Myocarditis, Pericarditis & Ischemic Heart Disease

Whats Ischemic Heart Disease ?

Coronary Artery Disease (CAD), Atherosclerosis or hardening of the arteries and this blockage can slow or block blood supply to the heart

→ heart wall progresses in 3 stages such as Ischemia, injury & then acute myocardial infarction(MI)

Describe the 3 stages the heart wall corresponds when there is an occluded artery

1. Ischemia→ caused by increased demand, decreased supply or both

2. Injury → theres injury to the myocardial cell when the ischemic process is more severe

3. Acute MI → occurs when the myocardial ischemia exceeds the hearts threshold for an extended period and results in irreversible cell damage or necrosis in the myocardial wall

Signs and symptoms for Ishcemic heart disease

• MI may be silent (asymptomatic)

• Epigastric discomfort/nausea/ vomiting

• SOB

• Sweating

• Tachy/bradycardia

• Cognitive Impairment

• Syncope/ near syncope

• Cardiogenic shock

• New murmur post MI: → Ischemic MR & Ischemic VSD

What is Ischemic MR is caused by

By LV dilation , papillary muscle ischemia/infarct/rupture or irregular rythm

What is Ischemic VSD caused by

Area of the IVS becomes weakened and Ruptures: not as common as ischemic MR

Potential Complications for Ischemic heart disease

arrhythmia, Cardiogenic shock, Dressler syndrome, LV/RV failure, MR, Papillary Muscle dysfunction, P. Eff, pericarditis, pseudoanuerysm, RV infarction, Thrombus, True anuerysm, Ischemic VSD

2D findings for Ischemic Heart Disease

1. Evaluate ventricular function

2. Stress echo is more diagnostic

3. WMA possible ischemia or infarct

4. Ventricular enlargement possible

5. Evaluate diastolic fx, regurge and possible complications

In IHD whats the Difference between Angina Pectoris vs. Stable Angina Pectoris

💔Angina= 1+ coronary artery is narrow or blocked

• CP due to IHD

Pressure/fullfulness/Squeezing that may radiate to the jaw/shoulder/arm/back

vs.

💗💔💗Stable→ CP is predictable, manageable, triggers include emotional stress, very hot/cold temp, large meals, & smoking

• episode can last seconds <5 mins; relieved by rest

In IHD, whats the difference between Unstable Angina Pectoris vs Variant Angina

🫨Unstable → unexpected CP→ treat as Emergency 🚨

• usually at rest/sleep/ with little exertion

• Common Cause is ASO / blood clots

• Rest / meds did not relieve CP

May worsen with time and may lead to MI

Variant Angina🏃💨 → in younger patients

• rare cause of CP, chronic condition

• Occurs at rest, usually early morning

• Relived with meds to control spasms

  assoicited with ST elevation 📈

Myocarditis defintion

🔥An inflammation of the myocardium that results in myocardial damage

→ some T-lymphocytes that have been traced as the primary cause and when severe HF results💔📉

What are findings in Myocarditis of 2D echo?

Ventricular Dilatation or Hypertrophy

Ventricular dysfunction

🌎Regional WMA

Evaluate valves

Evaluate diastolic function

What is the most common cause of Myocarditis?

An infectious agent(viral,bacterial, parasitic, fungal)→ most common cause is viral and the typical culprit is Coxsackievirus B

Whats the definition of Pericarditis?

Infiltration of inflammatory cells into the pericardium due to the release of fibrin, white blood cells and endothelial cells that cover the parietal and visceral layers and 🔪FRICTION between the layers causes irritation and inflammation 🩸

What causes are there in pericarditis

• Acute/post MI

• Autoimmune disorder

• Cancer

• Infectious

• Radiation therapy

• Tuberculosis

What types of pericarditis and describe them

Acute vs Chronic/Recurrent

Acute:

• occurs within 2 wks of offending condition

• Can last upto 6wks

• Obstructs heart venous👖system & lymphatic drainage→ fibrin material/serous fluid relase → pericardial effusion

🔑rate of accumulation is KEY→ Tamponade

when 2+ of 4 are present indicates ACUTE = CP/New P.Eff/ friction rub/ekg change

Chronic → reccurrence post asymptomatic for 6+ wks & can last up to 6 months ⏰

• related to original etiology or autoimmune disorder and symptoms (less common) but if present treatment may fail 🥺