Chapter 11 - Heart Disorders Flashcards
0
Q
What is afterload?
A
Afterload: resistance ventricle contracts against to eject blood in systole
1
Q
How does wall stress affect gene expression in the heart?
A
Wall stress increases gene-controlled sarcomere duplication
2
Q
What is the effect of increased afterload on sarcomeres and muscle?
A
↑Afterload: sarcomeres duplicate parallel to long axis; muscle is thicker
3
Q
Increased afterload results in what type of hypertrophy?
A
↑Afterload: concentric ventricular hypertrophy
4
Q
What are the causes of concentric LVH?
A
Concentric LVH: essential HTN, AV stenosis, hypertrophic cardiomyopathy
5
Q
What are the causes of concentric RVH?
A
Concentric RVH: PH, PV stenosis
6
Q
What is preload?
A
Preload: volume of blood ventricle must expel during systole
7
Q
How does increased preload affect sarcomeres and muscle fibers?
A
↑Preload: sarcomeres duplicate in series; muscle fibers longer/wider
8
Q
Increased preload causes what type of hypertrophy?
A
↑Preload causes eccentric ventricular hypertrophy
9
Q
What are the causes of eccentric LVH?
A
Eccentric LVH: MV/AV regurgitation; left-to-right shunt
10
Q
What are the causes of eccentric RVH?
A
Eccentric RVH: TV/PV regurgitation
11
Q
What are the consequences of ventricular hypertrophy?
A
Consequences: heart failure, S4, angina (subendocardial ischemia)
12
Q
What does the S4 heart sound indicate?
A
S4: blood entering noncompliant ventricle (concentric/eccentric hypertrophy)
13
Q
What does the S3 heart sound indicate?
A
S3: blood entering volume overloaded ventricle
14
Q
What is the most common cause of hospital admission for persons >65 years old?
A
CHF: MCC hospital admission for persons >65 years old
15
Q
What are the types of heart failure?
A
Types heart failure: left/right, biventricular, high output
16
Q
Where does blood back up into in LHF?
A
LHF: blood backs up into lungs
17
Q
Where does blood back up into in RHF?
A
RHF: blood backs up into venous system
18
Q
What type of edema is caused by LHF?
A
LHF → pulmonary edema
19
Q
What is the most common type of LHF? What is the pathogenesis of LHF?
A
SHF: MC type LHF; ↓ventricular contraction
20
Q
What are the causes of SHF? Which cause is the most common?
A
SHF: ischemia MCC; myocarditis, post-MI, dilated cardiomyopathy
21
Q
What is DHF?
A
DHF: noncompliant LV (stiff ventricle) with impaired relaxation; ↑LVEDP
22
Q
What is the most common cause of DHF?
A
DHF: MCC essential HTN
23
Q
How is the EF affected in SHF?
A
SHF: ↓EF
24
How is the EF affected in DHF?
DHF: normal EF at rest
25
What are the microscopic findings of LHF?
LHF: heart failure cells; alveolar macrophages with hemosiderin
26
What is dyspnea?
Dyspnea: cannot take full inspiration
27
How do the pulmonary capillary HP and OP compare in pulmonary edema?
Pulmonary edema: pulmonary capillary HP > OP
28
What causes cardiac asthma?
Cardiac asthma: peribronchiolar edema
29
What is a physical exam finding in LHF?
LHF: bibasilar inspiratory crackles (edema)
30
What are the chest radiograph findings in LHF?
LHF X-ray: bat-wing configuration, fluffy alveolar infiltrate, Kerley lines, air bronchograms
31
What is the first cardiac sign of LHF?
S3: first cardiac sign LHF
32
What type of regurgitant murmur may be present in LHF?
LHF: functional MV regurgitation
33
What is the cause of PND/orthopnea?
PND/orthopnea: ↑venous return to right side of heart at night → failed left heart → pulmonary edema
34
Describe how pillows relieve orthopnea.
Pillow orthopnea: pillows ↑gravitational effect → ↓venous return to right heart
35
What is BNP useful in?
BNP: useful in confirming/excluding LHF; predicting survival
36
How is ANP affected in LHF?
