Myocardial and Pericardial Disease Flashcards
What is cardiomyopathy?
Abnormal structure or function of the myocardium
Leads to HF
What is myocarditis?
S+S:
What are some obvious symptoms? - 2
Why do they get palpitations and tachycardia?
Inflammation of the myocardium
SOB
Chest pain
This is caused by abnormal heart rhythms (‘arrhythmias’) where the heart is beating too fast or erratically because the electrical messages which control the heart’s rhythm are disrupted.
Myocarditis Investigations
The majority of patients with myocarditis present with nonspecific ECG changes and the ECG may have a variety of findings.
What are some ECG changes that may occur? - list them (think about what goes wrong)
What bloods should be done?
What could CXR show?
ST elevation or depression
T wave inversion
Atrial arrhythmia
AV block
ESR/CRP/WBC raised
Troponin raised
HF
Management - how can it be managed?
Complications - 3
Supportive care
Treat cause
Treat HF as well
Dilated cardiomyopathy
HF
Sudden cardiac death
Acute pericarditis:
What is it?
What position is the pain worse in?
Is the pain worse on inspiration or expiration?
When is it relieved?
What could be heard on auscultation that indicates it is pericarditis?
Other symptom for systemic infection?
Inflammation of the pericardium
Worse on lying down and on inspiration
Sitting forward
Pericardial friction rub (scratchy noise)
Fever
Acute pericarditis - Investigations:
ECG:
- They get ST elevation. How does this ST elevation differ from a STEMI?
What bloods should be done? - 4
What should be done to look for a pathogen of cause? - 2
What imaging can you use to look for pericardial effusion as a result of pericarditis?
It is widespread - so over multiple leads
There is also wide spread PR depression and Spodick’s sign (downloading TP segment)
For further signs - https://www.emnote.org/emnotes/ecg-findings-of-pericarditis
FBC
CRP/ESR
U&E
Troponin
Viral serology
Blood culture
CXR and echo
Acute pericarditis - Management:
What drug is given for pain?
What drug is given to reduce inflammation (MOA unclear), improve remission and prevent reoccurrences?
Complications:
- What happens if there is penetration through the muscle and visceral layer of the pericardium?
- What could happen if there is too much inflammation or pericardial effusion?
NSAID’s
Colchicine - look up
Could turn into a tamponade
Constrictive pericarditis
Constrictive pericarditis:
What happens to the pericardium leading to constriction?
Causes:
- What is an iatrogenic cause?
- What infectious disease known for extra-pulmonary manifestations could also cause this?
- The cause can also be unknown or due to acute pericarditis!
Rigid
Fibrotic pericardium
Iatrogenic - open cardiac surgery for example
TUBERCULOSIS ***
Constrictive pericarditis:
S+S:
Constriction leads to HF. What symptoms do they have?
What are some signs of HF?
What organ becomes enlarged?
What is Kussmaul’s sign?
What will happen to their heart sounds?
What extra heart sound is there?
SOB
Cough
Oedema
Raised JVP
Pulmonary oedema
Hepatomegaly
Kussmauls sign - raised JVP on inspiration
Muffled heart sounds
S3
Constrictive pericarditis:
Investigations:
ECG - what you’d see
CXR:
- Why would they get pleural effusion?
- What may be seen in the pericardium itself?
Reduced voltage
P-mitrale
AF
T-inversion
Pleural effusion
Pleural effusion occurs in about 50% of patients with constrictive pericarditis [6], and several mechanisms have been proposed for its occurrence. The diastolic dysfunction of the left ventricle might cause elevations in the intravascular hydrostatic pressure, leading to a transudative pleural effusion.
Pericardial calcification
Constrictive pericarditis:
What surgery would be done?
Pericardiectomy usually required
Pericardial effusion:
What is it?
Causes
Fluid in pericardial sac
Acute pericarditis
Idiopathic
Viral
Cancer
Pericardial effusion:
It is usually assymptomatic in the early stages.
What does it cause if the sac if infected?
In later stages, it can progress to a tamponade. What is the main symptoms would they have?
What is the main sign?
Asymptomatic
Fever
SOB
Raised JVP
Pericardial effusion:
Investigations:
ECG - what would you see?
CXR - what would you see?
Tachycardia
Low voltage QRS complexes
Large cardiac silhouette - you could ask about previous cardiomegaly
Pericardial effusion:
What 2 drugs can be used to manage this? - also used in pericarditis!
Fluid can be aspirated from the pericardium. What is this called?
What is a major complication of this?
NSAID’S and colchicine
Pericardiocentesis
Tamponade
