Myocarditis and Infectious Diseases
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Questions and Answers

What is the most common cause of myocarditis worldwide?

  • Influenza A/B
  • Enteroviruses
  • Trypanosoma cruzi (correct)
  • Adenovirus

    • Which of the following is NOT a viral cause of myocarditis?

  • Streptococcus (correct)
  • Coxsackie B
  • Influenza A/B
  • Adenovirus

    • What is the mechanism by which Coxsackie B virus causes autoimmune destruction in myocarditis?

  • Sharing of 50% same amino acid sequences with beta myosin chain (correct)
  • Toxicity to cardiac cells
  • Endotoxins production
  • Direct invasion and necrosis

    • Which of the following systemic diseases is associated with myocarditis?

    <p>All of the above</p> Signup and view all the answers

    What is the treatment for Chagas disease?

    <p>Nifurtimox</p> Signup and view all the answers

    What percentage of HIV patients have myocarditis on autopsy?

    <p>46%</p> Signup and view all the answers

    What is the estimated percentage of ED patients presenting with chest pain who will have Benign Early Repolarisation (BER) on their ECG?

    <p>10-15%</p> Signup and view all the answers

    What is the primary use of ancillary tests in diagnosing pericarditis?

    <p>To rule out other diagnoses</p> Signup and view all the answers

    In which age group is Benign Early Repolarisation (BER) least common?

    <p>Over 70 years</p> Signup and view all the answers

    What is the gold standard for diagnosing pericarditis with effusion?

    <p>Echocardiogram</p> Signup and view all the answers

    What is the primary reason to avoid diagnosing Benign Early Repolarisation (BER) in patients over 50 years?

    <p>ST elevation is more likely to represent myocardial ischemia</p> Signup and view all the answers

    What is the recommended treatment for suspected viral pericarditis?

    <p>Anti-inflammatory medications</p> Signup and view all the answers

    What is a common clinical feature that suggests a myotropic pathogen?

    <p>Tachycardia out of proportion to fever</p> Signup and view all the answers

    What is the role of MRI in diagnosing myocarditis?

    <p>It is a useful tool for diagnosing myocarditis, especially with contrast enhancement</p> Signup and view all the answers

    What is the significance of a normal antimyosin scan in a patient with suspected myocarditis?

    <p>It excludes the diagnosis of acute myocardial infarction (AMI) and myocarditis</p> Signup and view all the answers

    What is the gold standard for diagnosing myocarditis?

    <p>Endomyocardial biopsy</p> Signup and view all the answers

    What is the primary goal of ED treatment for myocarditis?

    <p>Cardiac monitoring and bed rest</p> Signup and view all the answers

    What is the indication for anticoagulation in myocarditis?

    <p>Detection of intracardiac thrombi on echo</p> Signup and view all the answers

    What is the significance of histological changes in myocarditis?

    <p>It indicates a worse prognosis</p> Signup and view all the answers

    What is the goal of definitive treatment of myocarditis?

    <p>Treatment of the underlying cause of myocarditis</p> Signup and view all the answers

    What is the primary goal of treatment for viral pericarditis?

    <p>To provide pain and fever relief</p> Signup and view all the answers

    What is the minimum amount of fluid required in the pericardium to cause decompensation?

    <p>80-100cc</p> Signup and view all the answers

    What is the primary cause of low-pressure tamponade?

    <p>Severe dehydration</p> Signup and view all the answers

    What is the sensitivity of echocardiography in diagnosing pericardial tamponade?

    <p>98.1%</p> Signup and view all the answers

    What is the primary feature of Beck's triad?

    <p>All of the above</p> Signup and view all the answers

    What is the primary indication for pericardiocentesis?

    <p>Diagnostic and therapeutic</p> Signup and view all the answers

    What is the primary complication of pericardiocentesis?

    <p>All of the above</p> Signup and view all the answers

    What is the primary indication for admission in a patient with viral pericarditis?

    <p>Cannot rule out MI</p> Signup and view all the answers

    What is the primary cause of traumatic tamponade?

    <p>Penetrating trauma</p> Signup and view all the answers

    What is the primary feature of ultrasound in diagnosing pericardial tamponade?

    <p>All of the above</p> Signup and view all the answers

    What is the most common cause of viral pericarditis?

    <p>All of the above</p> Signup and view all the answers

    What is the function of pericardial fluid?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of pericardial pain?

    <p>Pleuritic pain</p> Signup and view all the answers

    What is the diagnosis of pericarditis in the presence of concomitant pneumonia or empyema?

    <p>Pericardiocentesis</p> Signup and view all the answers

    What is the treatment of uremic pericarditis?

    <p>ICU admission and NSAIDs</p> Signup and view all the answers

    What is the characteristic ECG finding in pericarditis?

    <p>All of the above</p> Signup and view all the answers

    What is the stage 2 of pericarditis on ECG?

    <p>ECG transiently normal</p> Signup and view all the answers

    What is the complication of pericarditis?