ANP: ↑with left atrial dilatation in LHF
37
How is the venous HP affected in RHF?
RHF → ↑venous hydrostatic pressure
38
What is the most common cause of RHF?
MCC RHF: ↑afterload from LHF
39
What are the causes of decreased RV contraction in RHF?
RHF: ↓RV contraction; e.g., myocarditis, RV infarction
40
What are the causes of a noncompliant RV in RHF?
RHF: RV noncompliant; e.g., restrictive cardiomyopathy, concentric RVH
41
What are the causes of increased RV preload in RHF?
RHF: ↑RV preload; e.g., valvular regurgitation; left-to-right shunt
42
What are the clinical findings in RHF?
RHF: prominence internal jugular veins; function TV regurgitation
RHF: S3/S4 heart sounds
RHF: painful hepatomegaly; centrilobular hemorrhagic necrosis
RHF: dependent pitting edema, ascites, cyanotic mucous membranes
43
What is the nonpharmacologic therapy for CHF?
Restrict sodium & water
44
What are two pharmacologic treatments for CHF? How do they work?
ACE inhibitor: ↓afterload, ↓preload
| β-Blocker: ↓myocardial O2 consumption; ↓heart rate
45
Describe the pathogenesis and causes of high-output heart failure.
HOF: ↑SV; e.g., hyperthyroidism
HOF: ↓blood viscosity; e.g., severe anemia
HOF: vasodilation PVRs; e.g., septic shock, thiamine deficiency
HOF: arteriovenous fistula
46
What is ischemic heart disease?
IHD: imbalance in demand of O2 and supply
47
When do coronary arteries normally fill?
Coronary arteries: fill in diastole
48
How does tachycardia affect diastole and the filling of coronary arteries?
Tachycardia: ↓diastole and filling of coronary arteries
49
What is the distribution of the LAD?
LAD: anterior portion LV; anterior IVS; apex
50
What is the most common site of coronary artery thrombosis?
LAD: MC site coronary artery thrombosis
51
What is the distribution of the RCA?
RCA: posterior LV; posterior IVS; RV; posteromedial papillary muscle; SA/AV nodes
52
What is the distribution of the left circumflex coronary artery?
Left circumflex: lateral wall LV
53
IHD is a major cause of what in the U.S.?
IHD: major cause of death in U.S.
54
What is the most common manifestation of coronary artery disease?
Angina pectoris: MC manifestation coronary artery disease
55
What is the most important risk factor for angina pectoris?
Angina pectoris: age most important risk factor
56
Which gender is more affected by angina pectoris?
Angina: males > females
57
What is the most common variant of angina?
Chronic (stable) angina: MC type of angina
58
What is the most common cause of stable angina?
Stable angina: MCC fixed atherosclerotic coronary artery disease
59
What are other causes of stable angina?
Stable angina: AV stenosis/HTN with concentric LVH
60
Describe the pathogenesis of stable angina.
Pathogenesis: subendocardial ischemia; ↓coronary artery blood flow/concentric hypertrophy
61
What is a clinical finding of stable angina?
Exercise-induced substernal chest pain; relieved by rest/nitroglycerin
62
How does subendocardial ischemia appear on a stress test?
Subendocardial ischemia: ST-segment depression on stress test
63
What is Prinzmetal angina?
Prinzmetal angina: vasospasm with transmural ischemia/ST-segment elevation
64
What is unstable angina?
Unstable angina: angina at rest; multivessel disease; disrupted plaques
65
What is the treatment for Prinzmetal variant angina?
Prinzmetal variant angina: calcium channel blockers vasodilate coronary arteries
66
What is CIHD?
CIHD: muscle replaced by noncontractile fibrous tissue; progressive CHF
67
What is sudden cardiac death? What is its most important risk factor?
SCD: unexpected death within 1 hour after symptoms; IHD most important
68
What is a NSTEMI?
NSTEMI = non-ST elevation myocardial infarction
69
What is the most common cause of SCD in children?
SCD in children: AV stenosis MCC
70
Describe the pathogenesis of SCD in adults.
SCD: coronary artery thrombosis not usually present; ventricular arrhythmia
71
What is the most common cause of death in adults in the U.S.?
