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Cardio Flashcards

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1
Q

Dilated cardiomyopathy

Etiology/RF

A

Idiopathic: 50 %: thought to be viral (myocarditis)
Alcohol
Cocain
Positiv family history

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2
Q

Dilated cardiomyopathy

Ssx

A

May present as
CHF, systemic or pulmonic emboli
Arrhythmia
Sudden death

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3
Q

Dilated cardiomyopathy

Diagnosis

A 
Lab; electrolytes(low Na, low hco3) cbc, high creatinine high bnp, ck,troponins, high LFT, TSH, TIBC
ECG 
CXR: cardiomegaly signs of chf 
Echo 
Biopsy
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4
Q

Management

Dilated cardiomyopathy

A 
Treat underlying cause 
Treat CHF
Anticoagulantion 
Treat arrhythmia 
Immunise against influenza and s.pneumonia
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5
Q

Hypertrophic cardiomyopathy

Def and general

A

Unexplained ventricular hyper trophy (mc septal hypertrophy). Cause is thought to be due to a genetic defect involving one of the cardiac sardine roc proteins. Generally present in early adulthood

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6
Q

Ssx

Hypertrophic cardiomyopathy

A

ASYMPTOMATIC
SOB
angina, syncope, CHF, arrhythmia. SCD

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7
Q

Hypertrophic cardiomyopathy

Diagnosis

A

ECG:LVH, p wave abnormality, prominent q wave (I, aVL, V5, V6)
TTE+ echo: asymmetric septal hypertrophy

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8
Q

Hypertrophic cardiomyopathy

Treatment

A

B blocker verapamil, phenylephrine
AVOID: acei, nitrates, diuretics= may worsen symptoms

If drug refractory: surgical myomectomy, ICD placement, septal ethanol ablation, dual chamber pacing

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9
Q

Restricted cardiomyopathy

Def

A

Impaired ventricular filling with preserves systolic function in a non-dilated, non-hypertrophied ventricle secondary to factors that decrease myocardial compliance = fibrosis or infiltration

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10
Q

Causes

Restricted cardiomyopathy

A

Infiltrative: sarcoidosis and amyloidosis
Non-infiltrated: scleroderma idiopathic fibrosis
Storage disease: hemochtomatosis, fabrys, gaucher, glycogen storage disease

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11
Q

Restricted cardiomyopathy

Clinical

A

CHF: usually with preserved LV systolic function, arrythmias, elevated JVP, kussmauls sign, S3, MR,TR

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12
Q

Restricted cardiomyopathy

Diagnosis

A 
Ecg 
Echo
CXR 
Cardiac catheterisation: 
Biopsy
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13
Q

Restricted cardiomyopathy

Treatment

A

Exclude constrictive pericarditis
Treat underlying disease
Supportive care and tx for CHF, arrhythmia, anticoagulants if A. Fib, heart transplant

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14
Q

Dilated cardiomyopathy

Definition

A

Unexplained dilatation and impaired systolic function of one or both ventricles

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15
Q

Myocarditis

Ssx

A 
Constitutional symptoms 
Acute CHF
Chest pain 
Arrhythmia 
Systemic or pulmonic emboli 
Sudden cardiac death
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16
Q

Myocarditis

Diagnosis

A 
Ecg 
Blood: troponins ckmb LDH, AST 
BLOOD cultures 
CXR
ECHO: dilated hypokinietic segmental wall motion abnormalities 
Biopsy
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17
Q

Tx myocarditis

A

Supportive care + rest
Treat CHF arrythmias and anticoagulation
Treat underlying cause

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18
Q

Left ventricular failure: ethiopatho

A

any acute cause or decompensation of chronic heart failure, characterized by acute dyspnea, due to pulm edema, +- peripheral edema and hypoperfusion.

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19
Q

Clinical: Left ventricular failure

A

dyspne, orthopnea, paroxymal nocturnal orthopnea, cough ( frothy pink sputum), fatigue, poor exercise tolerance, weight loss wheezing, cold peripheries

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20
Q

Dx Left ventricular failure

A

ECG, CXR (kerley B lines, plum effusion, cardiomegaly, inc pulm vasc markings), echo, BNP, cardiac enzymes,

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21
Q

DDX Left ventricular failure

A

PE, asthma, pneumonia.

