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Flashcards in Cardiology - Diseases Deck (17):
1

Ortner's Syndrome

Hoarseness associated with mitral valve stenosis

Increased pressures in the left atrium cause left atrial hypertrophy, which can compress the left recurrent laryngeal nerve as it hooks around the aorta near the ligamentum arteriosum

2

Rheumatic Heart Disease

Consequence of pharyngeal infection with Group A b-hemolytic streptococci; antibody production against M protein cross-reacts with self-antigen on heart valves (mostly mitral > aortic >>> tricuspid)

Causes early mitral regurgitation followed by late mitral stenosis; may lead to heart failure under conditions of increased cardiovascular strain (i.e. pregnancy)

3

Dilated cardiomyopathy

Most common cardiomyopathy (90%); most cases are congenital or idiopathic, also caused by chronic alcohol/cocaine abuse, wet Beriberi, Coxsackie B virus myocarditis, Chagas disease, hemochromatosis, peripartum

Findings: Systolic heart failure, S3, dilated heart on ECHO

Treatment: Na restriction, ACEIs/B-blockers, diuretics, Digoxin, ICD, heart transplant

4

Hypertrophic Cardiomyopathy

60-70% of cases are familial, usually autosomal dominant mutation of myosin heavy chain

Cause of sudden death in young athletes due to ventricular arrhythmia; sub-type with prominent septal hypertrophy causes outflow obstruction with dyspnea ad syncope

Findings: S4, systolic murmur, marked ventricular hypertrophy +/- septal thickening on ECHO

Treatment: Cessation of high-intensity athletics, B-blockers, non-DHP CCBs (Verapamil), ICD

5

Cardiac Tamponade

Compression of the heart by fluid (blood, effusion) within the pericardial space, leading to decreased cardiac output

Findings: Beck triad, Kussmaul sign, pulsus paradoxus, ECG shows low voltage QRS

6

Ebstein Abnormality

Congenital cardiac malformation associated with maternal Lithium use during first trimester

Characterized by downward displacement of the tricuspid valve leaflets with adherence to the RV wall; causes functional division of the RV into a proximal 'atrialized' (thinned) compartment and a smaller pumping compartment

If pump function is compromised, can lead to hypoxia and heart failure

7

Temporal (Giant Cell) Arteritis

Focal, granulomatous inflammation most commonly affecting branches of the carotid artery

Presents most commonly in elderly females with headache and jaw claudication; may cause irreversible blindness secondary to involvement of the opthalmic artery

Dx: Temporal artery biopsy

Treated with high dose corticosteroids

8

Takayasu Arteritis

Granulomatous inflammation of the aortic arch and proximal great vessels leading to thickening and narrowing of the vessel lumen

Most commonly presents in Asian females <40 years old with weak pulses of the upper extremities, fever, night sweats, myalgias, arthritis

Treated with corticosteroids

9

Polyarteritis Nodosa

Vasculitis of medium-sized vessels; immune-complex mediated inflammation of renal and visceral vessels

Most commonly presents in young adults with fever, malaise, weight loss, headaches, hypertension, abdominal pain, and melena; associated with HBV (30%)

Findings: Transmural inflammation of the vessel wall with fibrinoid necrosis and innumerable microaneurysms; vessels are spastic on arteriogram

Treated with corticosteroids

10

Kawasaki Disease

Medium-vessel vasculitis most commonly seen in Asian children < 4 years old with fever, cervical lymphadenopathy, conjunctival injection, "strawberry tongue," erythema of hands and feet, desquamating rash

Increased risk of coronary artery aneurysm or thrombosis

Treated with Aspirin (for anti-inflammatory and anti-platelet effect) + IVIG

11

Buerger Disease

Medium vessel vasculitis most commonly seen in male smokers < 40 years old

Presents with intermittent claudication; may lead to gangrene, auto-amputation of digits; Raynaud phenomenon often present

Findings: Segmental, thrombosing vasculitis

Treated with smoking cessation

12

Granulomatosis with polyangiitis (Wegener's Vasculitis)

Small vessel focal necrotizing vasculitis of the vasculature of the lungs and kidneys

Presents with chronic sinusitis, otitis media, hemoptysis, cough, dyspnea, hematuria, RBC casts

Pathological triad = focal necrotizing vasculitis + necrotizing granulomas of the lungs and upper airway + necrotizing glomerulonephritis

Treated with corticosteroids / cyclophosphamide

13

Microscopic Polyangiitis

Small vessel necrotizing vasculitis of the lungs, kidneys, and skin; characterized by pauci-immune glomerulonephritis and palpable purpura

Presentation is similar to GPA without nasopharyngeal involvement - hemoptysis, cough, dyspnea, hematuria, RBC casts

Treated with corticosteroids and cyclophosphamide

14

Churg-Strauss Syndrome

Small vessel granulomatous, necrotizing vasculitis with eosinophilia

Presents with asthma, sinusitis, palpable purpura, and peripheral neuropathy (wrist/foot drop); may also affect GI, heart, kidneys

15

Henloch-Schonlein Purpura

Small vessel vasculitis secondary to IgA complex deposition; associated with IgA Nephropathy, most common vasculitis of chilhood

Most commonly presents after URI with triad of: palpable purpura + arthralgias + GI symptoms (abdominal pain, melena)

16

Myxoma

Most common primary neoplasm of the heart

Comprised of amorphous extracellular matrix

Appears as a "ball-valve" obstruction of the L. atrium; may be associated with syncopal episodes or emboli

17

Transposition of great vessels

Congenital cardiac defect in which the aorta arises from the RV and the pulmonary artery arises from the LV; risk increased with maternal diabetes

Newborn infant is cyanotic, tachypnic

Findings: CXR shows enlarged cardiac silhouette (>50% of chest diameter) and increased pulmonary vasculature markings

Treatment: Balloon atrial septostomy, PGE1 to maintain patent DA