Pericardial Disease + Myocarditis

Question 1

What is myocarditis

Answer 1

Inflammation of the myocardium
Acute or chronic
Causes reduced function and conduction
Often associated with pericarditis

Question 2

What causes myocarditis

Answer 2

Idiopathic = 50%
Viral
Bacterial
Fungal
Parasitic
Toxins
Hypersensitivity 
Autoimmune

Question 3

What are viral causes

Answer 3

Adenovirus
Enterovirus
Coxsackie
CMV
Influenza
EBV
HSV
Hepatitis
Mumps
Rubella
HIV

Question 4

What are bacterial causes

Answer 4

Staph and strep
Chlamydia
Mycoplasma pneumoniae
TB
Meninigococcus
Treponema pallidum (syphillis) 
Brucellosis
Psittacosis

Question 5

What are fungal causes

Answer 5

Aspergillus

Candida

Question 6

What are parasitic causes

Answer 6

Schistosomiasis
Toxoplasmosis
Lyme’s
Leptospirosis

Question 7

What toxins can cause

Answer 7

Alcohol
Lithium
Cocaine

Question 8

What other drugs can cause

Answer 8

Cephalosporin
TCA
Penicillin
Sulphonamide
Cyclophosphamide
Spirnolactone 
Carbamazepine
Clozapine

Question 9

What autoimmune can cause

Answer 9

SLE
Sarcoid
Churg-Strauss
Sjogren
Microscopic 
Macroscopic
Kawasai

Question 10

How does myocarditis present

Answer 10

ACS
HF
Arrythmia
Palpitation
Fatgiue
Chest pain -pleuritic 
SOB
Fever
Tachycardia

Question 11

How do you Dx myocarditis

Answer 11

ECG
Cardiac biomarkers consistent with MI
ECHO = diastolic dysfunction / effusion
Bloods - raised ESR / CRP
MRI if stable
Biopsy = diagnostic 
Serology for cause

Question 12

What does ECG show

Answer 12

Persistent ST elevation >3 hours - would evolve if ischaemia
T wave inversion
AV block
Prolonged QT

Question 13

How do you treat myocarditis

Answer 13

Treat cause

Support HF

Question 14

What are the complications of myocarditis

Answer 14

Impaired function
Impaired conduction
Arrythmia
DCM

Question 15

What is pericarditis

Answer 15

Inflammation of pericardium (lining of heart) with or without myocardial involvement

Question 16

What causes pericarditis

Answer 16

POST MI
MYOCARDIAL RUPTURE 
Post viral - cocksackie 
Aortic dissection
Same causes as myocarditis
Cancer
Hypothyroid

Question 17

What are the symptoms of pericarditis

Answer 17

Pleuritic chest pain
Worse lying flat
Better sitting forward
Fever
Cough
SOB
Flu like symptoms prior 
Pericardial rub 
Pericardial effusion - JVP / low BP
Cardiac tamponande

Question 18

How do you Dx pericarditis

Answer 18

ECG
ECHO if suspect to look for fluid 
Bloods - FBC, U+E, LFT, CRP
Cardio biomarkers - troponin may be raised 
Bloods for cause 
CXR - effusion

Question 19

What does ECG show

Answer 19

Widespread ST changes

PR depression = pathomenumonic

Question 20

How do you Rx

Answer 20

Colchicine / NSAID for idiopathic / viral
Treat cause
Consider steroid if not improving

Question 21

What causes pericardial effusion

Answer 21

Same as pericarditis
Rupture - post MI / trauma / haemopericardium
Aortic dissection
Malignnaayc

Question 22

How does effusion present

Answer 22

SOB
FAtigue
Dizzy
Hypotension
Chest pain 
Pulsus paradoxus - decreased systolic on inspiration
Raised JVP
Muffled heart sounds

Question 23

How do you Dx

Answer 23

ECHO
CXR
ECG

Question 24

What does ECG show

Answer 24

Electrical pulses alternans (alternating height of QRS as heart swings back and forward)

Question 25

How do you treat

Answer 25

Pericardiocentesis - diagnostic and therapetuic

Question 26

What do you do with fluid

Answer 26

Send for ZN / culture / cytology | Most causes are exudates

Question 27

What are sings that structures being compressed by effusion

Answer 27

Phrenic nerve - nausea due to diaphragm Bronchial breathing - compressed base Hoarse voice - recurrent laygneal Horner - sympathetic

Question 28

What is constrictive pericarditis

Answer 28

Impaired filling of heart due to rigid pericardium even though myocardium is normal Very rare

Question 29

What causes constrictive pericarditis

Answer 29

``` Any cause particularly TB Idiopathic Radiation Post op Autoimmune SArcoid ```

Question 30

How does constrictive pericarditis present

Answer 30

``` RHF Increased JVP (X+Y) Fatigue SOB Couh Ascites Oedema Hepatomegaly Jaundice Kausmaul - JVP rise with inspiration (should decrease) ```

Question 31

How do you Dx constrictive pericarditis

Answer 31

CXR - calcification / small heart ECHO Right heart Cath / angio / MRI to differentiate from restrictive cardiomyopathy

Question 32

How do you treat

Answer 32

Diuretic | Pericardiotomy

Question 33

What are the complications

Answer 33

Pleural effusion | AF

Question 34

How do you differentiate from tamponade

Answer 34

X and Y descent Kausmaul sign present Calficication on CXR NO pulses paradoxus

Question 35

What is cardiac tamponade

Answer 35

Accumulation of fluid under pressure reducing ventricular filling and CO

Question 36

What causes

Answer 36

``` Post PCI / cardiac surgery Effusion Trauma - RTA Lung and breast Ca Pericarditis MI Bacteria e.g. TB ```

Question 37

What are the signs of tamponade

Answer 37

TRIAD Hypotension Muffled heart sounds Raised JVP - absent Y SOB Tachy Pulsus paradoxus - large drop in BP on inspiration NO KAUSMAUL

Question 38

How do you Dx

Answer 38

Beck trial ECG ECHO

Question 39

What does ECG show

Answer 39

Electrical alternans

Question 40

How do you treat

Answer 40

``` Urgent pericardiocentesis and send fluid HELP O2 Monitor ECG Group and save ```

Question 41

What are the outcomes

Answer 41

Cardiac arrest and shock rapidly

Question 42

What may patient have before pericarditis

Answer 42

Infection - viral cold etc