myocarditis and pericardits

Question 1

generalized inflammation of the myocardium associated with necrosis and degeneration of myocytes

Answer 1

myocarditis

Question 2

ischemic heart disease in myocarditis

Answer 2

nope

Question 3

myocarditis:

1. age
2. incidence
3. clinical presentation
4. etiology

Answer 3

1. occur at any age
2. difficult to establish many are asymptomatic
3. depend on cause and severity but common symptoms are chest pains, arrhytmia, SOB, fluid retention, fatigue but we can also see symptoms associated with a viral infection
4. infections, immune-related or unknown

Question 4

myocarditis clinical classification (3)

Answer 4

1. acute myocarditis- self-limited
2. acute, chronic active myocarditis
3. fulminant

Question 5

acute myocardits, self-limited

Answer 5

1. specific organism found in 60% of the cases
2. Cox B virus
3. excellent prognosis

Question 6

acute, chronic active myocarditis

Answer 6

1. recent onset of HF

2. significant progression to cardiomyopathy

Question 7

fulminant

Answer 7

1. uncommon
2. excellent response to immunosupresive drugs
3. presumed viral

Question 8

myocarditis infectious etiology

1. viral
2. rickettial
3. bacterial
4. chamydiae
5. fungi
6. parasites

Answer 8

1. viral- Cox A and B, rubella, echovirus, influenza
2. rickettial- typhus, rocky mountain spotted fever
3. bacterial- staphylococcal, diptheria, strept, mening, borrelia (lyme)
4. chamydiae- C.psittaci
5. fungi- toxoplasmosis, aspergillosis, cryptococcal, candida
6. parasites- chagas, echinococcus

Question 9

myocarditis etiology immune related

Answer 9

1. post-viral
2. rheum. fever
3. lupus
4. drug hypersensitivity
5. Heart transplant rejection

Question 10

myocarditis etiology of unknown cause

Answer 10

1. sarcoidosis

2. Giant cell arteritis

Question 11

viral myocarditis:

1. most cases of myocarditis in the US are viral due to (2)
2. patients have a history of upper respiratory tract viral infection with a positive
3. viruses can cause myocardial injury as a direct ________ or by a destructive _______
4. recovery
5. unusually severe in
6. histopathology
7. if there is extensive necrosis expect to see

Answer 11

1. Cox A and B and adenovirus
2. positive PCR
3. a direct cytopathic effect or by a destructive host immune response
4. most patients recover but a few dies of CHF or arrhythmias
5. it can be unusually severe in pregnant women and children
6. histopathology shows a patchy or diffuse interstitial infiltrate of T lymphocytes, macrophages and rare giant cells with focal myocyte necrosis
7. extensive necrosis expect to see many PMNs followed by chronic inflammation and repair may be found

Question 12

myocarditis in AIDS

1. evidence of Cardiac dx.
2. presentation
3. what is present in addition
4. symptomatic or asymptomatic

Answer 12

1. 50% have cardiac dx.
2. present with pericardial effusions, myocarditis, endocarditis or cardiomyopathy
3. opportunistic infections or infection of the heart
4. only a small percentage of pt. with AIDS related HD are symptomatic

Question 13

epicardial surface of the heart is smooth and glistening but there are small scattered pinpoint yellowish micro abscesses due to an

Answer 13

infectious myocarditis

Question 14

Chagas disease

1. infection caused by
2. incidence
3. epidemiology
4. myocardial involvement %

Answer 14

1. insect- Trypanosoma
2. 8 million in Latin America
3. kissing bug transmits the fusiform hemoflagellate to wild and domesticated animals and humans
4. myocardial involvement 10-40%

Question 15

Chagas transmission

Answer 15

1. by blood-feeding
2. through transfusion with infected blood
3. congenitally, from infected mother to fetus

Question 16

acute stage of myocarditis

Answer 16

1. 1-2 weeks of incubation, chagoma develops with fevers and swollen lymph nodes
2. in 2-3 weeks parasitemia appears with multiorgan involvement
3. myocardium is filled with thousands of parasite- filled pseudocytes, dense inflammation, and myocyte necrosis

Question 17

chronic chagas

Answer 17

1. 32% will have fatal damage to the heart and digestive tract
2. cardiac dilatation, prominent ventricular outflow tract with dilatation of valve rings
3. interstitial fibrosis with hypertrophies myofibers, chronic inflamation, mural thrombosis formation with embolization and apocal aneurysmal thinning

