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Flashcards in Cardio Quiz 2 Deck (41):
1

Most likely papillary muscle to be damaged in Mitral Regurg

Right coronary artery leading to posteromedial papillary muscle (leads to both medial side of both leaflets)

2

Early aortic stenosis epidemiology

think congenital defect (i.e. Bicuspid aortic valve)

3

What is cor pulmonale?

failure of the right side of the heart brought on by long-term high blood pressure in the pulmonary arteries and right ventricle of the heart.

4

Adverse Effects of Digoxin

1. Low therapeutic index
2. Affects all excitable tissues:
- GI tract
-Visual Disturbances
- Neuro (disoriented, hallucinations)
- Muscular (weakness and fatigue)
- Cardiac (arrhytmias)
3. Toxicity enhanced w/ hypokalemia
4. Drug interactions - quinidine, verapamil, amiodarone)

5

When is digoxin use indicated?

heart failure patients with LV systolic dysfunction (reduced ejection fraction) in A-fib

6

Other Inotropic drugs used in Reduced Ejection Fraction (LV systolic dysfunction)

1. B-agonsists (dobutamine and dopamine)
2. Phosphodiesterase Inhibs (milrinone)

7

Tx Effects of diuretics in Heart Failure

1. Reduce fluid volume and t.f. preload
2. Reduce heart size, improve efficiency and reduce wall stress
3. Reduce edema

8

Isosorbide Dinitrate/ hydralazine combo

Used for Tx of Reduced E.F. heart failure:
- provides mixed arterial and venous dilation
-decreases preload and afterload (increase SV)
-improves survival rate in clinical trials
-use indicated when ACE inhibs or ARBS are not tolerated

9

When do you add Aldosterone Antagonists to Tx regiment in heart failure?

Ex: Spironolactone and Eplerenone
-Used when pt has moderately severe to severe sx'x (class III-IV)
-improves mortality rate and reduces symptoms

10

Non-Drug Tx's in Heart Failure

1. Salt restriction
2. Bi-ventricular pacing
3. Implantable Cardiodefibrillator Devices (ICD)
4. Left ventricular assist device (LVAD)
5. Heart transplant

11

Tx Goals in LV diastolic (preserved EF) heart failure

• Relief of pulmonary and systemic congestion
• Address correctable causes of impaired diastolic function
• Diuretics to reduce pulmonary congestion and peripheral edema
– Use cautiously to avoid under filling of LV
– Could reduce stroke volume

• ACE inhibitors, b blockers, ARBs have no demonstrated mortality benefit
• Because contractile function is preserved, inotropic drugs have no role in this condition

12

Endocarditis:
Predisposing Heart Conditions

• Prosthetic valves (mechanical or bio-)
• Mitral valve prolapse with regurgitation or
thickened leaflets
• Rheumatic heart disease
• Complex congenital heart disease
• Mitral regurgitation, aortic stenosis, aortic
regurgitation, ventricular septal defect

13

Endocarditis:
Risk Factors

• Common denominators: abnormal heart
valves and risk of bacteremia
• Aberrant flow results in platelet-fibrin
thrombus on injured endothelium
• Bacteria enter bloodstream through skin or
mucosal surfaces and adhere to thrombus
• Once inside growing thrombus, bacteria are
resistant to host defenses

14

Peripheral Manifestations of Endocarditis

1. Splinter hemorrhages
2. Conjuctival Petechiae
3. Osler Nodes
4. Janeways lesions
5. Roth spots

Which are painful?

(Osler nodes)

15

I.E. - Microbio associations

- Most common = Strep species
- Acute = Staph aureus
- Prosthetic valves = coag-neg Staph (esp early after valve insertion)
- Elderly = Enterococcus

16

What is significance of Strep bovis?

Associated with colonic lesions
- would want to do endo scope and see if they have colon cancer

17

I.E. - Microbiology more likely in injection drug users?

Pseudomonas, Salmonella, Candida

18

I.E. - what causes Culture Negative Endocarditis ?

HACEK group:
• Haemophilus aphrophilus, paraphrophilus
• Actinobacillus actinomycetemcomitans
• Cardiobacterium hominis
• Eikenella corrodens
• Kingella kingae

*significance is that is takes longer to grow these cultures in lab, thus often missed
*gram negative, pleopmorphic

19

Imaging diagnostics for IE?

Trans-thoracic (TTE) or Trans-esophageal Echo (TEE)

TEE is more sensitive!
(can't r/o IE with negative TTE)

20

Major Duke Criteria? What does this diagnose?