    <p>All of the above</p> Signup and view all the answers

    What is the etiology of pericarditis?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of pericardial friction rub?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Pericarditis and Myocarditis

    Pericarditis

    • Non-specific inflammation of the pericardium, a rare emergent condition
    • Pericardial effusion: accumulation of fluid in the pericardial space, which can be serous, purulent, fibrinous, or hemorrhagic
    • Cardiac tamponade: impairment of ventricular filling due to fluid in the pericardial space, an emergent condition

    Pericardial Physiology

    • Two layers: parietal (thick, collagenous, stiff) and visceral (thin, closely adherent to epicardial surface)
    • Pericardial fluid: normally 15-60 cc, prevents friction, prevents infection, augments atrial filling, and maintains normal pressure-volume relationship
    • No physiological consequence to absent pericardium

    Pericardial Innervation

    • Parasympathetic (vagus, left recurrent laryngeal nerve)
    • Sympathetic (stellate, first thoracic ganglia)
    • Little somatic sensory innervation, resulting in visceral nature of chest pain

    Etiology of Pericarditis

    • Viral (most common, e.g., enteroviruses, HIV)
    • Bacterial (e.g., streptococcus, staphylococcus, gram-negatives, anaerobes, TB, Lyme disease)
    • Traumatic
    • Malignant (e.g., lung, breast, lymphoma, leukemia, melanoma)
    • Post-irradiation
    • Post-MI (e.g., Dressler's syndrome)
    • Collagen vascular disease (e.g., RA, SLE)
    • Drug-induced (e.g., SLE-like syndrome, procainamide, hydralazine, methyldopa, reserpine, doxorubicin)

    Viral Pericarditis

    • Most common cause of pericarditis
    • Mechanism of injury: direct viral cytotoxicity and indirect auto-antibody-mediated effects
    • Syndrome may be immediate or develop 2-4 weeks post-viral illness
    • Symptoms: chest pain, pericardial friction rub, fever, tachycardia, tachypnea, dyspnea, and diaphoresis

    ECG in Pericarditis

    • 4 stages of evolution over 3-4 weeks
    • Only 50% of patients have all 4 phases
    • Stage 1: diffuse ST elevation, PR depression, and reciprocal ST depression
    • Stage 2: ECG transiently normal, some T-wave flattening
    • Stage 3: T-wave inversion, deep and uniform
    • Stage 4: return to normal, some patients with residual T-wave inversion

    Management of Pericarditis

    • Treat underlying cause
    • Colchicine (1-2 mg PO OD) for pain and inflammation
    • Steroids (only if NSAID-resistant)
    • Admit if cannot rule out MI, pain control, or if effusion suspected

    Myocarditis

    • Inflammation of the myocardium
    • Etiology:
      • Viral (most common, e.g., enteroviruses, adenovirus, influenza)
      • Bacterial (e.g., S. aureus, streptococcus, mycoplasma, diphtheria)
      • Spirochetal (e.g., Lyme disease)
      • Mycotic (e.g., candida, aspergillus)
      • Rickettsial (e.g., Rocky Mountain Spotted Fever)
      • Helminthic (e.g., trichinosis, schistosomiasis)
      • Protozoal (e.g., Chagas disease)
      • HIV
      • Drugs (e.g., cocaine, emetine, doxorubicin, HIV treatment)
      • Systemic diseases (e.g., collagen vascular disease, sarcoidosis, Kawasaki's disease)

    Pathophysiology of Myocarditis

    • Three major mechanisms:
      1. Myocardial necrosis from direct invasion
      2. Autoimmune destruction (e.g., beta myosin chain and coxsackie B share 50% same amino acid sequences)
      3. Endotoxins produced by pathogens

    Clinical Features of Myocarditis

    • VERY NON-SPECIFIC!
    • Tachycardia out of proportion to fever
    • Severe myalgias
    • Non-anatomical ECG changes
    • Continued pain with no ECG evolution
    • Global (vs segmental) wall motion abnormalities on echo
    • Unexplained CHF or dysrhythmias in previously healthy patient

    Diagnosis of Myocarditis

    • MRI (contrast-enhanced, shown to be useful, maybe the future?)
    • Antimyosin scintigraphy (Indium-111, binds to exposed myosin in damaged myocardium)
    • Endomyocardial biopsy (gold standard, Dallas criteria used to standardize diagnosis)

    Treatment of Myocarditis

    • ED treatment:
      • Bed rest
      • Cardiac monitoring
      • Management of arrhythmias
      • CHF treatment (cautious, aggressive preload or afterload reduction may cause cardiogenic shock)
      • Anticoagulation (if intracardiac thrombi detected on echo)
    • Definitive treatment: treat specific cause if possible (e.g., Chagas disease, Lyme disease)

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    Related Documents

    Pericarditis, Myocarditis.ppt

    Description

    Test your knowledge on myocarditis, its causes, mechanisms, and relationships with various diseases. From viral causes to autoimmune destruction and treatment options, assess your understanding of this critical topic.

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