Acute Myocarditis Flashcards Preview

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Flashcards in Acute Myocarditis Deck (16):
1

What is the typical etiology of acute myocarditis?

Viral etiology usually associated with epidemics

(cocksackie ect.)

2

The majority of indiv. with acute myocarditis present with:

– Fever
– Chest pain with ECG changes
– Arrhythmia
– Heart failure

Note: 50% have preceding respiratory or GI symptoms

3

With regards to heart physiology, what does acute myocarditis cause?

Dilated cardiomyopathy:
Low ejection fraction (~20%) and heart failure --> (high mortality) --> can further develop a chronic dilated cardiomyopathy

--> Heart failure with a large silent heart with impaired systolic function

4

Clinical manifestations of Dilated cardiomyopathy

1. Heart failure
2. Arrhythmia
3. Thromboembolism

5

What can Arrhythmia from Dilated cardiomyopathy result in?

Injury,
Fibrosis,
Dilation

6

What can thromboembolism from Dilated cardiomyopathy result in?

Dilation,
Poor contraction,
Abnormal surface

7

Activation of AT1 receptors by angiotensin II can result in?

Vasoconstriction
Increased aldosterone release
Sodium Retention
Fibrosis
Increased Sympathetic Activity
Hypertrophy

8

What would you expect BNP levels to be in patients with CHF?

Super elevated compared to pts w/o CHF

9

Treatment of Cardiomyopathy

TREATMENT OF HEART FAILURE
ANTICOAGULATION
ANTI-ARRHYTHMIC AGENTS
ANTI-INFLAMMATORY / IMMUNO-SUPPRESSIVE

10

Treatment of heart failure from dilated cardiomyopathy

Diuretics, ACE Inhibitors, Beta blockers, Aldosterone antagonists, Vasodilators, Inotropes, LVads, Transplant

11

HYPERTROPHIC CARDIOMYOPATHY WITHOUT AORTIC OUTFLOW OBSTRUCTION
- what is it?
- What is a typical symptom?

•Diastolic dysfunction due to impaired diastolic relaxation & increased stiffness
•`Elevated LV diastolic pressure causes increased pulmonary venous & capillary pressures
•Dyspnea on exertion usual symptom

12

HYPERTROPHIC / OBSTRUCTIVE CARDIOMYOPATHY
- what is it?
- what can it result in?

•Asymmetric myocardial hypertrophy -->
Possibly . . . Mitral valve leaflet can obstruct aortic opening during systole
(systolic anterior motion of mitral valve)

•Diastolic dysfunction
•Enhanced systolic dysfunction
•Dynamic left ventricular outflow obstruction
•Propensity for syncope & sudden death

13

Vasodilator (pick one) increases/decreases ventricular volume, and (pick one) increases/decreases outflow obstruction

decreases
Increases

14

HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
- clinical manifestations
- what are they caused by

Variable: Asymptomatic to severe symptoms

1. DYSPNEA
- cause by Increased LV filling pressure
2. ANGINA
- Hypertrophic LV
- Increased systolic LV pressure
3. SUDDEN DEATH
- Arrhythmia
- (Frequent cause of sudden death in athletes)

15

HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY TREATMENT

Avoid competitive sports and other extreme exertion
•Decrease contractility – Beta blockers/Verapamil
•Surgical myomectomy or Alcohol ablation
•Automatic Implantable Cardiac Defibrillator if they had a syncope event!!! or else they can die O.O

16

Restrictive cardiomyopathy
- what is it?

Impaired ventricular filling due to
stiff (noncompliant) ventricles

- but note that the ventricles are usually not dilated and systolic fxn is normal