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CMPP > Miscellaneous Cardiac Disease > Flashcards

Miscellaneous Cardiac Disease Flashcards

1
Q

Bacterial or Fungal infection of the endocardium

A

infective endocarditis

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2
Q

what do patients have a history of when diagnosed with infective endocarditis?

A 
structural heart abnormality
   congenital
   valvular disease
   valve replacement
IV lines
IVDU
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3
Q

two subsets of infective endocarditis

A

left and right sided

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4
Q

what side is more common in infective endocarditis?

A

left

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5
Q

what side of infective endocarditis has systemic vascular involvement and why?

A

left side because there is bacteria in the blood stream

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6
Q

what side is associated with congenital and acquired valvular disease (prostetics and mitral regurg) in infective endocarditis?

A

left sided

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7
Q

is left sided infective carditis acute or chronic?

A

acute or subacute

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8
Q

what valve is most commonly affected in left sided infective endocarditis?

A

mitral valve

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9
Q

what are the most common pathogens in left sided infective endocarditis

A

strep. viridans

staph. aureus

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10
Q

what side has pulmonary vascular involvement in infective endocarditis

A

right side

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11
Q

what side is associated with IVDU in infective endocarditis?

A

right sided

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12
Q

is right sided infective endocarditis acute or chronic?

A

acute

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13
Q

what valve is most commonly affected in right sided infective endocarditis?

A

tricuspid

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14
Q

what is the most common pathogen in right sided infective endocarditis?

A

staph. aureus

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15
Q

when is the presentation of infective endocarditis acute?

A

sepsis and cardiac collapse

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16
Q

when is the presentation chronic for infective endocarditis?

A

fever, malaise, and weight loss

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17
Q

what does IVDU and new murmur signify?

A

ENDOCARDITIS until proven otherwise

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18
Q

4 physical findings (other than a murmur) in infective endocarditis

A

osler nodes
janeway lesions
splinter hemorrhages
roth spots

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19
Q

what are osler nodes?

A

tender nodules on pulp of fingers

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20
Q

what are janeway lesions?

A

non-tender hemorrhagic macules on palms and soles

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21
Q

what are splinter hemorrhages?

A

vertical hemorrhages under the nails

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22
Q

what are roth spots?

A

retinal hemorrhages

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23
Q

work up for infective endocarditis?

A

CBC
Sed Rate
CRP
Blood cultures (3 from 3 different sites)
ECHO (TEE over TTE)
CXR and EKG
admission to the hospital with ID consult

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24
Q

how do CXR and EKG typically look with Infective endocarditis?

A

unremarkable

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25
Q

is pericarditis acute or chronic?

A

either

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26
Q

4 main features of pericarditis

A

chest pain
friction rub
EKG findings
Pericardial effusion

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27
Q

how does chest pain present in pericarditis

A

sharp pain improved by tripoding

NO LEVINE’S SIGN

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28
Q

how does a friction rub present in pericarditis

A

scratcing heard along left lower sternal border

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29
Q

howcan you see a pericardial effusion in pericarditis?

A

ECHO

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30
Q

causes of pericarditis

A 
infectious
malignancy
myocardial infarction
systemic illness
medications
radiation
idiopathic
31
Q

types of infectious pericarditis

A

bacterial
viral
fungal
Coxasackie A & B

32
Q

types of malignant pericarditis

A

breast
lung
leukemia
lymphoma

33
Q

causes of MI induced pericarditis

A

acute MI

post-dressler’s syndrome

34
Q

what is dressler’s syndrome and how will it present in pericarditis?

A

someone who had an MI in the past few weeks

chest pain
friction rub
hypertension

35
Q

types of systemic illness pericarditis

A

SLE (lupus)
rheumatic fever
scleroderma

36
Q

medications that may cause pericarditis

A

anticoagulants (coumadin)
hydralazine (preeclampsia)
isoniazid (TB)

37
Q

4 stages of pericarditis

A

1: diffuse ST segment elevation in all leads with PR depression
2: pseudonomalization of ST segments
3: ST segment depression
4: normalization of ST segments (back to baseline)

38
Q

what types of pericarditis can be treated as an outpatient?

A

viral & idiopathic

39
Q

who should be admitted for pericarditis

A

anyone with an underlying pathology

40
Q

what do we use as pain control in pericarditis?

A

anti-inflammatories

motrin & naproxen

41
Q

MOA of motrin

A

COX-1 and COX-2 inhibition

42
Q

special note for motrin

A

do not exceed 2.4 gram/day

43
Q

what is motrin best for?

A

pericarditis

44
Q

MOA of Naproxen (Naprosyn)

A

COX-1 & COX-2 inhibition

45
Q

Special note for naproxen

A

black box warning of increased cardiovascular thrombotic event

46
Q

who should we use naproxen on

A

patients who can’t take ibuprofen or tylenol

47
Q

what is naproxen best for?

A

pericarditis

48
Q

increase in pericardial fluid to the point that it creates an inflow obstruction to the ventricles

A

cardiac tamponade

49
Q

normal amount of fluid in the pericardial sac

A

40-50ml

50
Q

can the pericardial sac normally expant?

A

no

51
Q

how many mls of fluid do you need the pericardial sac to produce symptoms of cardiac tamponade?

A

200ml

52
Q

what are the most common causes of cardiac tamponade

A

neoplastic disease
idiopathic pericarditis
renal failure

53
Q

what causes of accumulations of blood cause cardiac tamponade

A

post-op cardiac surgery
trauma
pericarditis + anticoagulants

54
Q

what does beck’s triad signify?

A

cardiac tamponade

55
Q

what is in beck’s triad?

A

hypotension: can not produce a good SV because it cannot contract against the surrounding fluid
decreased/muffled heart sounds
JVD

56
Q

what is a drop greater than 10mmHg in BP with inspiration

A

pulsus paradoxus

57
Q

what is pulsus paradoxus associated with?

A

cardiac tamponade

58
Q

pathophys of pulsus paradoxus

A

inspiration > increased RV filling
RV pushes intra-ventricular septum into LV
decreased LV volume, decreased SV, lower BP

59
Q

what is kussmal’s sign associated with?

A

cardiac tamponade

60
Q

what is kussmal’s sign?

A

rise in central venous pressure seen in JVP during inspiration

61
Q

EKG finding in cardiac tamponade

A

decrease in amplitude of QRS complexes

electrical alternanas

62
Q

what is electrical alternans

A

beat to beat variation of QRS due to shifting of fluid and heart position

63
Q

CXR findings in cardiac tamponade

A

chronic onset: water bottle cardiac shilouete

acute onset: normal

64
Q

what is the gold standard of diagnosis for cardiac tamponade

A

ECHO

65
Q

what is visualized on ECHO for cardiac tamponade

A

large hypoechogenic effusion (blackness)
swinging motion of heart in sac
diastolic collapse of RV

66
Q

treatment for cardiac tamponade

A

2 large bore IVs with fluids
inotropic support
pericardiocentesis (EKG or US guided)

67
Q

what is used for inotropic support in cardiac tamponade

A

pressors
dopamine
dobutamine

68
Q

dopamine MOA

A

dose dependent stimulation (dopa, beta, alpha)

69
Q

special note for dopamine

A

different dose with different effects

70
Q

what is dopamine bets for?

A

pressor support for cardiac tamponade

71
Q

dobutamine MOA

A

beta-1, beta-2, alpha-1 stimulation

72
Q

special note for dobutamine

A

vasodilation

73
Q

what is dobutamine best for

A

cardiac tamponade pressor support

CMPP (17 decks)

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