Download Myocarditis and cardiopathy

Subject 7 - Myocarditis and cardiopathy
(4 hours)
Place
Educational room, dpt. of Cardiology
Purpose
Students must know:
• Classification noncoronary heart disease.
• Etiology and pathogenesis of myocarditis , primary and secondary ( specific )
cardiomyopathies .
• Clinical manifestations of non-rheumatic myocarditis , menopausal , dilated and hypertrophic
cardiopathy .
• Methods of diagnostic criteria for the diagnosis and differential diagnosis ( exclusion criteria ) .
• Principles of treatment and prevention, especially the treatment of various clinical variants .
To Able:
Based on the examination of the patient with non-rheumatic myocarditis formulate the final
clinical diagnosis and treatment.
• Put a preliminary diagnosis and determine whether treatment for climacteric , hypertrophic
cardiomyopathy and dilated .
to formulate a clinical diagnosis
• to the differential diagnosis
• identify and evaluate tactical test results
• prescribe treatment
• identify and forecast performance
• recommend preventive measures
Professional orientation of students
Non-rheumatic myocarditis may occur in young patients after previous infection or syndrome as
in other diseases , timely diagnosis and appropriate treatment can significantly improve the
prognosis , secondary cardiomyopathy were widespread , their knowledge is necessary for the
differential diagnosis with other cardiac disease , prevention of coronary heart disease and
iatrogenic giperdiagnostitsi Purpose and effective therapy. Lately, more often diagnosed primary
cardiomyopathy . For their diagnosis requires knowledge of modern methods of examination ,
and the heavy forecast to be significantly improved by the application of modern methods of
treatment.
Base level of knowledges and abilities
№
Discipline
To know
1.
Anatomy
anatomical structure of the heart
2.
Histology
Structure and function of the
myocardium
and
cardiac
conduction system
3.
Biochemistry
myocardial metabolism and
cardiac muscle contraction
4.
Pathophysiology
Mechanisms pathophysiology of
myocardial hypertrophy and
dilatation . Mechanisms of
myocardial
metabolism
disorders
in
secondary
cardiomyopathy
5.
Propedevtik
diseases
of
To able
internal Semiotics of cardiac rhythm and to
assess
the
clinical,
conduction , circulatory failure instrumental and laboratory
tests
Plan of practical employment
№
Elements of practical employments
1.
Verification of present's students
5
2.
Entrance control and his analysis
15
Time(minutes)
3. * Distributing patients for Supervision ( card or clinical tasks )
10
4. * Review patients or study of educational hospital chart
40
5.
Discussion of findings, formulation of previous diagnosis, determination of
methods of additional inspection of patient, interpretation of their results,
formulation of final diagnosis and plan of treatment
50
6.
Exercises with clinical formulations for solving clinical situation tasks
20
7.
Output control of knowledge and its evaluation
15
8.
Results and final assessment of knowledge and skills of students and tasks
to self- preparation for the next lesson
5
Note: * - in the case of patients absence in clinical, practice can be made in the form of
preparation and decision of situational tasks.
List of theoretical questions addressed in class
1. Idea of Noncoronary heart disease and their classification.
2. The most common options myocardial damage ( dystrophy, inflammation , primary
cardiomyopathy ) .
3 . Etiology and pathogenesis of myocardial lesions of different options , the concept of
cardiomyopathy as a nosological entity and how pathophysiological form.
4 . Myocarditis : classification and diagnostic criteria . Principles of treatment .
5 . Clinical manifestations and additional methods for specific surveys ( menopause , alcohol
and thyrotoxic ) cardiomyopathies .
6. Basic principles of treatment of specific cardiopathy .
7. The treatment regimen of patients with climacteric cardiomyopathy .
8. Clinic hypertrophic cardiomyopathy and dilated .
9. Additional methods of research in dilated cardiomyopathy and hypertrophic .
10 . Treatment of hypertrophic and dilated cardiopathy .
Method of leadthrough of practical employment *
On the first employment teacher hold instructing from accident (if there are such terms) which
registers in the magazine of teacher's signature of student prevention.
* Students answer in writing on the tests of base knowledges entrance control. Then a teacher
distributes students for kuration patients and determines them a task.
№
Task
1.
Spend curation of patient During an inspection
diagnosed with dilated discover:
cardiomyopathy
1. Signs of heart failure
Teasher's
students
pointing
to Teacher's note for students
to Pay special attention to the absence
of a reason for hypertrophy and
dilatation of the heart cavities
2 . Increase in heart size
3 . Possible arrhythmias
4 . Characteristic changes in
DCM for ECG , X-ray ,
echocardiography
A teacher works in obedience to the plan of organization of employment, in the end - initial
control of knowledges. Before completion of employment teacher announce his results with the
estimation of every student and declares the theme of next employment.