AMI: MCC death in adults in U.S.
72
Describe the pathogenesis of developing an AMI.
Rupture of disrupted plaque → platelet thrombus → AMI
73
Describe the coronary arteries in a cocaine-induced AMI.
Cocaine: AMI with normal coronary arteries
74
What is a STEMI?
STEMI = ST wave elevation myocardial infarction; Q waves
75
What is the effect of early reperfusion following AMI?
Early reperfusion (<3 hr): ↑short- and long-term survival
76
What is reperfusion injury?
Reperfusion injury: ischemic myocardial cells not already irreversibly damaged become so after reperfusion
Reperfusion injury: previously ischemic cells become irreversibly damaged
77
What is reversible after reperfusion?
Myocardial stunning after reperfusion is reversible
78
Describe the mechanism of irreversible myocardial injury.
Irreversible injury: superoxide FRs
| Neutrophils contribute to irreversible myocardial injury
79
When does coagulation necrosis occur following an AMI?
AMI: coagulation necrosis within 24 hours
80
What period following an AMI is the risk for rupture the greatest?
AMI: heart softest 3–7 days; danger of rupture
81
What are the clinical findings of an AMI?
AMI: retrosternal pain >30 minutes, radiation to left inner arm/shoulder, diaphoresis
82
What are the nerves to the heart?
Nerves to heart: T1–T5
83
Inner arm pain is in the distribution of which nerve?
Inner arm pain: T1 distribution
84
The epigastrium is in which nerve distribution?
Epigastrium radiation: T4–T5 distribution
85
How does the early mortality rate of a STEMI compare to that of an NSTEMI?
STEMI: ↑early mortality rate
86
Having an NSTEMI increases the risk of what?
NSTEMI: ↑risk for SCD
87
What is the most common arrhythmia post-STEMI?
Ventricular premature contractions MC arrhythmia
88
What is the most common cause of death in a STEMI?
Ventricular fibrillation: MCC death in STEMI
89
When is myocardial rupture most common post-AMI?
Myocardial rupture: MC at 3–7 days
90
What is posteromedial papillary muscle rupture associated with? How does it present?
Posteromedial papillary muscle rupture: RCA thrombosis; MV regurgitation
91
What is the most common cause of an IVS rupture? What does it produce?
IVS rupture: left-to-right shunt; LAD thrombosis MCC
92
There is danger of what with a mural thrombus?
Mural thrombus: danger of embolization
93
Describe the characteristics of fibrinous pericarditis following STEMI AMI.
Fibrinous pericarditis: early (acute inflammation); late complication (autoimmune)
94
Describe the characteristics of ventricular aneurysm following STEMI AMI.
Ventricular aneurysm: precordial bulge with systole; CHF MCC death
95
What is a right ventricular AMI associated with? What are its clinical findings?
RV AMI: RCA thrombosis; hypotension, RHF, preserved LV function
96
How is reinfarction of the heart defined?
Reinfarction: reappearance of CK-MB after 3 days
97
What are the cardiac troponins tested for in an AMI? Can they be used to diagnose reinfarction?
cTnI, cTnT: cannot diagnose reinfarction
98
What is the gold standard for diagnosis of an AMI?
cTnI, cTnT: gold standard for diagnosis of AMI
99
What are the ECG findings in a STEMI?
ECG findings in STEMI: inverted T waves, elevated ST segments, Q waves
100
What do inverted T waves correlate with in an AMI?
Inverted T waves: correlates with ischemia at periphery of infarct
101
What does ST elevation correlate with in an AMI?
ST elevation: correlates with injured myocardial cells surrounding area of necrosis
102
What do new Q waves correlate with in an AMI?
Q waves: correlates with area of coagulation necrosis
103
Describe the role of the chorionic villus in the fetal circulation.
Chorionic villus: primary site O2 exchange; vessels become umbilical vein
104
Describe the role of the umbilical vein in the fetal circulation.
Umbilical vein: highest PO2 in fetal circulation
105
What keeps the ductus arteriosus open?
Ductus arteriosus kept open by PGE2, a vasodilator synthesized by placenta
106
Which two structures are patent in the fetal circulation but not the adult circulation?
