1. Pericarditis and Myocarditis

2. “ Inflammation of the pericardium”
What is pericarditis ?
“ Inflammation of the pericardium”

3. Symptoms Chest pain Dry cough, fever , fatigue Pericardial rub
ST elevation on ECG
Cardiac tamponade
CCF

4. Causes Infection -viral, bacterial Secondary to recent cardiac surgery
Post MI
IV Drug abuse
Kidney failure
Metatastic disease

5. 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

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

7. 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.

8. 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.

9. 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

10. 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.

11. Myocarditis
Inflammation of the heart muscle

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

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

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

15. 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