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MYOCARDITISMYOCARDITIS

-Inflammation of the muscular walls

of the heart

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Causes

Myocarditis is an uncommon disorderthat is usually caused by viral, bacterial, or

fungal infections that reach the heart.

Viral infections:

-Coxsackie

-Cytomegalovirus

-Hepatitis C

-Herpes

-HIV

-Parvovirus

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Bacterial infections:

-Chlamydia-Mycoplasma

-Streptococcus

-Treponema

Fungal infections:

-Aspergillus

-Candida

-Coccidioides

-Cryptococcus-Histoplasma

-Schistosomiasis

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Symptoms

Symptoms depend on the type ofinfection. Most symptoms may be similar to the

flu. If symptoms occur, they may include:

-Abnormal heartbeat-Chest pain that may resemble a heart attack

-Fatigue

-Fever and other signs of infection including headache, muscle

aches, sore throat, diarrhea, or rashes

-Joint pain or swelling-Leg swelling

-Shortness of breath

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Other symptoms that may occur with this

disease:

-Fainting, often related to irregular heart rhythms-Low urine output

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Exams and Tests

A physical examination may show no

abnormalities, or may reveal the following:

-Abnormal heartbeat or heart sounds (murmurs, extra heart sounds)

-Fever

-Fluid in the lungs

-Rapid heartbeat (tachycardia)

-Swelling (edema) in the legs

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Tests used to diagnosis myocarditis

include:

-Blood cultures for infection

-Blood tests for antibodies against the heart muscle and the body

itself

-Chest x-ray-Electrocardiogram (ECG)

-Heart muscle biopsy (endomyocardial biopsy)

-Red blood cell count

-Ultrasound of the heart (echocardiogram)

-White blood cell count

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Treatment

Treatment is aimed at the cause of the

problem, and may involve:

-Antibiotics-Anti-inflammatorymedicines to reduce swelling

-Diuretics to remove excess water from the body

-Low-salt diet

-Reduced activity

Abnormal heart rhythms may require the use of additional

medications, a pacemaker, or an implantable cardioverter-defibrillator.

If a blood clot is in the heart chamber, you will also receive blood

thinning medicine.

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Prevention

Appropriate immunization (eg. Influenza, hepatitis)

early treatment appears to be important in decreasing the

incidence of myocarditis.

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PERICARDITISPERICARDITIS

Inflammation of the pericardium-

the membranous sac around the heart

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Pathophysiology and etiology

1. Acute idiopathic pericarditis is most common and typical

form; etiology unknown

2. Other causes include:

a. Infection

i. viral (influenza, coxsakievirus)

ii. Bacterial ( staphylococcus, meningococcus,

streptococcus, pnuemonococcus, gonococcus,

mycobacterium tuberculosisiii. Fungal

iv. Parasitic

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b. Connective tissue disorder ( lupus erythematosus,

periteritis nodosa)

c. Myocardial infarction; early, 24 to 72 hours; late, 1 week

to 2 weeks afterMI (Dresslers syndrome)

d. Malignant disease; thoracic irradiation

e. chest trauma, heart surgery, including pacemakerimplantation

f. Drug induced ( procainamide [pronastyl] ); phenitoin

[dilantin] )

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Clinical manefestations

1. Pain in anterior chest, aggraviated by thoracic

motion

2. Pericardial friction rub

3. Dyspnea

4. Fever, sweating, chill

5. Dysrhythmia

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Management

1. Bacterial pericarditis- penicillin or other antimicrobial agent

2. Rheumatic fever- penicillin G or other antimicrobial agent

3. Tuberculosis- antituberculosis chemotherapy

4. Fungal pericarditis- Amphotericin B and fluconazole

5. Systemic lupus erythomatosus- steroid

6. Renal pericarditis- dialysis, indomethacin (indocin)

biochemical control of end stage renal disease

7. Neoplastic pericarditis- intrapericardial instillation of

chemotherapy; radiotherapy

8. Postmyocardial infarction syndrome- bedrest, aspirin,

prednisone

9. Postpericardiotomy syndrome- (after open heart surgery)-

treat symptomatically

10. Emergency pericardiocentesis if cardiac tamponade develops

11. Partial pericardiectomy ( pericardial windows) or total

pericadiectomy for recurrent constrictive pericarditis