Fetal circulation: foramen ovale and ductus arteriosus are patent
107
The presence of a single umbilical artery increases the risk for what?
Single umbilical artery: ↑risk congenital abnormalities
108
What are the changes in the fetal circulation at birth?
Ductus arteriosus becomes ligamentum arteriosum after birth
| Newborn: foramen ovale and ductus arteriosus are closed
109
What type of heart disease is the most common in children?
CHD MC heart disease in children
110
Which are the most common causes of congenital heart disease?
Genetic-environmental causes MCC CHD
111
How does the risk for CHD change with maternal age?
CHD: ↑risk with ↑maternal age
112
What are the maternal risk factors for CHD?
Previous child with CHD; poorly controlled DM
Alcohol; congenital infections (rubella)
Aspirin, diphenylhydantoin, SLE
113
Describe the spectrum of CHD.
CHD: valvular disorders, shunts (acyanotic, cyanotic)
114
What are the systemic complications of CHD?
Complications: 2° polycythemia, clubbing, infective endocarditis, metastatic abscesses
115
What are the types of shunts in CHD?
CHD shunts: left-to-right; right-to-left (often cyanotic)
116
Describe the effect of left-to-right shunts on SaO2.
Left-to-right shunts: step up of SaO2 in right heart
117
Describe the effect of right-to-left shunts on SaO2.
Right-to-left shunts: step down of SaO2 in left heart
118
What is shunt reversal due to in left-to-right shunts?
Shunt reversal due to PH and RVH
119
What is there danger of if a left-to-right shunt is uncorrected?
Left-to-right shunts: danger of shunt reversal if uncorrected
120
What is the most common type of CHD?
VSD: MC CHD
121
Which type of VSD is most common?
VSD MC a defect in membranous portion of IVS
122
What are the associations of VSD with other congenital heart diseases?
VSD associations: cri du chat syndrome, fetal alcohol syndrome
123
How is the SaO2 affected in a patient with a VSD?
VSD: step up SaO2 in RV and PA
124
What percentage of VSDs spontaneously close?
VSD: ~50% spontaneously close
125
What is the most common CHD in adults?
ASD: MC CHD in adults
126
What is the most common cause of ASD?
ASD: MCC patent foramen ovale
127
What are the associations of ASD with other CHDs?
ASD associations: fetal alcohol syndrome, Down syndrome (primum type)
128
What is the physical exam finding of ASD?
ASD: wide and fixed split of S2 very characteristic
129
ASD is associated with which type of embolism?
ASD: paradoxical embolism (venous clot in system circulation)
130
How is the SaO2 affected in a patient with an ASD?
ASD: step up SaO2 in RA, RV, PA
131
What are the associations of PDAs?
PDA associations: congenital rubella, RDS, transposition
132
What is the physical exam finding of a PDA? How is the SaO2 affected in a patient with a PDA?
PDA: continuous machinery murmur; step up SaO2 in PA
133
What is the physical exam finding of a shunt reversal in PDA?
Reversal of shunt in PDA: differential cyanosis (pink on top, blue on bottom)
134
What is the treatment for a PDA?
PDA: closed with indomethacin
135
What is the most common cyanosis CHD after one year of age?
Tetralogy of Fallot: MC cyanotic CHD after age 1 year
136
What are the defects in tetralogy of Fallot?
VSD, infundibular pulmonic stenosis, dextrorotation of aorta, RVH
137
What does the degree of PV stenosis correlate with in tetralogy of Fallot?
Degree of PV stenosis correlates with presence or absence of cyanosis
138
What is the effect of severe PV stenosis in tetralogy of Fallot?
Severe PV stenosis → cyanosis; mild PV stenosis → no cyanosis
139
How is the SaO2 affected in patients with tetralogy of Fallot?
Step down in SaO2 in LV and Ao
140
What are the cardioprotective shunts in tetralogy of Fallot?
Cardioprotective shunts in tetralogy: ASD, PDA
141
What are tet spells? Describe the mechanism of compensation.
Tet spells (hypoxemic episode): squatting ↑PVR → reverses shunt → ↑PaO2
142
What is transposition of the great arteries?
