Nu 735 Myocarditis and Pericarditis Flashcards
(29 cards)
****Acute Myocarditis : Fulminant Myocarditis
Miocardium muscular layer of heart also know as rebdo myocetes
Arrange in spide shape
Pathophysiology
Direct injury and invasio to myocardium
* Production of cardiotoxic substances
* Chronic inflammation w/wo infectio
Acute Myocarditis
Mode of Transportation
- Organ Receptor specific > Coxsackie- adenovirus receptor on heart
- Respitory > Viral > Organ receptor specific > Coxsackie- adenovirus receptor on heart.
Acute Myocarditis
Primary vs Secondary
a. **Primary Cause **
- Acute viral infection
- Post Viral Immune Response
- Protozoan TRypanosoma Cruzi
- Fulminant Myocaditis ( form acute myocarditis)
b. Secondary Cause
Non-invesive Inflammatory Response
Medicatiosn
Chemical Agents
Inflammatory Disease (loopus)
Acute Myocarditis
Clinica Manifestions
a. Young to middle age adults
Recent viral syndrome
Progressive dyspnea, weakness, fever, myalgias
b. Heart Failure
c. Chest pain that mimics pericarditis or AMI
d. Atrial or ventricular Tachyarrhythmia
e. Intracranial Thrombus (Emboli)
Acute Myocarditis
Fulminant Myocaditis ( form acute myocarditis) Due to Viral Invetion
Protozoan Trypanosoma Cruzi
*** Cardiogentic Shock **
* With Multiple organ failue
* characterized by severe LV dysfuntion
* May require Inotrops (force contraction increase CO) + Vent
* May leat ot Cadiomyopathy
**Laboratory (all non-specific)
- Elevated WBC, CRP, ESR
Troponin (only elevated 33% ; CK-MB only in 10%)
- Elevated WBC, CRP, ESR
**Diagnositic **
**a. EKG **
i. Non-specific tachycardia or arrhythmia
Ventricular conduction abnormalties
ii Ventricular conduction abnormalities +/- ectopy
iii. presence of Q-wave (droping) or LBBB
**b. Pulmonary HTN **
Pulmonary HTN
c. Chest X/Ray: Pulmonary edema
d. Endomyocadial Biopsy: Requires dx histology
Acute Myocaditis :
Threatment
Avoid Anti-inflammatories
and Immunosuppresents
Antimicrobial THerapy - can be given only of microbes identify
Ace
BBB
Diuretics
ECMO
Limit Exercies
Acute Myocaditis 2/2
Parasitic Involvement aka
Chaga’s Disease
1. Epidemiology
* 3rd most common parasitic infecion in the word
* Most common infection cause of cadiomyopathy
*** 2. Transmission **
a. Protozoa T cruzi via reduviid bug
**3. Managment **
a. Cardiomyopathy: HF threamtent
b. AV nodal dysfunction : Pacemaker
c. DVT +PE: Heparing
d. Antiparasitic therapy: Bensnidazole+nifurtimox (only pediatric )
Name of Acute Miocarditis caused by Parasitic Involent
Chaga’s Disease
Acute Myocarditis:
Toxoplasmosis
-
Trasmission
a. Undercooked infected beef. pork, or feline feces
b. Organ tranplant
c. Blood transfusion
2. At-Risk Population
Immunocompromized pt +s/s of myocarditis
IgG +
**3. S/s : **
* Pericardial effusion
* Constrictive pericarditis
* Encephalitis
* Chorioretinitis
4. Dx
a. IgM +IgG +
5. Tx
Pyrmethamine + Sulfadiazine OR
Clindamycin
Test
Causes of Toxoplasmoosis?
Diagnosis ?
**Causes **
Uncook meat
Organ Transplant
Blood Transfusion
**DX: **
IGM +IgG positive
Tx for Toxoplasmosis
Pyrimethamine + Sulfadiazine
or
Clindamycin
Acute Myocarditis : Bacterial Involvement
Epidemiology
a. Rare
b. Corynebacterium Diphtheria bacteria (50% of cases ) > Toxin released affecting cardiac conduction
c. At-risk: Non immune children ; Older adults no longer immune
**Pathology: **
Direct Invasion
Abcess formation
TX: Diphtheria Antitoxin therapy (DAT)
Antitoxintoxin Prioritized > Antibiotics
Name of Bacteria caused Acute Myocarditis
Corhnebaterium Diphtheriae
Acute Myocarditis :
Noninfective Involvement
**Etiology: **
a. **Cardiac Transpalant Rejection **
b. Cardiac Sarcoidosis
Tiny collections of immune cells that form granulomas in the heart
Interferes with mechanial function
c.** Giant cell myocarditis **
i. rare and Idiopathic disease
ii. Characterized by rapid onset HF + VT
Non-Invesive Myocarditis
S/s
Rapid onset HF
VT
Conduction block
Chest pain syndrome
**High Suspicious
V-tac or conduction blocks
rapid onset
Pericarditis
Acute Pericarditis
** Epidemiology **
a. Viral > Bacterial
b. Male <age 50 most affected
Acute Pericarditis
Classifiction
Acute: <6 weeks fibrinous (exudative) or effusion
Subacute Pericarditis: 6 wks to 6 month a/w effusion or contrictive
Chronic pericarditis > 6 moth a/w constrictive or adhesive
Acute Pericarditis S/s
a.** Chest pain**
* Pleuritic and postural
* * Susternal w/radiation > neck, Shoulder, back
* epigastrium
* Dyspnea and Fever
*
* **b. Pericardial fricion rub
**occur w/wo accumulation +/- restriction **
Highly specific Findings
**c. Diffuse non-specific ST elevation ** d. Pericardial effusion
Acute Pericarditis
DX
- Viral :
Clinical diagnosis w/leukocytosis
TTE: typicaly normal and r/o effusion
2. Bacterial
Dx pericardiocentesis
3. Uremic Pericarditis
Correlates wit BUN/Cr
Perigadium is Shaggy
Effusion is hemorrhagic and exudative
Pericaditis TX
- ASA 1 g Q 8 rhs w/taper +
- NSAID 600 to 800 mg TID
- PPI: cover NSAID
* Colchicine :
i. enhanced response of ASA
ii. dosing: <70g > 0.5 to 0.6
>701g > BID
*** Post MI: **
ASA and colchicine
Containidcated : NSAIDs and Corticosteroids
CRP: Prednisone 1mg /mg /day for 2 to 4 days then tapper
Cardiac Tamponade
Overview
- Accumulation fluids in Pericardium Space
- Fluids 200ml -2L to produce tamponate
- Elevated Intercranial Pressure >15 mmHG
i. IP Normal: -5 -5 mmHg - Obstruction LVOT
Tamponade
Etiology
i. Idiopathic Pericarditis
Pericarditis 2/2 Neoplastic disease, TB, or Hemorrhage
Fluids/Bloody
Neoplastic
Renal Failure
Cardiac Injury
