Pericarditis & Myocarditis

Question 1

What is pericarditis?

Answer 1

Inflammation of the pericardium (double-walled membrane that encloses heart)

Pericarditis can lead to complications such as pericardial effusion and cardiac tamponade.

Question 2

What is myocarditis?

Answer 2

Inflammation of the myocardium (heart muscle), resulting in cardiac myocyte degeneration and necrosis

Myocarditis can severely affect heart function.

Question 3

What does the acronym CARDIAC RIND stand for in the context of pericarditis and myocarditis causes?

Answer 3

C: Collagen vascular diseases and CDs, A: Aortic aneurysm, R: Radiation, D: Drugs, I: Infections, A: Acute renal failure, C: Cardiac infarction, R: Rheumatic fever, I: Injury and hypersensitivity reactions, N: Neoplasms, D: Dressler’s syndrome

This acronym helps to remember the various causes of pericarditis and myocarditis.

Question 4

What are the three main effects of pericarditis pathophysiology?

Answer 4

Inflammation, pericardial effusion, fibrosis

These effects can lead to significant clinical symptoms and complications.

Question 5

What is pericardial effusion?

Answer 5

Fluid accumulation in the pericardial sac

Can be serous, haemorrhagic, or purulent and causes reduced diastolic filling.

Question 6

How does inflammation affect the pericardium?

Answer 6

Causes pericardial effusion and results in a fibrinous reaction leading to pericardial fibrosis and constriction

The parietal layer of the pericardium is sensitive to inflammation.

Question 7

What is the most common symptom of pericarditis?

Answer 7

Chest pain that can be stabbing or dull pressure-like

Pain is felt retrosternal or on the left side of the chest and can refer to the shoulder and arms.

Question 8

What are some flu-like symptoms associated with pericarditis?

Answer 8

Lightheadedness, fever, shortness of breath (SOB), nausea

These symptoms accompany the chest pain in pericarditis.

Question 9

What are some examination findings in pericarditis?

Answer 9

Pericardial rub, cardiomegaly on percussion, distant heart sounds

These findings can help diagnose pericarditis during a physical examination.

Question 10

What are the three important complications of pericarditis?

Answer 10

Pericardial effusion, constrictive pericarditis, cardiac tamponade

These complications can lead to serious clinical outcomes.

Question 11

What is constrictive pericarditis?

Answer 11

Thickened, fibrosed pericardium forms a rigid shell around the heart

Causes are usually idiopathic but can arise from any cause of pericarditis.

Question 12

What are the main causes of constrictive pericarditis?

Answer 12

Usually idiopathic, but can be due to any cause of pericarditis

Examples include infections, autoimmune diseases, and malignancies.

Question 13

What is the pathophysiology of constrictive pericarditis?

Answer 13

Inflammatory exudate and neutrophils result in a fibrinous reaction leading to pericardial fibrosis and constriction, causing increased systemic venous pressure and low cardiac output.

Question 14

What are the clinical presentations of constrictive pericarditis?

Answer 14

Increased systemic venous pressure: Elevated JVP, peripheral edema, ascites, hepatomegaly.

Question 15

List the five examination findings associated with constrictive pericarditis.

Answer 15

• Elevated JVP and distended neck veins
• Tachycardia
• Kussmaul sign
• Distant heart sounds
• Pericardial knock

Question 16

What is the triphasic model of myocarditis pathophysiology?

Answer 16

1. Direct damage to myocardium caused by primary triggers (e.g., viruses, autoimmunity, toxins)
2. Immune-mediated disease by cytokines, anti-heart antibodies, T-cells
3. Resolution and full recovery or chronic inflammation progressing to dilated cardiomyopathy.

Question 17

What are the symptoms of myocarditis?

Answer 17

Chest pain, arrhythmias, acute or chronic heart failure, flu-like symptoms.

Question 18

What are the characteristics of chest pain in myocarditis?

Answer 18

Pressure, tightness or squeezing in the chest that is worse on inspiration.

Question 19

What arrhythmias are commonly associated with myocarditis?

Answer 19

Usually AV block or ventricular tachycardias.

Question 20

What are the four important complications of myocarditis?

Answer 20

• Sudden cardiac death
• Dilated hypertrophy
• Heart failure
• Cardiogenic shock

Question 21

What is the first-line investigation for pericarditis and myocarditis?

Answer 21

Transthoracic echocardiography (TTE).

Question 22

What is pericardiocentesis?

Answer 22

A procedure to drain excess pericardial fluid with a needle, which can be therapeutic and diagnostic.

Question 23

What are the ECG findings for pericarditis?

Answer 23

Wide saddle-shaped ST elevation and PR segment depression.

Question 24

What are the ECG findings for myocarditis?

Answer 24

Sinus tachycardia.

Question 25

What lab tests are commonly performed in the evaluation of pericarditis and myocarditis?

Answer 25

Inflammatory markers and blood cultures.

Question 26

What imaging test is used to assess for cardiomegaly in myocarditis?

Answer 26

Chest x-ray.

Question 27

Fill in the blank: Myocarditis can mimic _______.

Answer 27

MI.

Question 28

What is the purpose of cardiac catheterisation in the context of heart muscle biopsy?

Answer 28

To test for infection ## Footnote Cardiac catheterisation allows for direct sampling of heart tissue.

Question 29

What is the primary management strategy for pericarditis?

Answer 29

Treat underlying cause and pericarditis itself ## Footnote Management involves addressing both the cause and symptoms.

Question 30

What medications are typically used for acute pericarditis?

Answer 30

NSAIDs and colchicine ## Footnote These medications help reduce inflammation and pain.

Question 31

What surgical intervention may be required for congestive pericarditis?

Answer 31

Surgery to remove fibrotic shell ## Footnote This procedure helps relieve symptoms caused by the fibrous layer.

Question 32

What is pericardiocentesis?

Answer 32

A procedure to remove fluid from the pericardial space ## Footnote It is often done to relieve pressure on the heart.

Question 33

What is the management approach for myocarditis?

Answer 33

Treat underlying cause and myocarditis itself ## Footnote Similar to pericarditis, it involves addressing both cause and symptoms.

Question 34

What treatments are used for autoimmune causes of myocarditis?

Answer 34

Corticosteroids or immunosuppressants ## Footnote These drugs help reduce immune-mediated damage to the heart.

Question 35

What types of drugs are administered for infections causing myocarditis?

Answer 35

Drugs for infections ## Footnote This may include antibiotics or antiviral medications.

Question 36

What types of support may be provided for severe myocarditis?

Answer 36

Mechanical support such as: * Intra-aortic balloon pump * Ventricular assist device * ECMO ## Footnote These devices help maintain circulation and support heart function.

Question 37

What is a potential treatment option for severe myocarditis?

Answer 37

Heart transplant ## Footnote This is considered when other treatments are not effective.