Transposition: abnormal formation of truncal and aortopulmonary septa
143
What are the defects of complete transposition?
Transposition: Ao empties RV; PA empties LV; atria normal
144
What are the cardioprotective shunts in transposition?
Cardioprotective shunts: ASD, VSD, PDA
145
Describe the characteristics of infantile coarctation.
Infantile coarctation: preductal; constriction proximal to ligamentum arteriosum; associated with Turner syndrome
146
Describe the characteristics of adult coarctation.
Adult coarctation: constriction distal to ligamentum arteriosum
147
What is commonly present in patients with an adult coarctation?
Adult coarctation: bicuspid AV commonly present
148
What are the clinical findings and possible complications proximal to the coarctation in adult coarctation?
↑Upper extremity systolic blood pressure (SBP); ↑cerebral blood flow (risk for berry aneurysms)
148
What are the clinical findings and possible complications distal to the coarctation in adult coarctation?
Disparity between upper/lower extremity blood pressure >10 mm Hg
Leg claudication: pain in calf/buttocks when walking
HTN due to activation of RAA system from ↓renal blood flow
149
Describe the collateral circulation that develops in coarctation.
Coarctation collaterals: anterior ICAs → posterior ICAs → Ao; superior epigastric artery → inferior epigastric artery → external iliac artery
150
What causes rib notching?
Rib notching from enlarged ICAs
151
Acute rheumatic fever only occurs after what?
Acute RF: only after group A streptococcal pharyngitis
151
Describe the pathogenesis of RF.
Type II HSR (most common); cell-mediated immunity type IV HSR
M protein antibodies cross-react with human tissue (mimicry)
152
What is the most common initial presentation of RF?
Migratory polyarthritis MC initial presentation
153
What types of carditis may be present in acute RF?
Carditis: pericarditis, myocarditis, endocarditis (valves)
154
What is the most common cause of death in acute RF?
Myocarditis MCC death in acute RF
155
Describe the characteristics of endocarditis in RF.
Endocarditis: MV most often involved, followed by AV; sterile vegetations
156
How does valvular disease differ between acute RF and chronic RF?
MV regurgitation in acute RF; MV stenosis in chronic RF
157
The subcutaneous nodules in RF are comparable to those in what disease?
Subcutaneous nodules similar to rheumatoid arthritis nodules
158
Describe the physical exam findings in erythema marginatum.
Erythema marginatum: circular or C-shaped areas of erythema around normal skin
159
Describe the characteristics of Sydenham chorea in acute RF.
Sydenham chorea: late manifestation; reversible
160
How is acute RF diagnosed?
Acute RF: diagnose with revised Jones criteria
161
What are the major criteria of the revised Jones criteria?
Acute RF: carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules
162
What are the lab findings and ECG finding of acute RF?
Acute RF: carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules
163
What is the most common cause of MV stenosis?
MV stenosis: MCC is recurrent RF
164
What are the effects on the LA caused by MV stenosis?
MV stenosis: LA dilated/hypertrophied
165
What are the pulmonary clinical findings in MV stenosis?
Dyspnea; rust-colored sputum from pulmonary congestion
| Pulmonary venous hypertension → RVH → RHF
166
What are the cardiovascular clinical findings in MV stenosis?
Atrial fibrillation: common in MV stenosis; danger thrombus formation/embolization
MV stenosis: opening snap followed by an early to middiastolic rumble
167
What are the gastrointestinal clinical findings in MV stenosis?
Dysphagia for solids from LA dilation
168
What is MV regurgitation?
MV regurgitation: retrograde blood flow into LA during systole
169
What is the most common cause of mitral valve regurgitation?
MVP: MCC of MV regurgitation
170
What is the effect of MV regurgitation on cardiac output and the LA?
MV regurgitation: ↓cardiac output; LA dilated/hypertrophied
171
What is the effect of MV regurgitation on the pulmonary vein, right ventricle, and right side of the heart?
Pulmonary venous hypertension → RVH → RHF
172
How do the stroke volume and cardiac output change in chronic compensated mitral regurgitation?
Normalization of stroke volume/cardiac output in chronic compensated mitral regurgitation
173
What is the effect of MV regurgitation on the left ventricle?
