFT, CRP Cardio biomarkers - troponin may be raised Bloods for cause CXR - effusion
What does ECG show
Widespread ST changes
PR depression = pathomenumonic
How do you Rx
Colchicine / NSAID for idiopathic / viral
Treat cause
Consider steroid if not improving
What causes pericardial effusion
Same as pericarditis
Rupture - post MI / trauma / haemopericardium
Aortic dissection
Malignnaayc
How does effusion present
SOB FAtigue Dizzy Hypotension Chest pain Pulsus paradoxus - decreased systolic on inspiration Raised JVP Muffled heart sounds
How do you Dx
ECHO
CXR
ECG
What does ECG show
Electrical pulses alternans (alternating height of QRS as heart swings back and forward)
How do you treat
Pericardiocentesis - diagnostic and therapetuic
What do you do with fluid
Send for ZN / culture / cytology
Most causes are exudates
What are sings that structures being compressed by effusion
Phrenic nerve - nausea due to diaphragm
Bronchial breathing - compressed base
Hoarse voice - recurrent laygneal
Horner - sympathetic
What is constrictive pericarditis
Impaired filling of heart due to rigid pericardium even though myocardium is normal
Very rare
What causes constrictive pericarditis
Any cause particularly TB Idiopathic Radiation Post op Autoimmune SArcoid
How does constrictive pericarditis present
RHF Increased JVP (X+Y) Fatigue SOB Couh Ascites Oedema Hepatomegaly Jaundice Kausmaul - JVP rise with inspiration (should decrease)
How do you Dx constrictive pericarditis
CXR - calcification / small heart
ECHO
Right heart Cath / angio / MRI to differentiate from restrictive cardiomyopathy
How do you treat
Diuretic
Pericardiotomy
What are the complications
Pleural effusion
AF
How do you differentiate from tamponade
X and Y descent
Kausmaul sign present
Calficication on CXR
NO pulses paradoxus
What is cardiac tamponade
Accumulation of fluid under pressure reducing ventricular filling and CO
What causes
Post PCI / cardiac surgery Effusion Trauma - RTA Lung and breast Ca Pericarditis MI Bacteria e.g. TB
What are the signs of tamponade
TRIAD
Hypotension
Muffled heart sounds
Raised JVP - absent Y
SOB
Tachy
Pulsus paradoxus - large drop in BP on inspiration
NO KAUSMAUL
How do you Dx
Beck trial
ECG
ECHO
What does ECG show
Electrical alternans
How do you treat
Urgent pericardiocentesis and send fluid HELP O2 Monitor ECG Group and save
What are the outcomes
Cardiac arrest and shock rapidly
What may patient have before pericarditis
Infection - viral cold etc
