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Flashcards in Cardiac Deck (20):
1

Complications of Myocardial Infarction - Mechanical

Mechanical:
- cardiogenic shock
- CCF
- mitral regurg. (if LV infarct and papillary muscle rupture) - cardiac rupture: wall (tamponade) or septum (shunt)
- ventricular aneurysm a month later

2

Complications of Myocardial Infarction - Arrhythmias

- VF that day (most common cause of sudden death)
- 90%(!) have other arrhythmia

3

Complications of Myocardial Infarction - Pericardial

- Early pericarditis (dusky tissue)
- Pericardial effusion (?tamponade)
- Dressler's Dyndrome: CP, fever, effusion, weeks/months later (autoimmune response)
- Fibrinous Pericarditis: if infarct reaches pericardium

4

Histological evolution of MI

Normal for first 6 hours;
6-24 hours: necrosis and loss of nuclei;
1-4 days: polymorphs then macrophages;
5-10 days: debris removal;
1-2 weeks: granulation tissue, new vessels, myofibroblasts, collagen synthesis;
4+ weeks: scar tissue.

5

Causes of heart failure (6)

- IHD
- Hypertension
- Valve disease
- Dilated cardiomyopathy
- Myocarditis
- Arrhythmias

6

Complications of heart failure

- Sudden death
- Systemic emboli
- DVT/PE
- Arrhythmias
- Pulmonary oedema (pink transudate) (+ infection)
- Hepatic cirrhosis (nutmeg liver)

7

Three types of cardiomyopathy,
and do they cause systolic or diastolic dysfunction?

Dilated - Systolic (doesn't stretch)
Hypertrophic - Diastolic (doesn't fill)
Restrictive - Diastolic

8

Causes of dilated cardiomyopathy

Idiopathic,
Alcohol,
Giving birth,
Gentic,
Sarcoid,
Myocarditis.

9

Causes of hypertrophic cardiomyopathy

Genetic,
Inborn errors of metabolism.

10

Causes of restrictive cardiomyopathy

Sarcoid,
Amyloid,
Radiation-induced fibrosis.

11

Genetics of hypertrophic cardiomyopathy

Autosomal Dominant,
Sarcomeric protein genes,
beta-MHC (myosin heavy chain) most common,
also MYBP-C and Trop-T.

12

What does acute rheumatic fever affect?

Heart: pancarditis;
Joints: arthritis and synovitis;
Skin: erythema marginatum, subcutaneous nodules;
Neuro: Encephalopathy, Sydenham's chorea.

13

Steps of atherosclerosis

1. Endothelial injury
2. LDL accumulation
3. LDL oxidised (foreign, so inflam)
4. Macr use scavenger R, become foam cells
5. Apoptosis: more inflam and more chol
6. Adhesion molecules, so more macr
7. Fibrous cap by smooth muscle

14

Modifiable atherosclerosis RFs

T2DM,
Hypertension,
Hyperchol,
Smoking.

15

Non-modifiable atherosclerosis RFs

Male,
Old,
FHx.

16

Acute rheumatic fever criteria

Jones:
- Carditis
- Arthritis
- Sydenham's Chorea
- Erythema marginatum
- Subcutaneous nodules

17

Criteria for Infective Endocarditis

Duke's: 2M / M+3m / 5m
* Persistent (2+) blood cultures
* Vegetations on echo
* Serology of Brucella/Coxiella/Bartonella
- RF (murmur, IVDU)
- Fever or CRP
- Immune complexes (splinter haemorrh., haematuria)
- Vascular phenomena
- Other positive echo
- One blood culture

18

Rheumatic fever buzzwords (histology)

Lancefield Group A strep,
Antigenic mimicry,
Beady fibrous warty vegetations (verrucae),
Aschoff bodies,
Anitschkov myocytes.

19

Chronic rhaematic valve disease

Mitral prolapse (sometimes Aortic).
Middle aged woman SOB and chest pain, mid-systolic click and late systolic murmur.

20

5 types and causes of Pericarditis

- Fibrinous: MI, uraemia;
- Purulent : Staph;
- Granulomatous: TB;
- Haemorragic: tumour;
- Fibrous (constrictive): any of the above.