Eccentric LVH due to ↑LV volume
174
What are the clinical findings of MV regurgitation?
Pansystolic murmur; S3/S4; no ↑intensity with deep held inspiration
175
MVP is associated with what syndromes?
MVP: association with Marfan, Ehlers-Danlos, Klinefelter syndromes
176
Describe the pathophysiology of MVP.
Bulging anterior and/or posterior leaflets into LA during systole
MVP: myxomatous degeneration; excess dermatan sulfate in MV
177
What are the clinical findings of MVP?
MVP: systolic click followed by murmur; most patients are asymptomatic
178
What does preload alter in MVP?
Preload alters click and murmur relationship to S1/S2
179
What is the effect of decreasing preload on MVP? List three causes of decreased preload.
↓Preload (anxiety, standing, Valsalva) click/murmur closer to S1
180
What is the effect of increasing preload on MVP? List three causes of increased preload.
↑Preload (reclining, squatting, sustained hand grip) click/murmur closer to S2
181
What is the treatment for symptomatic MVP?
Symptomatic MVP: β-blockers
182
What is the most common valve lesion in Western countries?
AV stenosis is MC valve lesion in Western countries
183
What is the most common cause of stenosis in patients >60 years old?
Calcific AV stenosis: MCC of stenosis in patients >60 years old
184
What is a major cause of stenosis <30 years old?
Congenital AV stenosis major cause of stenosis <30 years old
185
How does obstruction to LV outflow tract in AV stenosis affect the left ventricle?
Obstruction to LV outflow tract → concentric LVH
186
Describe the physical exam findings of AV stenosis.
Harsh systolic ejection murmur with radiation into neck; S4 heart sound
187
What changes the murmur intensity in AV stenosis?
Changing preload changes murmur intensity
188
How does the murmur intensity of AV stenosis change with preload?
↓Murmur intensity with ↓preload; ↑murmur intensity with ↑preload
189
What is the most common valvular lesion causing syncope/angina with exercise?
MC valvular lesion causing syncope/angina with exercise
| AV stenosis
190
What is the most common cause of microangiopathic hemolytic anemia with schistocytes and hemoglobinuria?
MCC microangiopathic hemolytic anemia with schistocytes and hemoglobinuria
AV stenosis
191
What is the most common cause of AV regurgitation?
Isolated AV root dilation MCC AV regurgitation
192
What are the other causes of AV regurgitation?
Chronic RF, syphilitic aortitis, infective endocarditis, aortic dissection, coarctation
193
How are LVEDP, SBP, pulse pressure and cardiac output affected in acute AV regurgitation?
Acute AV regurgitation: ↑LVEDP, ↓SBP, normal/↓pulse pressure, ↓cardiac output
194
How are LVEDP, SBP, DBP, pulse pressure and cardiac output affected in chronic AV regurgitation?
Chronic AV regurgitation: normal LVEDP, ↑SBP, ↓DBP, ↑pulse pressure, normal cardiac output
195
How does AV regurgitation affect the left ventricle?
AV regurgitation: eccentric LVH
196
What are the clinical findings of AV regurgitation?
Early diastolic murmur; S3, S4; no ↑intensity with inspiration
Wide pulse pressure → bounding pulses, head nodding, pulsating nail bed
Austin Flint murmur: sign for AV replacement
197
What is the most common cause of TV regurgitation in adults?
TV regurgitation: functional (stretching of ring), MCC in adults
RHF
198
What is the most common cause of TV regurgitation in adolescents/young adults?
Adolescents/young adults: CHD MCC
199
What is the most common cause of TV regurgitation in IVDA?
IVDA: infective endocarditis of valve MCC
200
Describe the pathophysiology of TV regurgitation.
Retrograde blood flow into RA during systole
| RA dilatation/hypertrophy; eccentric RVH; ↑pressure in venous system
201
What are the clinical findings of TV regurgitation?
Pulsating liver; ascites; ↑portal vein pressure
| Giant c-v wave; pansystolic murmur + S3/S4 that ↑in intensity with deep held inspiration
202
What is PV stenosis associated with?
PV stenosis: CHD, carcinoid heart disease
203
What is the most common cause of PV regurgitation?
