15.2.2.1 Aquired Heart Disease

Question 1

List causes of acquired heart disease

Answer 1

• Myocarditis
• TB Pericarditis
• Endocarditis
• Acuterheumaticfever/rheumaticheartdisease
• Kawasaki Disease

Question 2

Myocarditis
Def

Answer 2

• Myocarditis is clinically and pathologically defined as an
  inflammatory disease of the myocardium
• diagnosed by established histological, immunological, and immunohistochemical criteria”

Question 3

Myocarditis common causes

Answer 3

Infectious
- viral (most common)
- bacterial
- fungal
- parastitic
- protozoal

Non-infectious
- Toxins
- hypersensitive reactions to drugs (antibiotics)
- immunological syndromes

Slide 5

Question 4

Consequences of viral infection

Answer 4

Consequences are downstream from viral infection

Acute phase
- viremic dissemination
- viral replication
- IFN response
- cell death through virulence
- cyrokine release

Subacute phase

Chronic phase

Slide 8

Question 5

Clinical presentation of acute viral myocarditis

Answer 5

• some without symptoms (have inflam process in heart but don’t know about it)
• sudden death
• Chronic dilated cardiomyopathy
• Acute myocarditis
• Fulminant myocarditis

Slide 9

Question 6

Presentation of myocarditis in children

Answer 6

• vast majority of children at first presentation, it is not possible to decide whether the patient has acute myocarditis or cardiomyopathy
• will present with signs of cardiac failure
• shocked, poor perfusion

Symptoms (same features of someone who have pneumonia or upper resp distress)
- Fever
- cough
- rapid breathing
- poor feeding
- lethargy

Question 7

Presentation of myocarditis (adults vs children)

Answer 7

Young adults:
- chest pain
- palputations
- mostly viral
- hardly ever fatal

Children
- severe heart failure

Question 8

Pericardial disease in children Causes / epidemiology

Answer 8

• HIC – idiopathic (viral or)
• LMICs - TB (very common)
• HIV disease
• Purulent pericarditis rare
• Staphylococcal pericarditis - setting of septicamia
• Constriction - rare (long-term)

Question 9

Endocarditis
General
Epidemiology

Answer 9

Infection of the valve; results in damage of valve and surrounding structures

Epidemiology
- 30 X more common in adults
- Congenital heart disease is the most common predisposing factor in children
- Unrepaired CHD – even small defects
- Prosthetic material
- ASD/Repaired VSD/Repaired PDA not a risk
- Rheumatic heart disease/Bad teeth

Need to prevent endocarditis -> look for signs at top in pt (especially dental hygiene)

Question 10

Endocarditis Prophylaxis vs Rheumatic fever prophylaxis

Answer 10

Endocarditis
- Antibiotics given at time of dental procedures to prevent endocarditis
- Need good dental health
- Underlying valvular or structural heart disease

Rheumatic fever
- Penicillin given monthly intramuscularly to prevent recurrence of rheumatic fever
- Patient with previous rheumatic fever May have a normal heart