Pericarditis and Myocarditis

Question 1

What is pericarditis

Answer 1

inflammation of the pericardium (visceral and/or parietal)

Question 2

What is pericarditis most often associated with

Answer 2

Other cardio infections (Myocarditis) 
Thoracic infections (TB)

Question 3

What causes pericarditis

Answer 3

bacteria and viruses
Rarely, fungi
Trauma, radiation, open heart surgery

Question 4

What particular diseases can affect the pericardium

Answer 4

Rheumatic heart disease
severe AI diseases (SLE)
Chronic renal failure (metabolic waste accumulation causes uremia

Question 5

What are the pathologic characteristics of pericarditis

Answer 5

Exudation of clear fluid into pericardial sac

Question 6

What are the possible appearances of fluid in pericarditis

Answer 6

Serous pericarditis (viral): clear yellow 
Staph or Strep (bacterial): purulent

Question 7

What are the types of exudates in pericarditis

Answer 7

Serofibrinous pericarditis (more severe damage, RF)
Fibrinous pericarditis (bread and butter)

Question 8

What is fibrinous pericarditis

Answer 8

Shaggy, yellow layers of fibrin cover the heart (fills pericardial space)

Question 9

What is myocarditis

Answer 9

acute inflammation of the myocardium that can occur as a primary disease or as a result of another disorder

Question 10

What is the #1 cause of myocarditis

Answer 10

COXSACKIE B VIRUS

can also be caused by fungi and parasites, radiation rxn, hypersensitivity rxn, sarcoidosis

Question 11

Can bacteria cause myocarditis?

Answer 11

Very rarely.

If it does, it’s usually due to a secondary d/o (Diphtheria, meningococcus, staph endocarditis)

Question 12

How do viruses cause myocarditis

Answer 12

verses can’t survive outside of cells so they invade myocardial cells
They damage vital cell organelles and cause cell death
This weakens the myocardium leading to acute HF
T-cells are attracted there to kill virus, and secrete IL and TNF

Question 13

What do lymphokines (IL and TNF) do once in the myocardium

Answer 13

They destroy the virus AND the virus infected myocardial cells, further contributing to HF

Question 14

What is “the tiger effect”

Answer 14

When viral myocarditis causes pale and congested areas of the heart with biventricular dilation and hypokinesis of the myocardium

Question 15

What do the hearts of patients dying of myocarditis look like

Answer 15

flabby and dilated

Question 16

What does viral myocarditis look like histologically

Answer 16

patty, diffuse interstitial infiltrate (composed of T cells and macrophages) surrounding individual cells with myonecrosis

Question 17

How long does it take for symptoms to appear in myocarditis

Answer 17

a few weeks after infection

Question 18

What are myocarditis symptoms

Answer 18

mild fever
SOB
malaise
If severe, HF Sx (tachycardia, peripheral cyanosis, pulmonary edema)

Question 19

What is the prognosis of myocarditis

Answer 19

few die from CHF and arrhythmias

most patients recover from acute myocarditis

Question 20

How do you diagnose viral myocarditis

Answer 20

Endomyocardial biopsy (cath into femoral artery/neck vein–>LV or R heart, where punch biopsies are taken)

Question 21

What is the treatment of Myocarditis

Answer 21

No specific treatment for viral myocarditis.

Supportive measures