Question 18

what are the 2 drugs that can be used for the early chronic phases of Chagas

Answer 18

nifurtimox and benznidazole

Question 19

prevntion and control of chagas: (4)

Answer 19

1. tx. with residual inseticides
2. blood screening to prevent transmission through transfusion
3. drug treatment for acute early indeterminate and congenital cases
4. house improvement

Question 20

giant cell myocarditis:

1. disease is (2)
2. etiology
3. age
4. treatment
5. gross heart

Answer 20

1. rare disease that is usually rapid and fatal
2. unknown cause seen in SLE, hyperthyroidism and thymoma
3. young to middle age pt.
4. no effective treatment available
5. heart is flabby and dilated

Question 21

isolated pericardial disease is common or uncommon

Answer 21

very uncommon

Question 22

most pericardial lesions are seen in association with diseases found in

Answer 22

other areas of the heart, surrounding structures or secondary to systemic diseases

Question 23

accumulation of excess fluid transudate or exudate within the pericardial cavity thus producing friction between the visceral and parietal layers during contraction and compresses the heart

Answer 23

pericardial effusions

Question 24

accumulation of blood in the pericardial sac due to rupture of a heart wall by either MI, trauma, tumor infiltration or aortic rupture

Answer 24

hemopericardium

Question 25

hemopericardium can lead to _____ and it associated with these symptoms:

Answer 25

lead to cardiac tamponade with rapid accumlation of blood and cardiovascular collapse symptoms include tachy, anxiety, SOB, distant hearts sounds and narrow pulse pressure

Question 26

inflammation of the visceral or parietal pericardium with the formation of pericardial effusions most are due to acute rxn., chronic less common

Answer 26

pericarditis

Question 27

etiology of pericarditis: 1. infectious agents 2. immunologically mediated 3. miscellaneous

Answer 27

1. infectious agents: viruses, bacteria, TB, fungi, parasites 2. immuno: Rheum. fever, collagen dx., postcardiotomy, post MI 3. miscellaneous- uremia, neoplasia, trauma, radiation

Question 28

acute pericarditis: 1. cause 2. classification (5)

Answer 28

1. viral infections | 2. (i) serous (ii) fibrinous and serofibrinous (iii) purulent or suppurative (iv) hemorrhagc (v) caseous

Question 29

inflammatory reaction of the epicardial and pericardial surfaces with scant inflammatory cells and slow accumulation of fluid - susually non-infectious causes, Rheum. fever, SLE, scleroderma, tumors , uremia

Answer 29

serous pericarditis

Question 30

inflammatory reaction of the epicardial and pericardial surfaces in the form of an exudate with ot w/out resolution - MI, post MI, uremia, chest radiation, Rheum. fever, SLE, trauma

Answer 30

fibrinous pericarditis

Question 31

fibrinous pericarditis 1. frequent or rare? 2. what do we hear?

Answer 31

1. most frequent type of pericarditis | 2. loud pericardial friction rub

Question 32

inflammatory rxn. in the form of an exudate usually secondary to microorganisms in the pericardial space by direct extension, blood or lymphatics - usually no resolution with organzation - friction rub

Answer 32

purulent pericarditis

Question 33

a bloody and fibrinous exudate is present, usually secondary to alignant neoplastic involvement, TB and bleeding diathesis

Answer 33

hemorrhagic pericarditis

Question 34

pericardial involvement by direct spread form a tuberculous foci within the tracheobroncial lymph nodes

Answer 34

caseous pericarditis

Question 35

chronic fibrosing disease of the pericardium

Answer 35

constrictive pericarditis

Question 36

constrictive pericarditis: 1. gross heart 2. usually begins with an 3. progression 4. what is the result 5. etiology

Answer 36

1. fibrotic, thickened, and adherent pericardium restricts diastolic filling of the heart 2. begins with an episode of acute pericarditis 3. progression: (a) progresses slowly to a subacute stage of organization and resorption of effusion (b) leading to fibrous scarring and thickening of the pericardium with obliteration of the pericardial space 4. uniform restriction of the filling of all heart chambers 5. idiopathic, TB in 15% of the cases

Question 37

myocardium is scarred, thickened with narrowed venae cava, a small, quiet heart with restricted venous inflow and low diastolic volume

Answer 37

constrictive pericarditis

Question 38

found deep in the pericardial surface, may involve the pericardium, endocardium, and aorta

Answer 38

rheumatoid nodules

Question 39

rheumatoid heart disease can lead to _______ in about 20%

Answer 39

fibrinous pericarditis