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Test-5-Clinical Med

Myocarditis Cardiomyopathy Rheumatic

Myocarditis is the cause of sudden cardiac death in approx what % of cases? 9%
Most recently what has been the most commonly detected viral genome causing myocarditis? Parvovirus B19
Early on Enterovirus was a major cause of myocarditis now the major cause is what NONenterovirus? HCV = hepatitis C virus; HHV6 = human herpesvirus 6; PV-B19 = parvovirus B19 (currently).
Patients with Myocarditis most of the time are asymptomatic. Patients who experienced symptoms had what symptom 72% of the time? 72% had dyspnea, 32% chest pn, 18% arrhythmias.
What can acute focal myocarditis mimic? Myocardial infarction, acute onset of chest pain, tachyarrhythmia, or sudden death.
Levels of cardiac biomarkers CK-MB, troponin 1 and troponin T are elevated in a minority of case with what condition? Myocarditis, Troponin 1 increased most frequently with acute myocarditis.
Why is echocardiography an important component of dx work up in myocarditis? Establish LV function and rule out other causes of heart failure.
With myocarditis coronary angiography usually reveals what findings of the coronary arteries? Normal
What non-invasive imaging is useful to dx myocarditis associated with edema, hyperemia, or fibrosis? Cardiac MRI
What is required to confirm the Dx of Myocarditis? and what are its limiting factors? Histologic Exam of heart biopsy. Limited b/c error from patchy inflam infiltrates
Hemodynamically stable Pt with myocarditis and Sx heart failure may benefit from what Meds? ACE inhibitor or ARB (angiotensin receptor blockade).///beta blockers may improve LV function and decrease inflammation
Dx of Acute myocarditis at this time would recommend Antiviral therapy? True of false? False.
Acute myocarditis Pts recovering should be recommended to or not to start aerobic exercise? yes or no No aerobic activity for several months. and low NA diet and avoidance of NSAIDs.
Pts with fulminant (explosive/sudden and sharp) onset myocarditis had a better or worse prognosis than acute nonfulminant myocarditis? Better with fulminant.
What should always be considered as a cause of Acute DCM? Recent viral infection, be mindful of the spectrum of viruses that cause myocarditis and its continuum to change.
What are 4 types based on structure and function of the chambers of the heart of cardiomyopathy? 1. Dilated // 2.Hypertrophic // 3. Restrictive // 4. Arrhythmogenic right ventricular cardiomyopathy
What is characterized by enlargement and impaired systolic functions of primarily the LV, but can be both? DCM - Dilated CArdiomyopathy // Etiology: genetic, viral, Toxin (ETOH), pregnancy, nutritional (SCurvy)
Pulmonary Crackles (rales), narrow pulse pressure, right sided failure with hepatomegally are clinical presentation of what? Dilated Cardiomyopathy
DCM will have what findings on CXR? CArdiomegally, pulmonary venous congestion, pleural effusion. L side heart is weak and causes back up in lungs.
What is the tx for DCM? Correct potentially reversible causes (ETOH, Scurvy), /// Loop Diuretics in volume overload//// Vasodilators to dec afterload (ACEI, ARB, Nitrates)
Hypertrophic Cardiomyopathy differs from DCM how and what is primarily the cause of Hypertrophic Caridomyopathy? DCM is dilating of ventricle with no increase in wall size. /// Hypertrophic CArdiomyopathy has increased wall size. // Primarily Hypertrophic Cardio disease due to LV outflow obstruction, with diastolic dysfunc, mitral regurg and arrhythmias.
Pulsus biferiens is an initial brisk upstroke with subsequent weakening and then another upstroke which is found in what DCM or Hypertrophic cardiomyopathy? Hypertrophin cardiomyopathy.
What is the Tx of Hypertrophic cardiomyopathy? Reduce outflow track obstruction, improving diastolic dysfunction and arrhythmias.
What meds are used to Tx Hypertrophic cardio? B blockers to decrease rate and caontractility, Pacemakers to control pacing of right vent separately from left vent.//septal surgery or ablation b/c sometimes this blocks blood outflow.
Increased myocardial stiffness causes LV pressures to rise w/o an increase in LV volume is what condition? Restrictive Cardiomyopathy - muscle does not expand (stiffer) causing increase pressure with same volume of blood.
M/C form is Familial amyloidosis in what cardiomyopathy? Restrictive. Dx should be considered in patients with primarily RV failure w/o cardiomegaly or systolic dysfunc.
Will Diuretic help or worsen Restrictive cardiomyopathy? Worsen, decreases intravasular volume making CO worse. Tx should focus on etiologies (phlebotomy in hemochromatosis, or chelation - removal of heavy metals in system)
Acute rheumatic fever/chronic rheumatic Heart disease affect which valve or valves? Mitral>Aortic, stiffening of valve cusps and shortening of chordae tendineae
Rheumatic Fever Beta Streptococcal infection is remembered by using the JONES PEACE criteria, what does it stand for? Joints: migratory..O (heart shape) carditis (new onset murmur)..Nodules, subcutaneous: extensor surfaces..Erthema marginatum..Sydenham's chorea/// minor criteria: P-r interval prolonged..Esr elevated..Arthralgias..Crp elevated..Elevated temperature(fever)
Use of JONES (major) PEACE (minor) criteria you need how many major or how many major and minor plus evidence of recent GAS infections (throat culture, rapid antigen test, or rising strep antibody titer)? 2 major // or // 1 major and 2 minor
Created by: cmuox2000