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Senoir paeds > PERICARDITIS, MYOCARDITIS AND CARDIOMYOPATHIES IN CHILDREN > Flashcards

PERICARDITIS, MYOCARDITIS AND CARDIOMYOPATHIES IN CHILDREN Flashcards

1
Q

Pericarditis

Definition: ___________ or ___________ of the
___________.

A

Infection or inflammation of the
pericardial space.

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2
Q

• Normally there is _________ ml of pericardial fluid in the pericardial space.

Pericarditis can result in increased _________ in the pericardial space (pericardial _________).

A

10-50ml

fluid accumulation

effusion

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3
Q

Aetiology of pericarditis

• __________
• __________
• __________

A

• Idiopathic
• Infectious
• Non-infectious

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4
Q

Aetiology of pericarditis

Infectious
• Viral pericarditis

•_____________ (most common viral cause)
• Other viruses – Echo, Adeno, Influenza.
Mumps, Varicella, Epstein-Barr, CMV, Viral
hepatitis B, HIV, Human herpesvirus 6,
Parvovirus B19.

A

Coxsackievirus B

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5
Q

Infectious
•_________ pericarditis- commonest infectious cause of pericarditis in children.

A

Viral

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6
Q

Bacterial pericarditis: Primary infection is (common or rare?).

• Pathogenesis
–_______________ of an infection from an
adjacent pneumonia or empyema.
–distant infection can ___________ seed the
pericardium

A

Rare; direct extension

haematogenously

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7
Q

Common bacterial organisms in pericarditis
•______________
•__________________
• Neisseria meningitidis
• Streptococcus pneumoniae
• Others: Mycobacterium tuberculosis, pseudomonas
aeruginosa

A

• Staphylococcus aureus
• Haemophilus influenzae

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8
Q

Aetiology (rare) infectious

• Fungal - ____________
• Parasitic- _____________

A

Histoplasma

Echinococcus

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9
Q

CLINICAL MANIFESTATIONS of pericarditis
• Often preceded by _______.
• ______ (low to mod) and __________.

• Pericardial _________ (cardinal sign)-
• _________,__________.
• _______ cough, anxiety, fatigue.
• Bacterial pericarditis presents as ____________.

A

URTI.

Fever ; Chest pain.

Pericardial friction rub

Tachycardia ; tachypnoea.
Dry ; sepsis.

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10
Q

Pericarditis:

Chest pain is (dull or sharp?) & (variable or constant?). Radiates to _______,_______, and _________. ________ and ___________tends to ease the pain, while ___________ and ___________ worsens it.

A

Sharp; constant

neck, shoulders ±abdomen

Sitting up and leaning forward

lying down and breathing deep

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11
Q

Pericardial friction rub (cardinal sign)-
–________,______ -pitched, to-and-fro sound caused by the _______________________ during cardiac motion.

Loudest when the patient is _________ and ___________, the sound is heard best in the 2nd to 4th intercostal spaces along the left sternal border or the midclavicular line.

A

scratchy, high

inflamed pericardial surfaces rubbing together

upright and leaning forward

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12
Q

Pericardial effusion
• Pericardial effusion: Inflammation of the
pericardium secondary to infection leads to
________________________ to proteins and
inflammatory cells, and _________________
between the visceral and parietal layers.
• This fluid can be serous, serosanguinous, pus, fibrinous, caseous, lymph or blood.

A

increase in permeability

fluid accumulates

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13
Q

Pericardial effusion

Onset: can be _______,_______, or ____________

Distribution: ____________ or ____________

Composition :
Transudate- e.g. _________
Exudate – e.g. ______

A

Acute , Sub-acute, or Chronic (>3 months)

Circumferential or Loculated

serous fluid; pus

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14
Q

Size of pericardial effusion

Physiologic/trivial <___mm
Mild <___mm
Moderate _____mm
Large >____mm

A

5
10
10-20
20

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15
Q

Complications of pericarditis
• ____________
• Cardiac __________
• _______________
• ____________ pericarditis-

A

• Recurrence
• Cardiac tamponade
• Arrhythmia –
• Constrictive pericarditis-

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16
Q

Constrictive pericarditis-
– Characterised by a _________, adherent
pericardium that __________________ and
limits chamber _________ and maximal __________ volumes.

A

thickened

restricts ventricular filling

expansion ;diastolic

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17
Q

Presence of continued heart failure
without a large cardiac silhouette suggests
__________

A

constriction

18
Q

Cardiac tamponade

• Cardiac tamponade is a life-threatening, slow or rapid __________ of the heart due to the ________________ of fluid, pus, blood,
clots or gas as a result of inflammation,
trauma, rupture of the heart or aortic
dissection.

A

compression; pericardial accumulation

19
Q

The clinical features of cardiac tamponade are caused by reduction of _____________and elevated ____________.

It can lead to ______________ (weak
peripheral pulses, cool and clammy
extremities.

A

cardiac output

venous pressure

obstructive shock

20
Q

Clinical signs of cardiac tamponade
•________
•____________
•___________________ (an exaggerated fall in SBP with inspiration)
• Raised _____________, hepatomegaly
•____________________ heart sounds
• Decreased electrocardiographic voltage with electrical alternans
• Enlarged globular cardiac silhouette on chest x-
ray.

A

Tachycardia; Hypotension

Pulsus paradoxus; jugular venous pressure

Absent, distant or muffled

21
Q

Beck’s triad in cardiac tamponade

• ___________
• Elevated systemic venous pressure, often
with raised ______
• __________________

A

• Hypotension
• Elevated systemic venous pressure, often
with raised JVP
• Muffled heart sounds

22
Q

Diagnosis of acute pericarditis
• Presence of at least ____ of the following
four criteria:
1. Characteristic ________
2. Pericardial ________
3. Characteristic ___________ changes
4. new or worsening ________

A

two

chest pain; friction rub

electrocardiographic

pericardial effusion.

