pericarditis, myocarditis, and endocarditis Flashcards Preview

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Flashcards in pericarditis, myocarditis, and endocarditis Deck (18):

What are the common etiologies of pericarditits, myocarditis, and endocarditis?

pericarditis in the community is usually viral. in the hospital, it is usually non-infectious: post MI, uremia, hypothermia, bypass, malignancy
myocarditits: viral >> bacterial. (ocasional toxins- very rare)
endocarditis: bacterial >> viral


mechanism of damage in pericarditis and myocarditis

coxachie, adeno, or rheumatic fever, toxic. may be via direct destruction


predisposing factors for endocarditis

infectious agent in the blood stream and endocardial lesion (except occasioally S aureas from IV drug use)


Pain in pericarditis

sharp and positional; usually better sitting forward and worse lying down. afferent fibers with the phrenic nerve


pain in myocarditis

through the myocardial mechanism- poorly localized


pain in endocarditis

often none, unless the infection spreads to the myocardium


PE findings in pericarditis

rub that is present when the pt holds his breath and cycles with the pericardial cycle.


PE findings in myocarditis

none, or potentially an S4


PE findings in endocarditis

classically, a new murmur as a high velocity jet of blood goes through a narrow orifice. vegetations are usually on the low pressure sides of valves and usually cause regurg murmurs


EKG findings for pericarditis

diffuse ST elevation, though focal ST elevations are possible. Only exception is that AVR usually shows ST seg depression.
often see PR depression in the atrium


EKG findings in myocarditis

EKG changes in a patchy distribution (patchiness also means biopsy is only 30% sensitive)
hard to distinguish from coronary ischemia


EKG changes with endocarditis

potentially PR increase. no ST changes unless infection gets to the myocardium. you can see prolongation of PR interval as infection spreads to AV node


troponin in pericarditis, myocarditis, and endocarditis

may be elevated in pericarditis and myocarditis
not usually elevated in endocarditis unless the infection invades the myocardium.
this is a lengthy troponin elevation- helps distinguish it from MI, which usually shows rapid rise and fall


DDx of pericarditis

pleuritic pain, pneumonia
this is a clinical diagnosis- you must see rub, EKG, chest pain- 2/4 criteria:
1. rub
2. pain
3. EKG changes
4. Echo with effusion


myocarditis DDx

coronary ischemia, vasospastic angina
potentially with angiogram you will have a pt without coronary disease. if the pt has co-existing coronary disease or vasospastic angina, it can be very hard.
try cardiac MRI with uptake of gadolinium. IF it is myocarditis, uptake will be very patchy


Tx of pericarditis and complications

NSAIDs, colchicine to reduce recurrence (but be wary of bad diarrhea)
watch for tamponade and pericardial constriction
Inflammed pericardium may heal with a rigid scar and can act like an eggshell around the heart to prevent expansion during diastole


Tx for myocarditis and complications

steroids, IVIg, antivirals, but nothing is actually effective. basically, do supportive care and exclude ischemia
this is a problem, since myocarditis can be fulminant and lead to severe arrhythmias and death


Tx of endocarditis and complications

IV abx. long duration, cidal. usually 4-6 wks of continuous IV therapy. can be accomplished as an outpatient.
complications: valve destruction, CHF, septic emboli, infarcts, myocarditis
if these are occuring, you must make a difficult decision about valve replacement- if you put a new valve in before the infection has been cleared, it will invite infection. On the other hand, waiting too long invites further complications