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Cardiac Infections
Will Deaton, D.O.
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Myocarditis
•In=
flammation
of the cardiac muscle.
•Us=
ually
involves focal infiltration of lymphocytes, <=
/span>pl=
asma
cells, or histiocytes into the myocardium.
•Va=
rying
amounts of cardiac reticulum network and <=
/span>my=
ocyte-lysis
are seen.
•MA=
NY
infectious agents are responsible. Some target only =
the
myocardium, some are systemic infections.
•Pe=
ricarditis
usually accompanies myocarditis.
![](3D"slide0002_image005.jpg")
Myocarditis
•Fe=
ver
and tachycardia OUT OF PROPORTION are th=
e most
common clinical features.
•The
remainder of the clinical signs are dependent on the amount of myo=
cyte
involvement.
•My=
algia,
headache, rigors, retrosternal chest pain, peripheral edema, and se=
vere
CHF all may be seen.
Myocarditis
•Ch=
est XR
is usually normal. All
abnormalities are non-diagnostic and are usually
from the local inflammation.
•ECG
changes may include non-specific ST changes, =
ST
elevation, AV block, or QT prolongation.
•Ca=
rdiac
enzymes may be elevated.
•Ec=
ho may
show depressed EF.
•Ch=
ildren
present in the same way adults do.
Myocarditis
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•Viral agents
=
;
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•Coxsackie B
=
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•Echovirus
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•Influenza
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•Parainfluenza=
3;
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•Epstein-Barr =
3;
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•Hepatitis B/C=
3;
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•HIV
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•Bacterial agents=
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•Diphtheria
<=
/span>
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•N. meningitides&=
#13;
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•M. pneumoniae=
3;
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•BHS
<=
/span>
<=
span
class=3DHBB style=3D'position:absolute;left:-9.7%;top:-.15em'>•Lyme disease
Myocarditis
•Tr=
eatment
is supportive is MOST cases.
•If=
a
bacterial agent is suspected, directed an=
tibiotics
for minimum of 6-8 weeks will be needed.
•Im=
munosuppressive
agents may be needed in cases of viral myocarditis with
severe CHF.
•Pa=
tients
should be admitted to tele floor if no he=
art
failure is present. ICU with
pressor therapy or peripheral edema.
Pericarditis
•Mo=
st
common of the cardiac infections.
=
•Most common symptom is sh=
arp/stabbing
chest pain that is retrosternal and sudden OR =
gr=
adual
in onset. This usually ra=
diates
into the back, arm, neck, or left shoulder. Pain is in=
creased
with inspiration or movement. Pain is worse with =
su=
pine
positioning, resolves with sitting forward.
![](3D"slide0007_image007.jpg")
Pericarditis
•As=
sociated
symptoms may include fevers, chills, dyspnea (due to the pain with
inspiration), and dysphagia (due to esophageal
irritation.
•A
PERICARDIAL FRICTION RUB IS THE MOST IMPORTANT PHYSICAL
FINDING.
•Th=
is is
best heard over the left sternal border us=
ing
the diaphragm and when the patient is si=
tting
forward.
Pericarditis
•Serial ECGs over=
a
number of days is best in acute pericarditis.
<=
span
class=3DBB style=3D'position:absolute;left:-4.08%;top:-.15em'>•The ECH has four
definite stages, I-IV.
![](3D"slide0009_image009.jpg")
Pericarditis
•St=
age
I- ST elevation is prominent=
in
the precordial leads, especially in I, V5-6. PR <=
span
style=3D'font-family:Tahoma;mso-ascii-font-family:Tahoma;font-size:88%'>de=
pression
may be noted in 2,3,aVF, V4-6.
•St=
age
II- ST elevation returns to
isoelectric. T =
wa=
ve
amplitude decreases.
•St=
age
III- Isoelectric ST segment,=
T
wave inversion in the leads that previously had the ST el=
evation
•St=
age
IV- The ECG returns to normal.
Pericarditis
•Ch=
est XR
is usually normal.
•Yo=
u may
have a effusion, but this is very rare.&n=
bsp;
Pulmonary venous hypertension may also be =
pr=
esent
in a rare few individuals. &=
#13;
•The
“epicardial fat-pad sign” is the classical sign for =
pe=
ricarditis,
but is seen in only 15% or patients.
•Ec=
ho is
the best study to see a effusion.
•Ca=
rdiac
enzymes may be elevated IF associated with my=
ocarditis.
Pericarditis
![](3D"slide0034_image011.jpg")