Forms and methods of self-control
Tests
1. 32 years old patient complained of disruption of the heart , dizziness,
shortness of breath on exertion . Still sick. Objectively : Ps - 74/hv . ,
rhythmic. AT 130/80 mmHg Auscultation : first normal tone sonority ,
systolic murmur over the aorta. ECG showed left ventricular hypertrophy, signs of
repolarization in V5, V 6 leads. Echocardiography : interventricular peretenka 2
see what is the most likely diagnosis ?
A. * Hypertrophic Cardiomyopathy
B. hypertonic disease
C. myocardial infarction
D. aortarctia
E. Aortic stenosis
2 . Female 37 years old complains of choking, squeezing chest pain . week ago
suffered flu. OBJECTIVE: akrotsianoz , HR - 98/hv . , BP - 90/75 mm Hg. Art. , BH - 26
/ Min. Heart borders zmischeni i left right 3 cm Heart sounds muffled , over the top
protodiastolichny gallop , systolic murmur . Hb - 130 g / L ESR - 25 mm / hour. which
Early diagnosis can be ?
A. Acute myocarditis
B. Dilyatatsiyna kardiomiopatiya
C. pericardial effusion
D. metabolic cardiomyopathy
E. CHD : angina
3 . Patient 49 years old, complains of pain in the heart, fatigue,
confusion. Pain occurred three years ago and involves a violation of the menstrual
cycle , the emergence of " hot flashes ." Objectively : the limits of the heart is not enlarged,
muted tones . AO
155/90 mmHg ECG T-wave flatness in V5 - V6. On repeated ECG - without
dynamics. What is the most likely diagnosis ?
A. * Dishormonal cardiomyopathy
B. hypertonic disease
C. CHD : angina
D. myocarditic kardiosklerosis
E. cardiopsychoneurosis
Situational tasks
1. When prophylactic tuberculin testing in men 35 years showed an increase in heart size . No
complaints. OBJECTIVE: Heart sounds moderately weakened. On ECG - signs of left
ventricular hypertrophy . In an.krovi unchanged. Further examination revealed that either
causes enlargement of the heart . What is the most likely diagnosis ? What additional research
needs to appoint ? Your tactics of treatment of the patient ?
2 . Patient 35 years old, complains noyuchy pain in the heart , yadihu , increasing t to 37,3
C. Sick 3 days . 15 days ago suffered " flu ." OBJECTIVE: HR = PS = 98 in 1 min. BH = 22 at 1
min. AT-120/80 mmHg Heart borders + 2 cm left, muted tones , in systole soft noise is heard . In
an. Blood Lake . - 10,6
September 10 / l, ESR -32 mm / hour. What is the most likely
diagnosis ? What additional research needs to appoint ? Your tactics of treatment of the patient
?
Ilustrative material
1. Tables and slide classifications noncoronary heart disease , myocarditis , cardiomyopathy .
2 . Audiocassettes rhythm disorders .
3 . Videotape with ehokardiografichnimi studies of the heart in noncoronary heart disease .
4 . Set ECG .
5 . Set of benchmark tests and situational problems with standards answers.
sources of information
Sources of information (literature)
Basic:
Therapy. Course of lectures. Simferopol. -2003.- 444p.
Additional:
1. Harrison's Principles of Internal Medicine 18th edition.
.org)
2. ESC Guidelines. Cardiovascular medicine. (Www.escardio.org / guidelines)
The program of preparation students to the theme
To learn:
• Presentation of Noncoronary heart disease and their classification.
• The most common options myocardial damage ( dystrophy, inflammation , primary
cardiomyopathy ) .
• Etiology and pathogenesis of myocardial lesions of different options , the concept of
cardiomyopathy as a nosological entity and how pathophysiological form.
• Myocarditis : classification and diagnostic criteria . Principles of treatment .
• Clinical manifestations and additional methods for specific surveys ( menopause , alcohol and
thyrotoxic ) cardiomyopathies .
• Basic principles of treatment of specific cardiopathy .
• The treatment of patients with climacteric cardiomyopathy .
• Clinic and dilated hypertrophic cardiomyopathy .
• Additional methods of research in dilated cardiomyopathy and hypertrophic .
• Treatment of hypertrophic and dilated cardiopathy .
draw:
• echocardiographic picture in primary cardiomyopathy .
To Able:
• Establish a definitive diagnosis of myocarditis , assign the necessary examination and
treatment.
• Establish a preliminary diagnosis of climacteric , dilated and hypertrophic cardiomyopathy,
assign the necessary examination and determine whether treatment for these diseases .
Note the use of modern methods of instrumental examination at Noncoronary myocardial
pathology .