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Pericarditis and Myocarditis

Pericarditis and Myocarditis . What is pericarditis ?. “ Inflammation of the pericardium”. Symptoms. Chest pain Dry cough, fever , fatigue Pericardial rub ST elevation on ECG Cardiac tamponade CCF. Causes. Infection -viral, bacterial Secondary to recent cardiac surgery Post MI

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Pericarditis and Myocarditis

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  1. Pericarditis and Myocarditis

  2. What is pericarditis ? “ Inflammation of the pericardium”

  3. Symptoms • Chest pain • Dry cough, fever , fatigue • Pericardial rub • ST elevation on ECG • Cardiac tamponade • CCF

  4. Causes • Infection -viral, bacterial • Secondary to recent cardiac surgery • Post MI • IV Drug abuse • Kidney failure • Metatastic disease

  5. Constrictive Pericarditis • Restricts the heart – reduces operative chamber compliance • Thickened pericardium isolates heart from normal respiratory swing, however respiratory fluctuations in pulmonary venous pressure still occurs • Tamponade

  6. Treatment • Bacterial – antibiotics • Fungal – antifungal agents • Hospitalisation • Constictive • Pericardetomy may be required

  7. Pericarditis on the ECG • ST elevation in any lead • May be in all leads • May not be anatomically grouped • J-point notching can be presentpresent • Fish hook

  8. Look for notch at J-point • ST segment and J-point create a “fish hook” appearance

  9. Stage Ieverything is UP (i.e., ST elevation in almost all leads - see below) • Stage IITransition ( i.e., "pseudonormalization"). • Stage IIIEverything is DOWN (inverted T waves). • Stage IVNormalization

  10. Pericarditis

  11. Myocarditis • Inflammation of the heart muscle

  12. Symptoms • Generalised aches and pains • fever • SOB • chest pain • Increase in heart rate

  13. Causes • Viral – coxsackievirus B • Bacteria – Staphyloccus aureus, borrelia burgdorferi • Diptheria • Parasites – trypanosoma cruzi • Fungi • Chemicals • Medications • Systemic diseases

  14. Investigations • ECG – non specific changes • Echo- enlarged heart • Biopsy NB ECG can be normal

  15. treatment • REST • Steroids – severe cases • May need to manage electrolyte imbalances or complications of heart failure NB 10% of patients proceed to develop dilated cardiomyopathy

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