PV regurgitation: MCC stretching of ring from PH
204
Describe the characteristics of carcinoid heart disease.
Must be liver metastasis to produce carcinoid heart disease; serotonin causes valve fibrosis
Carcinoid heart disease: PV stenosis, TV regurgitation
205
IE is most frequent at what age?
IE most frequent at age 45–65 years
206
What is the most common cause of IE?
Acute IE: Staphylococcus aureus MCC
207
What is the most common cause of IVDA IE?
IVDA IE: Staphylococcus aureus MCC
208
What is the most common cause of subacute IE?
Subacute endocarditis: viridans Streptococcus MCC
209
What are the most common overall pathogens causing IE?
Viridans group of Streptococcus: overall MCC IE
210
What is the most common cause of early IE associated with prosthetic heart valves?
Prosthetic valve IE early: Staphylococcus epidermidis (coagulase negative) MCC
211
What are the causes of late IE associated with prosthetic heart valves?
Prosthetic valve IE late: Staphylococcus aureus, enterococci, group D streptococci
212
What is the most common cause of nosocomial IE in patients with intravenous catheters?
Nosocomial IE intravenous catheters: Staphylococcus aureus MCC
213
What is the most common cause of nosocomial IE in patients with indwelling urinary catheters?
Nosocomial IE indwelling urinary catheters: enterococci MCC
214
What is the cause of IE associated with ulcerative bowel lesions?
IE associated with ulcerative bowel lesions: Streptococcus bovis
215
What is the most common valve involved in IE?
MC valve involved in IE: MV
216
What are the valvular lesions in IVDA IE?
IVDA IE: TV regurgitation/AV regurgitation
217
What do the viridans group of streptococci infect in IE?
Viridans group of streptococci infect previously damaged valves
218
What does Staphylococcus aureus infect in IE?
Staphylococcus aureus infects normal or damaged valves
219
What type of murmurs are the most common in IE?
Regurgitant murmurs MC in IE
220
What is the most consistent sign in IE?
Fever is most consistent sign in IE
221
What are the immunocomplex signs in IE?
Immunocomplex signs: glomerulonephritis (nephritic), Roth spot in eyes
222
What are the microembolization signs in IE?
Microembolization signs: splinter hemorrhages, Janeway lesions (painless), Osler nodes (painful), infarctions
223
What are the other clinical findings in IE?
Changing heart murmurs, splenomegaly (only subacute)
224
What are the lab findings in IE?
Positive blood culture majority of cases
225
Describe the characteristics of Libman-Sacks endocarditis.
Libman-Sacks endocarditis: associated with SLE; MV regurgitation
226
Describe the characteristics of NBTE.
NBTE: sterile vegetations MV; paraneoplastic syndrome; mucin-producing tumors
227
Myocarditis is a major cause of sudden death in what age group worldwide?
Major cause sudden death in adults <40 years old
228
What is the most common cause of acute myocarditis in the U.S.?
Viruses: MCC acute myocarditis U.S.
229
What is the most common cause of myocarditis leading to CHF in Central/South America?
Chagas disease: MCC myocarditis leading to CHF in Central/South America
230
What type of RF is an etiology of myocarditis?
Myocarditis in acute RF
231
Which toxins are etiologies of myocarditis?
Toxins: diphtheria, carbon monoxide, black widow and scorpion venoms
232
Which drugs are etiologies of myocarditis?
Drugs: doxorubicin, daunorubicin, cocaine, alcohol
233
Which systemic and collagen vascular diseases are etiologies of myocarditis?
SLE, systemic sclerosis, Kawasaki disease, radiation, sarcoidosis
234
Describe the pathology of myocarditis.
Myocarditis: global enlargement of heart; dilation of all chambers
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What are the clinical findings of myocarditis?
Myocarditis: fever, dyspnea, chest pain
Myocarditis: arrhythmias, pericarditis, biventricular CHF, MV regurgitation
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What are the lab findings in myocarditis?
Myocarditis: ↑CK-MB, troponin I/T
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Describe the etiology of most cases of pericarditis.
Pericarditis: most cases are idiopathic
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What are the clinical findings in pericarditis?