23
Q

Prognosis
• Good for _______ or _________ pericarditis.
• A mild idiopathic effusion is usually
asymptomatic has a good prognosis.
• ________________ effusions (>10 mm) may worsen, and especially severe effusions may evolve towards cardiac tamponade in up to one-third of cases.

A

acute viral or idiopathic

Moderate to large

24
Q

Myocarditis
– Definition: inflammatory disease of the _____________[.
– Myocarditis can be acute, subacute, or
chronic and may either involve _______ or _______ areas of the myocardium.
• It is (common or rare?) in children.

A

heart muscle cells

focal or diffuse

Rare

25
Q

Aetiology of myocarditis
• Infection
– Commonest cause - _______ infections
• _____________
• Medications
• Chemicals
• Radiation

A

viral

Acute rheumatic fever

26
Q

Aetiology of myocarditis
• Infection
– Commonest cause - _______ infections
• _____________
• Medications
• Chemicals
• Radiation

A

viral

Acute rheumatic fever

27
Q

Pathophysiology of myocarditis-
phases
1. ________ injury
2. Injury related to the ensuing ________________________ responses
3. Recovery, or transition to scar with
_________.

A

Acute

innate and acquired immunologic

DCM

28
Q

Clinical presentation of Myocarditis

• The clinical presentation is extremely varied, ranging from ___________ to _____________
• A high index of suspicion is therefore crucial

A

asymptomatic to sudden unexpected death.

29
Q

Clinical presentation of myocarditis

•____________ is the most common presenting picture in all ages.

– Older children - Hx of ______,______,
exercise intolerance and lack of energy,
malaise, _____-grade fever, arrhythmia, _______ and gradual onset of CCF.

– Newborns –____________, lethargy, periodic
episodes of ______, ________ , hypothermia,
tachypnea, anorexia, failure to thrive,
diaphoresis

A

Heart failure

URTI ; chest pain; low; cough

Irritability; pallor ; fever

30
Q

Complications of myocarditis

• ___________
• ___________
• ___________
• Further decrease in ventricular function
• ___________ cardiomyopathy

A

Complications
• Arrhythmia
• Congestive heart failure
• Thromboembolism
• Further decrease in ventricular function
• Dilated cardiomyopathy

31
Q

Prognosis of myocarditis

• Viral myocarditis
– ______________ of ventricular function -50% of patients.
– Some develop _________ myocarditis (ongoing or resolving),
– some develop ___________________.
– Those who develop dilated
cardiomyopathy may require a heart
transplant.

A

Complete recovery

chronic; dilated cardiomyopathy

32
Q

Cardiomyopathy
• Definition: Abnormalities of the __________ unexplained by abnormal loading
conditions or congenital heart disease.

A

ventricular myocardium

33
Q

TYPES OF CARDIOMYOPATHY

• list 4

A

TYPES OF CARDIOMYOPATHY

• Dilated
Cardiomyopathy:

• Hypertrophic Cardiomyopathy

• Restrictive cardiomyopathy e.g.
endomyocardial fibrosis.

• Arrhythmogenic right ventricular
cardiomyopathy

34
Q

Commonest cardiomyopathy is ???

A

DCM

35
Q

DILATED CARDIOMYOPATHY
• Definition: A progressive disease of heart
muscle that is characterized by ———————————- (mostly _______) and _________ dysfunction with or without CCF.

A

ventricular chamber enlargement

left; contractile

36
Q

Pathogenesis of myocardial damage in DCM
• Major factors
– preceding ____________
– ______________
– underlying ____________________.

A

viral myocarditis

Autoimmunity

genetic predisposition

37
Q

Pathophysiology of DCM
• Decrease ____________
• ___________ of the heart and an increase in the ____________ volume caused by increased preload.
• Inflammatory mediators, such as cytokines and adhesion molecules, as well as apoptotic mechanisms, are
activated.
• The progressive increase in LV end-diastolic volume increases LA, pulmonary venous, and pulmonary arterial
pressures, resulting in increasing hydrostatic forces.
• These increased forces lead to _________ and __________.
• Without treatment, this process may progress to death.

A

myocardial function

Enlargement; end-diastolic

pulmonary edema and CCF

38
Q

Clinical manifestations of DCM
•__________ onset.
•________ onset in a quarter of cases.
• Hx of previous _______ in half of cases.

A

Insidious; Acute

viral illness

39
Q

Clinical manifestations of DCM
Initial
• ————
• ———— feeding
• Irritability
• ———— of breath
• ————
• Sweating
• Fatigability
• Failure to ————
• Decreased ————

A

Clinical manifestations
Initial
• Cough
• Poor feeding
• Irritability
• Shortness of breath
• Pallor
• Sweating
• Fatigability
• Failure to gain weight
• Decreased urine output

40
Q

Clinical manifestations of DCM

Others
• _______ pain
• Palpitations
• Orthopnea
• Hemoptysis
• Frothy sputum
• Abdominal pain
• Syncope
• Neurologic deficit

A

Chest

41
Q

Complications of DCM
• _______________
•__________
• ____________
• Pulmonary or systemic emboli from intracardiac thrombi.

A

Ventricular arrhythmia

Syncope

Sudden death

42
Q

Prognosis of DCM
• 1/3 recover completely
• 1/3 stabilize
• 1/3 progressively worsen
• 5 year survival is ______%.
• If the cause of DCM is ___________, children are more likely to improve and have a better outcome than children with other causes of
DCM.

A

40-50

myocarditis

Senoir paeds (15 decks)

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