Myocarditis & pericarditis
- 1. MYOCARDITIS & PERICARDITIS K A R O L I N A S Ę C Z KO W S K A 5 D M 3 C
- 2. MYOCARDITIS • Myocarditis is an inflammation of the heart muscle(myocardium) • The inflammation can reduce the heart's ability to pump and cause rapid or irregular heart rhythms (arrhythmias). • symptoms of myocarditis include: chest pain, fatigue, shortness of breath, and rapid or irregular heartbeats, shortness of breath, at rest or during activity, swelling of the legs, ankles and feet, fatigue; Sometimes, myocarditis symptoms may be similar to a heart attack. • Early diagnosis of myocarditis is important to preventing long-term heart damage and its possible causes like: Heart failure, Heart attack or stroke, Sudden cardiac death.
- 3. PERICARDITIS • Pericarditis is swelling and irritation of the saclike tissue surrounding heart- pericardium. • Chest pain is the most common symptom of pericarditis. It usually feels sharp or stabbing. However, some people have dull, achy or pressure-like chest pain. • The sharp chest pain occurs when the irritated layers of the pericardium rub against each other. • The pain usually occurs behind the breastbone or in the left side of your chest and may spread to your left shoulder and neck. • It often gets worse when you cough, lie down or take a deep breath. • Sitting up and leaning forward makes you feel better. • Pericarditis is usually mild and goes away without treatment but more-severe cases may include medications and, rarely, surgery.
- 4. CAUSES MYOCARDITIS: • Viruses(most common):common cold (adenovirus); COVID-19; herpes simplex virus, echoviruses, Epstein- Barr virus and rubella v. • Bacteria: Corynebacterium diphtheriae, Borrelia • Parasites: Trypanosoma cruzi and toxoplasma gondii • Fungi: candida; molds, such as aspergillus; and other fungi, such as histoplasma PERICARDITIS: • Heart attack or heart surgery, which may trigger pericarditis • Infection(usually viral) • lupus and rheumatoid arthritis • Trauma • AND: kidney failure, AIDS, tuberculosis or cancer
- 5. CLINICAL FEATURES MYOCARDITIS • Often asymptomatic • Cardiac arrhythmias: sinus tachycardia, ventricular extrasystoles with palpitations or syncope, heart block with bradyarrhythmia • Auscultation findings: Brief systolic murmurs Heart failure: S3 and S4 galop, Pericarditis: pericardial friction rub (perimyocarditis) PERICARDITIS(ACUTE) • Improves on sitting and leaning forward & can radiate to the neck and shoulders • Pericardial friction rub: high-pitched scratching on auscultation Best heard over the left sternal border during expiration while the patient is sitting up and leaning forward; Occurs in atrial and ventricular systole, as well as early diastole • Pericardial effusion Faint heart sounds; Ewart sign(described as an area of dullness)
- 6. DIAGNOSTICS • Patients suspected of myocarditis should have an ECG and laboratory tests conducted to support the diagnosis but if diagnosis is unclear, a biopsy may be indicated to help determine treatment. • ECG/24-hour Holter monitoring • Chest x-ray and CT: cardiac enlargement, pleural effusions • Laboratory findings: ↑ Cardiac enzymes, ↑ ESR CRP, Leukocytosis, Virus serology • At least two of the following four criteria must be present for a diagnosis of acute pericarditis: 1. Characteristic chest pain 2. Pericardial friction rub 3. New or worsening pericardial effusion 4. Typical ECG changes: (diffuse ST elevations, ST depression in aVR and V1, PR segment depression) • Cardiac MRI (Thickened pericardium, pericardial enhancement, pericardial effusion)
- 7. TREATMENT Myocarditis: • cardiac monitoring, oxygen administration, management of fluid status • Antibiotic therapy for bacterial infection • Antimycotic therapy e.g. amphotericin B for fungal infections • Treatment of complications- Congestive heart failure: (e.g., management of fluid accumulation with diuretics, beta blockers, ACE inhibitors) • Heart transplantation Pericarditis: Acute pericarditis is often self-limited but NSAIDs can alleviate symptoms and prevent a recurrence. Consider anti- inflammatory therapy also for chronic pericarditis. • NSAID therapy: Aspirin, Ibuprofen • colchicine • prednisone(only in severe cases) • Pericardiocentesis (done to remove of fluid that has built up in the pericardium)
- 8. • The ECG findings most commonly seen in myocarditis are diffuse T wave inversions; saddle-shaped ST- segment elevations may be present (these are also seen in pericarditis). • Findings on chest x-ray suggestive of myocarditis include cardiomegaly, pericardial thickening in presence of pericarditis, pulmonary edema, and pleural effusion. • MRI shows thickening of the pericardium; abnormal contour of the ventricles; an enlarged atria; a dilated inferior vena cava, superior vena cava, and hepatic veins; and bilateral pleural effusions.
- 9. SOURCES: • https://www.amboss.com/us/knowledge/Myocarditis/ • https://www.amboss.com/us/knowledge/Pericarditis • https://www.mayoclinic.org/diseases-conditions/myocarditis/symptoms-causes/syc- 20352539 • https://www.mayoclinic.org/diseases-conditions/myocarditis/diagnosis-treatment/drc- 20352544 • https://www.mayoclinic.org/diseases-conditions/pericarditis/symptoms-causes/syc- 20352510
- 10. THANK YOU!