9. Primary Myocardial Diseases - Myocarditis

Front 1

What is Myocarditis?

Back 1

Inflammation of the heart that leads to myocardial injury

Front 2

What are the 4 categories of etiological causes of myocarditis?

Back 2

1. Infectious
2. Immune
3. Unknown
4. Idiopathic

Front 3

What are 3 viral causes of myocarditis?

Back 3

Coxsackie A/B and CMV

Front 4

When is CMV life threatening?

Back 4

In immunosuppressed patients

Front 5

What is a bacterial cause of myocarditis?

Back 5

Lymes disease

Front 6

What protozoan disease can cause myocarditis?

Back 6

Chaga's disease (trypanosoma)

Front 7

What is a helminth that causes myocarditis?

Back 7

Trichinosis

Front 8

What is a more common cause of myocarditis than infectious causes?

Back 8

Immune

Front 9

What are 5 categories of immune causes of myocarditis?

Back 9

-Post viral immune responses
-Post streptococcal immune responses (Rheumatic fever)
-Lupus
-Drug sensitivities
-Transplant rejection

Front 10

What are two diseases that have unknown etiologies themselves, and can lead to myocarditis?

Back 10

-Sarcoidosis
-Giant cell myocarditis

Front 11

What are 5 variable clinical presentations of myocarditis?

Back 11

ASAPH
1. Asymptomatic
2. Sudden death
3. Arrythmias
4. Precursor to dilated cardiomyopathy
5. Heart failure

Front 12

What other condition does myocarditis resemble? How?

Back 12

Myocardial infarct - all the same cardiac enzymes are present, but it's due to multiple small infarcts throughout the heart.

Front 13

What are 3 possible gross findings you might see in myocarditis pathology?

Back 13

-Normal looking heart
-Mural thrombi 2nd to arrythmia
-Dilated heart if its in CHF

Front 14

What is seen microscopically in myocarditis pathology?

Back 14

Inflamatory infiltrates with myocyte damage.

Front 15

What cell types typically make up the inflammatory infiltrate in myocarditis?

Back 15

Lymphocytes
-But can also be PMNs or EOS

Front 16

What are 2 arrangements of inflammatory infiltrates that might be seen in myocarditis?

Back 16

-Granulomatous (sarcoid)
-Giant cell

Front 17

What are 3 types of cardiac transplant rejection?

Back 17

1. Hyperacute
2. Acute
3. Chronic

Front 18

What is the cause of hyperacute cardiac transplant rejection? What is the timeframe in which it occurs?

Back 18

Preformed antibodies in the recipient to antigens on the tissue; occurs within the operating room.

Front 19

What is the cause of acute cardiac transplant rejection?

Back 19

Cell mediated rejection - the patient's Tcells recognize the MHC of the donor.

Front 20

What age of people are better transplant candidates, and why?

Back 20

Older people - because their immune systems are already on the downswing.

Front 21

What is used to prevent acute rejection?

Back 21

Immunosuppressive therapy

Front 22

If the recipient is not immunosuppressed, how soon will acute rejection manifest?

Back 22

Weeks-years after transplant

Front 23

What exactly IS chronic rejection?

Back 23

An obliterative arteropathy

Front 24

What happens to the transplant vessels in chronic rejection?

Back 24

They undergo an atherosclerotic type narrowing

Front 25

What is the most frequently seen type of cardiac transplant rejection seen today?

Back 25

Chronic

Front 26

What are the 2 main components of cardiac transplant followup?

Back 26

-Interval biopsies to assess if rejection is occurring
-Rule out infections

Front 27

What are the 3 main grades of acute rejection?

Back 27

-Mild
-Moderate
-Severe

Front 28

What are the findings in mild acute rejection? How is it treated?

Back 28

-Perivascular lymphocytes
-No myocyte damage
-No treatment

Front 29

What is seen in moderate acute rejection? How is it treated?

Back 29

-Mural lymphocytes
-Some myocyte damage
-Treat this

Front 30

What is seen in severe acute rejection? How is it treated?

Back 30

-Mural lymphocytes
-Neutrophils
-Hemorrhage
-Micro infarcts
-Treat but it may not reverse