ACUTE MYOCARDITIS Flashcards Preview

zz CVPR > ACUTE MYOCARDITIS > Flashcards

Flashcards in ACUTE MYOCARDITIS Deck (37):
1

ACUTE MYOCARDITIS

Acute inflammation of the cardiac muscle that is usually viral in etiology

2

ACUTE MYOCARDITIS
Common Presentations:

– Often seen in young adults/children
– Fever
– Chest pain with ECG changes
– Arrhythmia
– Heart failure

3

ACUTE MYOCARDITIS- Low ejection fraction and heart failure have high mortality but some recover and others develop a _______

chronic dilated cardiomyopathy

4

ACUTE MYOCARDITIS- _________ have high mortality but some recover and others develop a chronic dilated cardiomyopathy

Low ejection fraction and heart failure

5

DILATED CARDIOMYOPATHY

a disease of the heart muscle, usually starting in left ventricle.

The ventricle stretches and thins (dilates) and can't pump blood as well as a healthy heart can.

6

DILATED CARDIOMYOPATHY- PRESENTATION

Heart failure with a large silent heart
with impaired systolic function

7

DILATED CARDIOMYOPATHY- ETIOLOGY

Usually idiopathic
Genetic
Viral
Cocaine
Chemotherapy
Ischemic

8

DILATED CARDIOMYOPATHY
CLINICAL MANIFESTATIONS:

HEART FAILURE
ARRHYTHMIA
THROMBOEMBOLISM

9

The renin–angiotensin system (RAS) or the renin-angiotensin aldosterone system (RAAS) is a hormone system that regulates ________

blood pressure and fluid balance.

10

Enlarged Heart & Congested Lung fields on x ray indicat?

DILATED CARDIOMYOPATHY-

11

If renal blood flow is reduced, juxtaglomerular cells convert prorenin from the blood into renin and secrete it into circulation.

Plasma renin then carries out the conversion of angiotensinogen released by liver to angiotensin I.

A-1--> angiotensin II by the enzyme ACE found in the lungs.

A-II causes blood vessels to constrict, resulting in __________

increased blood pressure.

12

Activation of AT1 receptors by angiotensin II results in

Vasoconstriction
Increased aldosterone release
Sodium Retention
Fibrosis
Increased Sympathetic Activity
**Hypertrophy

13

DILATED CARDIOMYOPATHY
TREATMENT

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

14

DILATED CARDIOMYOPATHY- TREATMENT OF HEART FAILURE

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

15

DILATED CARDIOMYOPATHY- ANTI-ARRHYTHMIC AGENTS

Drugs, Implantable defibrillators

16

If renal blood flow is reduced, juxtaglomerular cells convert prorenin from the blood into renin and secrete it into circulation.

Plasma renin then carries out the conversion of angiotensinogen released by liver to angiotensin I.

A-1--> angiotensin II by the enzyme __________ found in the lungs.

angiotensin-converting enzyme

17

HYPERTROPHIC / OBSTRUCTIVE CARDIOMYOPATHY

Disproportionate thickening of the intraventricular septum

18

Diastolic dysfunction due to impaired diastolic relaxation & increased stiffness

Elevated LV diastolic pressure causes increased pulmonary venous & capillary
pressures

Dyspnea on exertion usual symptom

HYPERTROPHIC CARDIOMYOPATHY
WITHOUT AORTIC OUTFLOW
OBSTRUCTION

19

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

HYPERTROPHIC OBSTRUCTIVE
CARDIOMYOPATHY

20

HYPERTROPHIC OBSTRUCTIVE
CARDIOMYOPATHY

CLINICAL MANIFESTATIONS
Variable: Asymptomatic to severe symptoms


-DYSPNEA

-ANGINA

-SUDDEN DEATH

21

If renal blood flow is reduced, juxtaglomerular cells convert prorenin from the blood into renin and secrete it into circulation.

Plasma renin then carries out the conversion of ___________

angiotensinogen released by liver to angiotensin I.


A-1--> angiotensin II by the enzyme ACE found in the lungs. A-II causes blood vessels to constrict, resulting in increased blood pressure.

22

Relation of Neurohumoral Activation to Development and Reversal of Remodeling:

Myocyte dysfunction
Structural alteration

Cardiac adrenergic
RAAS signaling
-->
Remodeled Ventricle (hypertrophic)

23

Relation of Neurohumoral Activation to Development and Reversal of Remodeling:

Improved function
Reverse remodeling

ACE Inhibitors and
β-blocker therapy
-->
Relatively normal
chamber size and
geometry

24

BNP Levels of Patients W/ CHF is?

Often elevated

25

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

TREATMENT OF HEART FAILURE in DILATED CARDIOMYOPATHY

26

Vasodilators can cause?

hypotension
not tolerated by all people

(TREATMENT OF HEART FAILURE in DILATED CARDIOMYOPATHY)

27

Disproportionate thickening of the intraventricular septum

HYPERTROPHIC / OBSTRUCTIVE
CARDIOMYOPATHY

28

HYPERTROPHIC CARDIOMYOPATHY vasodilators fx

Vasodilator decreases ventricular volume - increases outflow obstruction

BAD!

29

Drugs that reduce preload (eg, nitrates, diuretics, ACE inhibitors, angiotensin II receptor blockers) decrease chamber size and worsen symptoms and signs of

HYPERTROPHIC CARDIOMYOPATHY

30

HYPERTROPHIC CARDIOMYOPATHY can easily cause sudden death:

In younger people
usually athletes training

31

___________ increase the outflow tract gradient and cause a reflex tachycardia that further worsens ventricular diastolic function in HCM

Vasodilators

32

Inotropic drugs (eg, digitalis glycosides, catecholamines) worsen outflow tract obstruction, do not relieve the high end-diastolic pressure, and may induce __________ in HCM

arrhythmias.

33

By decreasing myocardial contractility, these drugs dilate the heart.

By slowing the heart rate, they prolong the diastolic filling period.

Both effects decrease outflow obstruction, thus improving ventricular diastolic function.

GOOD for HCM!

β-Blockers and rate-limiting Ca channel blockers with a lower arterial dilation capacity (usually verapamil), alone or combined,

34

HYPERTROPHIC OBSTRUCTIVE
CARDIOMYOPATHY
TREATMENT

•Avoid extreme exertion
• Decrease contractility – Beta blockers/Verapamil
• Surgical myomectomy or Alcohol ablation
• Automatic Implantable Cardiac Defibrillator

35

RESTRICTIVE CARDIOMYOPATHY

Most commonly infiltrative:
amyloidosis, sarcoidosis

36

Impaired ventricular filling due to
stiff (noncompliant) ventricles

Systolic function often normal
and ventricles usually not dilated

Diagnosed by echocardiography with
Doppler assessment of ventricular filling

RESTRICTIVE CARDIOMYOPATHY

This rare entity has a poor prognosis. Intractable
failure and fatal arrhythmias may occur

37

HYPERTROPHIC OBSTRUCTIVE
CARDIOMYOPATHY is only caused by

GENETICS!