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22
Q

Tx Left ventricular failure

A

o2, diuretics, sodium restriction, nitro, dobutamine.

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23
Q

Aortic dissection

clinical picture

A

Aortic dissection is a tear in intima allowing blood to dissect into the media. Acute 2 w.
Clinical: Sudden onset chest pain radiating to back, Htn, asymmetric BP in arms, ischemic syndromes due to occlusion of aortic branches. New diastolic murmur, rupture into pericardium, peritoneum, pleura. syncope

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24
Q

Aortic dissection

dx and ddx

Study These Flashcards
A

Dx: CT = gold standars, CXR (widened mediastinum, pleural cap), ECG, TEE, blood:amylase, troponin, lactate to rule out other causes.

25
Aortic dissection | Tx
Pharmacologic: B blocker + ACEI if insufficient BP and HR control. Target is sBP 110 mmhg and HR
26
Cardiac tamponade Def:
major complication of rapidly accumulating pericardial effusion or rapidly accumulating pericardial fluid. It is a clinical diagnosis characterized by; hyptension. tachycardia, inc JVP, pulsus paradoxus.
27
Cardiac tamponade | symptoms
Disastolic filling of the heart gets mechanically impaired leading to decreased SV and CO. Clinical: JVD, narrow pulse pressure, pulsus paradoxus (inspiratory fall in sBP >10 mmHg during quiet breathing), distant muffeled heart sounds, tachycardia, tachypnea, dyspnea, hypotension, evt leading to cardiogenic shock.
28
Cardiac tamponade | etiology
Penetrating trauma, iatrogenic (CVC, pacemaker insertion, pericardiocentesis) pericarditits, post MI free wall rupture.
29
Treatment | Cardiac tamponade
pericardiocentesis, pericardiotomy, avoid diuretics and vasodilators, treat underlying cause.
30
DX of Cardiac tamponade
echo, cxr (cardiomegaly without pulm vascular congestion) ECG (electrical alterans)
31
Long QT syndrome | definition
QT: start of Q wave until the end of T wave. represents the time taken for ventricular depolarization, and reploarization. QT shortens as HT inc and prolonges as HR dec. Abnormally prolonged QT is associated with Inc risk of ventricular arrhythmia.
32
Long QT syndrome | etiology
Hypokalemia, hypomg, hypoca, hypotermia, MI, congential long QT syndrome, inc ICP; post cardiac arrest, DRUGS: antipsychotic, antiarrhythmic, TCA, MACROLIDES (erythromycin)
33
Long QT syndrome | clinical presentation
syncope, cardiac arrest and SCD
34
clinical features of aortic aneurysm
75 % = ASYMPTOMATIC, syncope, pain (chest, abdomen, flank, back), hypotension, pulsatile abd mass, hoarsness, airway or esophageal obstruction, hoarsness, hemoptysis, hematemesis
35
Classical trias of ruptured AAA
pain, hypotension, pulsatile abdominal mass.
36
aortic aneurysm | etiology
Degeneration, traumatic, CT disorders, vasculitis, infection (syphilis, fungal), RF = smoking, HTN, age, FHx.
37
Dx of anurysm
CBC, electrolytesm urea creatin, PTT, abdominal usg, CT MRI
38
TX of aneurysm
5,5 cm or rapid rate of enlargement or symptoms + comorbidities = surgery.
39
Peripheral vascular disease: symptoms
pain decreases with walking, better with hanging legs out of bed and worse when elevating foot. (reverse of symptoms of DVT)
40
cardiac tamponade | etiology
major complication of rapidly accumulating pericadial effusion. Cany be due to any cause of pericarditis but esp: malignancy, uremia, trauma, proximal aortic dissection w rupture
41
cardiac tamponade | SSX
tachycardia, hypotension, distenden neck veins (inc JVP), pulsus paradoxus: inspiratory fall in s BP >10 mmhg during quiet breathing.. Muffeled heart sounds.
42
aortic dissection etiology
HTN; CT disease (marfan, elhers danlos) atherosclerosis, infections (syphilis) trauma
43
Atheroslerosis definition
