21. diseases of pericardium and myocardium

Question 1

Myocardial disease etiology

Answer 1

Infections (Myocarditis)

Familial-Hereditary

Metabolic, Nutritional, Endocrine

Connective Tissue-Granulomatous Disease

Drugs-Toxins

Coronary Arteries

Other

Question 2

causes of Infection (myocarditis)

Answer 2

 Viral (e.g., coxsackievirus, mumps, Epstein-Barr virus, influenza, parainfluenza, measles, varicella, HIV)

 Rickettsiae (e.g., psittacosis, Coxiella,

 Bacterial (e.g., diphtheria, Mycoplasma, meningococcus, leptospirosis, Lyme disease)

 Parasitic (e.g., Chagas disease, toxoplasmosis, Loa loa)
Familial-Hereditary

Question 3

Familial-Hereditary examples

Answer 3

Muscular dystrophies (Duchenne (Becker, limb girdle)
 Myotonic dystrophy

 Mitochondrial myopathy syndromes

 Friedreich ataxia

 Pompe disease (glycogen storage)

 Endocardial fibroelastosis

 Familial cardiomyopathy

Question 4

Metabolic, Nutritional, Endocrine

Answer 4

 Beriberi (thiamine deficiency)

 Keshan disease (selenium deficiency)

 Hypothyroidism, Hyperthyroidism

 Pheochromocytoma

 Mitochondrial myopathies II

Question 5

Connective Tissue-Granulomatous Disease

Answer 5

 SLE
 Scleroderma
 Rheumatic fever
 Dermatomyositis

Question 6

Drugs-Toxins

Answer 6

 Doxorubicin (Adriamycin)
 Iron overload (hemosiderosis)
 Irradiation
 Cocaine
 Amphetamines

Question 7

Coronary Arteries

Answer 7

 Anomalous left coronary artery

 Kawasaki disease

Question 8

Other

Answer 8

 Sickle cell anemia
 Hypereosinophilic syndrome
 Endomyocardial fibrosis
 Idiopathic

Question 9

Myocarditis def

Answer 9

inflammation of the heart muscle.

Question 10

Myocarditis sx depend on

Answer 10

age and the acute or chronic nature of the infection.

Question 11

Myocarditis sx in neonates

Answer 11

initially have fever, severe heart failure, respiratory distress, cyanosis, distant heart sounds,
weak pulses, tachycardia out of proportion to the fever, mitral insufficiency caused by dilatation of the valve
annulus, a gallop rhythm, acidosis, and shock.
associated rash

Question 12

outcome of fulminant myocarditis in neonates

Answer 12

death may occur within 1–7 days of the onset of symptoms.

Question 13

CXR of myocarditis in neonates

Answer 13

enormously enlarged heart and pulmonary edema.

Question 14

electrocardiogram in myocarditis in neonates

Answer 14

sinus tachycardia, reduced QRS complex voltage, and ST segment and T-wave
abnormalities. Arrhythmias may be the first clinical manifestation

Question 15

older patient with acute myocarditis

Answer 15

initially acute congestive heart failure;

more commonly, patients have a gradual onset of congestive heart failure or a sudden onset of ventricular
arrhythmias.

Question 16

what kind of cardiomyopathy is present in older pt w/myocarditis

Answer 16

idiopathic dilated

cardiomyopathy is present as acute infectious phase has usually passed

Question 17

dg of myocarditis

Answer 17

elevated:
sedimentation rate, heart enzymes, and brain natriuretic
peptide (BNP)

Serum viral titers

PCR of ventricular biopsy and serum samples

Echocardiography

Endomyocardial biopsy

Question 18

what are the cardiac ez

Answer 18

creatine phosphokinase, lactate dehydrogenase)

Question 19

why is ventricular vcr done

Answer 19

(viral genome routinely present in cardiac samples yet absent in
peripheral blood)

Question 20

what does echocardiography show in myocarditis

Answer 20

poor ventricular function
pericardial effusion, mitral valve regurgitation
absence of coronary artery
other congenital heart lesions.

Question 21

rx for paediatric myocarditis

Answer 21

for severe congestive heart failure or cardiogenic shock?