Precordial friction rub; pain relieved by leaning forward; worse when leaning back
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A young woman with pericarditis and effusion most likely has what?
Young woman with pericarditis and effusion most likely has SLE
240
What is the physical exam findings of a pericardial effusion? How is the cardiac output affected?
Effusion: muffled heart sounds
Effusion: ↓cardiac output; neck vein distention with inspiration
Effusion: hypotension with pulsus paradoxus on inspiration
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What is the pericardial effusion triad?
Effusion triad: muffled heart sounds, neck distention on inspiration, pulsus paradoxus on inspiration
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What are the chest x-ray findings of pericardial effusion?
Effusion: chest X-ray shows water bottle configuration of heart silhouette
243
What is the most common cause of constrictive pericarditis worldwide?
Constrictive pericarditis: TB MCC worldwide
244
Most cases of constrictive pericarditis are due to what in the U.S.?
Constrictive pericarditis U.S.: idiopathic or post open heart surgery
245
Describe the pathophysiology of constrictive pericarditis.
Constrictive pericarditis: incomplete filling of chambers; pericardial knock
246
What are the findings of constrictive pericarditis on chest x-ray?
Constrictive pericarditis: calcification pericardium on x-ray
247
What are the types of cardiomyopathy?
Cardiomyopathies: dilated, hypertrophic, restrictive
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What is the most common cardiomyopathy in young people?
Dilated: MC cardiomyopathy
247
What is the most common known cause of dilated cardiomyopathy?
Dilated: myocarditis MC known cause
247
What are the other causes of cardiomyopathy?
Dilated: alcohol—direct toxic effect; thiamine deficiency (↓ATP)
Dilated: drugs—doxorubicin, daunorubicin, cocaine
Dilated: postpartum, organic solvents, acromegaly, myxedema heart
248
Describe the pathophysiology of dilated cardiomyopathy.
Dilated: global enlargement of heart
249
What are the clinical findings in dilated cardiomyopathy?
Dilated: signs/symptoms biventricular failure
Dilated: narrow pulse pressure; arrhythmias
250
How is dilated cardiomyopathy diagnosed?
Dilated: echocardiography—EF <40%
251
What is the most common cause of sudden death in young athletes?
HCM: MCC sudden death in young athletes
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What is the most common type of HCM? Describe its characteristics.
Familial type HCM: AD with complete penetrance; MC type
253
Who is affected by the sporadic type of HCM?
Sporadic type HCM: elderly population
254
Describe the pathophysiology of HCM.
HCM: obstruction outflow tract below AV
HCM: aberrant myofibers in conduction system cause fatal arrhythmia, sudden death
HCM: noncompliant LV—diastolic dysfunction
255
What are the clinical findings in HCM?
HCM: palpable double apical impulse
256
How do preload changes in HCM compare to preload changes in AV stenosis?
HCM: preload changes are opposite those for AV stenosis
257
What are the clinical findings when exercising in HCM? These findings also occur in what condition?
HCM: angina/syncope with exercise similar to AV stenosis
258
What is the cause of sudden death in HCM?
HCM: sudden death due to ventricular tachycardia/fibrillation
259
What is the treatment for HCM?
HCM: treat with β-blockers
260
Which is the least common cardiomyopathy?
Restrictive: least common cardiomyopathy
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What is the most common cause of restrictive cardiomyopathy?
Restrictive: amyloidosis MCC
262
Describe the pathophysiology of restrictive cardiomyopathy.
Restrictive: ↓ventricular compliance; biventricular heart failure
263
What are the ECG findings of restrictive cardiomyopathy?
Restrictive: characteristic low voltage ECG
264
Describe the epidemiology of heart tumors.
Heart tumors: metastasis > primary tumors
264
Where is the most common site for metastasis in the heart?
Pericardium MC site for metastasis
264
What is the most common adult primary tumor of the heart? Where in the heart is its most common site?
Cardiac myxoma: MC adult primary tumor; MC in LA
265
What are the complications of cardiac myxoma?
Myxoma: embolization; syncopal episodes
266
Describe the characteristics of rhabdomyomas.
Rhabdomyomas: associated with tuberous sclerosis in children; hamartoma