is a specific form of arteriosclerosis in whihch an artery-wall thickens as a result of invasion of and accumulating WBC (foam cells) and proliferation of intimal smooth muscle cell creating a fibrofatty plaque
44
RF for Atheroslerosis
Non modifiable: age, male , FHx Modifiable: hyperlipidemia, HTN, DM, smoking. Metabolic syndrome, obesity, sedentary lifestyle, heavy alkohol intake.
45
Etiopatopathgenes
RF cause endothelial injury -- >monocyte recruitment and enhanced LDL permeability , monocytes enters into intimal space --> becomes macrophage take up oxidized LDL to become foam cell, cytokines and growth factors --> medial smooth muscle proliferation.
46
Consequence of formation of an atherosclerotic plaque
thrombose, emboli, bleeding into plaque (obstruction) calcification, aneurysm
47
Treatment of atherosclerois
Treatment of RF, lifestyle modification.
48
Infective endocarditits etiopathogenesis, clinical picture, differential diagnosis
Fever + new murmur is IE until proven otherwise. Acute IE = s. aureus, usually on normal valves. RF for acute: Iv injection, dermatitis, renal failure, organ transplant, post op wounds, DM. Subacute (MC) usually have abnormal heart valves. Strep viridans. RF for subacute: Aortic and mitral valvular disorder. prothetic valves. Can also be caused by HACEK, fungal, SLE
49
Infective endocarditits clinical picture
fever, chills, malaise, weight loss, clubbing, cardiac murmus. osler node (painful in pulp, subacute), janeway lesion (acute, paimless: palmar and plantar). Emboli may cause abscess: brain kidney, spleen, gut
50
DDx IE
``` Antiphospholipid Syndrome Atrial Myxoma Infective Endocarditis Lyme Disease Systemic Lupus Erythematosus Polymyalgia Rheumatica Primary Cardiac Neoplasms Reactive Arthritis ```
51
Rheumatic fever | etiopathogenesis
peake age: 5-15. Due to GAS infection of phraynx, 2-4 weeks later. antibody cross react and may cause permanent damage to the heart valves.
52
Clinical picture and dx rheumatic fever
Jones criteria: migratory artheritis (large joints), carditis (tachycardia, murmur, cardiomegaly, pericardial rub), subcutaneous nodules (painless, extensor surfaces), erythema marginatum: (thigh, trunk, arms). Sydenham´s chorea. Minor: inc temp and crp, arthralgia, prolonged PR time, previous RF.
53
differential diagnosis rheumatic fever
``` Gonococcal Arthritis Juvenile Idiopathic Arthritis Lyme Disease Mixed Connective-Tissue Disease Systemic Lupus Erythematosus Reactive Arthritis Rheumatoid Arthritis Septic Arthritis ```
54
Rheumatic fever | treatment
Bedrest, Penicillin, analgesia for arthritis and carditis, haloperidol or diazepam for chorea
55
Pericarditis: etiopathogenesis, clinical picture, diagnosis, treatment
``` Iddiopathic: most common viral: coxackie a, B (MC) echovirus Bactrial: s pneumonia, s aureus TB fungal: hisoplasmosis, blastomycosis Post MI, post cardiac surgery or trauma, uremia (common), neoplasm (hodgkin, breast, lung, RCC, melanoma), SLE, RA, scleroderma, dissecting aneurysm, drugs (hydralazine), infiltrative disease ```
56
clinical picture Pericarditis
pleuritic chest pain, pericardial friction rub, fever and malaise
57
Diagnosis Pericarditis
ECG: initially diffuse elevated ST segments, can be depressed. CXR: normal heart size, pulm infiltrates. ECHO: assess for pericardial effusion
58
Tx Pericarditis
Treat underlying disese, high dose NSAIDS, analgesi.
59
DDx Pericarditis
Acute Gastritis Angina Pectoris Aortic Dissection Aortic Stenosis Coronary Artery Vasospasm Esophageal Rupture Esophageal Spasm Esophagitis Gastroesophageal Reflux Disease Myocardial Infarction Myocardial Ischemia Peptic Ulcer Disease Pulmonary Embolism

Internal medicine (9 decks)

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