Intravenous immunoglobulin (IVIG) 2 g/kg

prednisone (2 mg/kg daily, tapered to 0.3 mg/kg daily over a period of 3 mo)

antiviral drugs- enterovirus (pleconaril), Epstein-Barr virus (acyclovir)

Question 22

cardiomyopathy

Answer 22

chronic disease of the heart muscle that can be

1. dilated
2. hypertrophic
3. restrictive

Question 23

dilated cardiomyopathy causes

Answer 23

Infectious 
Sporadic 
Infiltrative
Toxic 
Idiopathic

Question 24

haemodynamics in dilated cardiomyopathy

Answer 24

Decreased systolic

function

Question 25

Treatment in dilated cardiomyopathy

Answer 25

``` Positive inotropes Diuretics Afterload reduction   Corticosteroids β-Blockers   Antiarrhythmics Anticoagulants Cardiac transplantation ```

Question 26

Hypertrophic cardiomyopathy causes

Answer 26

sporadic inherited

Question 27

Hypertrophic cardiomyopathy haemodynamics

Answer 27

``` Diastolic dysfunction (impaired ventricular filling) ```

Question 28

rx in cardiomyopathy haemodynamics

Answer 28

β-Blockers Calcium channel blockersation

Question 29

Restrictive cardiomyopathy causes

Answer 29

infiltrative myocardial hypertrophy myocardial fibrosis idiopathic

Question 30

haemodynamics in Restrictive cardiomyopathy

Answer 30

``` Diastolic dysfunction (impaired ventricular filling) ```

Question 31

rx in Restrictive cardiomyopathy

Answer 31

diuretics anticoagulants corticosteroids cardiac transplantation

Question 32

pericarditis def

Answer 32

inflammation of the pericardium

Question 33

pericarditis etio

Answer 33

 Idiopathic (Presumed Viral)  Infectious Agents  Collagen Vascular-Inflammatory and Granulomatous Diseases  Traumatic  Contiguous Spread-  Metabolic-  Neoplastic-  Others-

Question 34

examples of Infectious Agents causing pericarditis

Answer 34

Group A streptococcus, Staphylococcus aureus, Mycobacterium tuberculosis, Coxsackievirus (group A, B),

Question 35

examples of Collagen Vascular-Inflammatory and Granulomatous Diseases causingg pericarditis

Answer 35

Systemic lupus erythematosus (idiopathic and drug-induced), vasculitis, familial Mediterranean fever,

Question 36

examples of Traumatic causes of pericarditis

Answer 36

cardiac contusion (blunt trauma), penetrating trauma, postpericardiotomy syndrome radiation,

Question 37

example of a Contiguous Spread causing pericarditiss

Answer 37

pleural disease pneumonia

Question 38

Metabolic causes of pericarditis

Answer 38

hypothyroidism, uremia, chylopericardium,

Question 39

Neoplastic causes of pericarditis

Answer 39

primary, contiguous (lymphoma), metastatic, infiltrative

Question 40

sx of pericarditis

Answer 40

Chest pain: (worsened if lying down or with inspiration) Dyspnea Malaise Patient assumes sitting position Dry: sharp pain due to rubbing of the layers Large effusion: dull heavy pain

Question 41

types of pericarditis

Answer 41

non constrictive tamponade constrictive

Question 42

sx of non constrictive

Answer 42

 Fever  Tachycardia  Friction rub (accentuated by inspiration, body position)  Enlarged heart by percussion and x-ray examination  Distant heart sounds

Question 43

sx of tamponade

Answer 43

```  Distended neck veins  Hepatomegaly  Pulsus paradoxus (greater than 10 mm Hg with inspiration)  Narrow pulse pressure  Weak pulse  Poor peripheral perfusion ```

Question 44

sx of constrictive

Answer 44

```  Distended neck veins  Kussmaul sign (inspiratory increase of jugular venous pressure)  Distant heart sounds  Pericardial knock  Hepatomegaly  Ascites  Edema  Tachycardia ```

Question 45

dg of pericarditis

Answer 45

ECG CXR ECHO pericardiocentesis blood test

Question 46

ECG evidence for pericarditis

Answer 46

Elevated ST segments, T wave inversion (late), tachycardia, reduced QRS voltage,?? electrical alternans (variable QRS amplitudes)

Question 47

CXR evidence for pericarditis

Answer 47

Cardiomegaly (water bottle heart)

Question 48

ECHO evidence for pericarditis

Answer 48

Pericardial fluid

Question 49

pericardiocentesis evidence for pericarditis

Answer 49

``` Gram and acid-fast stains, culture, PCR (virus, bacteria, mycobacteria, fungus), cytology, cell count, glucose, protein, pH ```

Question 50

Blood tests evidence for pericarditis

Answer 50

``` ESR, viral titers, ANA, ASO titers, EBV titers ```

Question 51

rx pf pericarditis

Answer 51

* Pericardiocentesis | * Anti-inflamatory drugs