TP8.1 - Doenças do Miocárdio e Pericárdio

Question 1

Surgical Septal Myectomy? When?

Answer 1

Reduzir a obstrução retirando parte da parede do septo interventricular.

• • A resting or maximum provoked LVOT gradient of >50 mmHg who are in NYHA Class III-IV, apesar de terapêutica máxima tolerada.
• • Se já necessita de outra intervenção.

Question 2

ACC guidelines?

Answer 2

Do not rank either option as superior to the other.
Guidelines favor ventricular septal myectomy as first-line therapy, reserving alcohol septal ablation for patients who are either at high operative risk or wish to avoid surgery.

Question 3

Tratamento cirúrgico de cardiomiopatia dilatada?

Answer 3

– Transplante

Question 4

Prioridade na Listagem para Transplante?

Answer 4

Status I
- Cardiac Assistance
- Ionotropic dependent for maintaining cardiac output &in hospital ICU
- Younger than 6 months
Status II
- Patients not a status I according to criteria – stable on PO medications & able to wait at home
Status VII
- Patients improved and not in immediate need of transplantation or with new complications making transplantation contraindicated - Inactive

Question 5

Resultados do Transplante?

Answer 5

• • 1-year survival rate to be 82% and 3-year survival rate to be 74%.
• • The most common cause of mortality was cardiac allograft vasculopathy
• • Similar survival rates between men and women.
• • Lowest survival in patients < age 1 and approaching age 65

Question 6

Patofisiologia da Pericardite?

Answer 6

Rigid, scarred pericardium encircles heart: normal systolic contraction and inhibits diastolic filling of both ventricles

Question 7

Síndromes pericárdicos? Causas?

Answer 7

• • Pericardite aguda
• • Pericardite incessante (> 4-6 sem e < 3 meses)
• • Pericardite recorrente (recorrência após intervalo assintomático ≥ 4 sem)
• • Pericardite crónica (> 3 meses)

Infeciosa: vírus, bactérias, fungos
Autoimune
Neoplásica (tumor primário, metástase)
Metabólica
Traumática e iatrogénica
Relacionada com fármacos

Question 8

Pericardite aguda: critérios de diagnóstico?

Answer 8

Pelo menos 2 de 4 critérios:

(1) Dor
(2) Atrito pericárdico
(3) Derrame pericárdico (de novo ou agravado)
(4) ECG: elevação difusa do segmento ST ou infradesnivelamento do PR

Question 9

Pericardite aguda: tratamento inicial?

Answer 9

Aspirina
Ibuprofen
Colquicina

Question 10

Tamponamento Cardíaco?

Answer 10

• • Agudo – Trauma (iatrogénico), ruptura de parede livre pós EAM, POP
• • Gradual – aumento gradual derrame pós síndrome pericárdico

Fluído sob pressão comprime câmaras cardíacas

Question 11

Patofisiologia do Tamponametno Cardíaco?

Answer 11

Accumulation of fluid under high pressure: compresses cardiac chambers & impairs diastolic filling of both ventricles

Question 12

Pericardite Constritiva?

Answer 12

Complicação tardia de pericardite de qualquer causa
Inflamação aguda cura com cicatrização
◦ Fusão dos pericárdios
◦ Fibrose
◦ Calcificação
◦ Constrição

Question 13

Constriciton vs Tamponade?

Answer 13

TAMPONADE:

• • Pulsus parodoxus: Present
• • Echo/MRI: Normal systolic function, Large effusion and RA & RV compression
• • Treatment: Pericardiocentesis

CONSTRICTION:

• • Pulsus parodoxus: Absent
• • Echo/MRI: Normal systolic function, No effusion and Pericardial thickening
• • Treatment: Pericardial striping