Duke Criteria Diagnose I.E.

Microbiologic
– typical organism from 2 separate blood cxs
– organism from persistently pos. blood cxs
– positive serology for C. burnetti
• Evidence of endocardial involvement
– new valvular regurgitation
– positive echocardiogram

21

when do you add rifampin to IE therapy?

when it is a staph infection or when it is on prosthetic material (remember biofilm formations in osteomyelitis)

-Rifampin has special ability to kill organisms in resting state and biofilm

22

Tx of HACEK organisms
-what can't you use
-what can you use

Can't use vancomycin (b/c these are gram- )

-Used ceftriaxone and Cirpofloxacin

23

What is a mycotic aneurysm?

When bacteria infect the arterial wall or immune complex deposition
-weakens vessel
-usually silent until they bleed

24

Biggest Risk factors for Endocarditis?

1. previous IE
2. Prosthetic Heart Valve

25

Indications for IE prophylaxis

Not at all for any GI/GU procedures
• For manipulation of gingiva or periapical teeth, or
perforation of oral mucosa
• Highest risk cardiac conditions only:
– Prosthetic valve
– Previous IE
– Cardiac transplant with valvulopathy
– Congenital heart disease—unrepaired cyanotic,
for 6 months after repair with prosthetic, or
repaired prosthetic with residual defect

26

Prophylatic Regimen for IE

For dental procedures:
- single dose 30-60 minutes prior of Amoxicillin and Clindamycin (PO).
-if unable to take PO, ampicillin and ceftriaxone (IV)

27

How do you increase forward cardiac output?

decrease afterload (don't give inotroic agents)

28

Arrhythmogenic Right Ventricular Cardiomyopathy
-characteristics

severely thinned RV wall b/c of loss of myocytes
-extensive fatty infiltration and fibrosis
-possibly due to defective desmosomes lining cardiac myocytes

29

"Myofiber disarray" is a buzz word for ______?

Hypertrophic Cardiomyopathy

30

Genes most often mutated in HCM?

– myosin heavy chain β-MHC
– myosin binding protein MYBP-C – cardiac TnT

31

Pathophysiology of HCM (5)

1. Left ventricular outflow tract obstruction
2. Mitral regurgitation (Venturi effect)
3. Diastolic dysfunction
4. Myocardial ischemia
5. Cardiac arrhythmias

32

Treatment of HCM

-Pharm: B-blockers = negative inotropic effect to decrease outflow gradient and prolong diastolic filling
-CCB's: if you don't tolerate B-blockers
-Disopyramide= strong negative inotropic effects
-Surgery= septal myectomy, alcohol-induced septal ablation
-Dual-chamber pacemaker
-Heart Transplant

33

Causes of Restrictive CM

• Idiopathic or
• Secondary to:
– Post-radiation fibrosis
– Amyloidosis
– Sarcoidosis
– Metastases
– Inborn errors of metabolism (Fabry’s disease, Pompe’s disease)

34

Diagnosing RCM

Endomyocardial biopsy--> do a congo red stain (look fro apple-green fluorescence under polarized light)

35

Loeffler Endomyocarditis
(RCM)

endomyocardial fibrosis, large mural thrombi, peripheral eosinophilia (underlying cause), eosinophilic infiltrates in organs
-thickening of basal inferior wall
-endocardial deposition of thrombus

36

Endocardial fibroelastosis
(RCM)

- kids and YA's in Africa
- mural lLV endocardium
- Most common in 1st 2 yrs of life

37

Iron overload in heart is associated with __________ CM?

Dilated CM

-disease = hereditary hemochromatosis

38

Takotsubo Cardiomyopathy

sudden intense emotional or physical stress-leading to acute LV dysfunction
- think octopus jar where apex balloons, but base does not, thus does not allow contents out

-sudden ruch of catecholamines

39

Symptoms of Heart Failure

• Dyspnea on exertion
• Orthopnea (Difficulty breathing when lying flat; “How many pillows...?”)
• Paroxysmal nocturia
dyspnea (PND) (Waking up at night due to shortness of breath)
• Lower extremity edema/swelling
• Ascites
• Decreased
appetite/anorexia
• Weakness/fatigue

40

Right Sided HF signs

– Dependent (pitting) edema
– Jugular venous distension
– Hepatomegaly
– Splenomegaly
– Ascites
– Anorexia

41

Etiology of DCM

- Alcohol
- Coxsackie Virus (viral myocarditis)
- Idiopathic
- Pregnancy