Pericarditis and Myocarditis

“ Inflammation of the pericardium” 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 IV Drug abuse Kidney failure Metatastic disease

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

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

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 The ST elevation of pericarditis is caused by inflammation of the epicardium secondary to inflammation of the pericardium. This process is not related to coronary artery disease and, therefore, ST changes do not tend to follow anatomical groups typically seen with ACS. Like BER, pericarditis may produce a notching of the J-point and a “fish hook” shaped ST and J-point.

Look for notch at J-point ST segment and J-point create a “fish hook” appearance One ECG sign that should make you consider is the notched J-point, creating a fish hook like appearance of the ST segment.

Stage I everything is UP (i. e Stage I everything is UP (i.e., ST elevation in almost all leads - see below) Stage II Transition ( i.e., "pseudonormalization"). Stage III Everything is DOWN (inverted T waves). Stage IV Normalization

Pericarditis This ECG has ST elevations and some similarities to BER. However, in this case, BER is not present. This is an example of pericarditis.

Myocarditis Inflammation of the heart muscle

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

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

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

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