Chapter 11 - Heart Disorders Flashcards Preview

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Flashcards in Chapter 11 - Heart Disorders Deck (274):
0

How does wall stress affect gene expression in the heart?

Wall stress increases gene-controlled sarcomere duplication

1

What is afterload?

Afterload: resistance ventricle contracts against to eject blood in systole

2

What is the effect of increased afterload on sarcomeres and muscle?

↑Afterload: sarcomeres duplicate parallel to long axis; muscle is thicker

3

Increased afterload results in what type of hypertrophy?

↑Afterload: concentric ventricular hypertrophy

4

What are the causes of concentric LVH?

Concentric LVH: essential HTN, AV stenosis, hypertrophic cardiomyopathy

5

What are the causes of concentric RVH?

Concentric RVH: PH, PV stenosis

6

What is preload?

Preload: volume of blood ventricle must expel during systole

7

How does increased preload affect sarcomeres and muscle fibers?

↑Preload: sarcomeres duplicate in series; muscle fibers longer/wider

8

Increased preload causes what type of hypertrophy?

↑Preload causes eccentric ventricular hypertrophy

9

What are the causes of eccentric LVH?

Eccentric LVH: MV/AV regurgitation; left-to-right shunt

10

What are the causes of eccentric RVH?

Eccentric RVH: TV/PV regurgitation

11

What are the consequences of ventricular hypertrophy?

Consequences: heart failure, S4, angina (subendocardial ischemia)

12

What does the S4 heart sound indicate?

S4: blood entering noncompliant ventricle (concentric/eccentric hypertrophy)

13

What does the S3 heart sound indicate?

S3: blood entering volume overloaded ventricle

14

What is the most common cause of hospital admission for persons >65 years old?

CHF: MCC hospital admission for persons >65 years old

15

What are the types of heart failure?

Types heart failure: left/right, biventricular, high output

16

Where does blood back up into in LHF?

LHF: blood backs up into lungs

17

Where does blood back up into in RHF?

RHF: blood backs up into venous system

18

What type of edema is caused by LHF?

LHF → pulmonary edema

19

What is the most common type of LHF? What is the pathogenesis of LHF?

SHF: MC type LHF; ↓ventricular contraction

20

What are the causes of SHF? Which cause is the most common?

SHF: ischemia MCC; myocarditis, post-MI, dilated cardiomyopathy

21

What is DHF?

DHF: noncompliant LV (stiff ventricle) with impaired relaxation; ↑LVEDP

22

What is the most common cause of DHF?

DHF: MCC essential HTN

23

How is the EF affected in SHF?

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

235

What are the clinical findings of myocarditis?

Myocarditis: fever, dyspnea, chest pain
Myocarditis: arrhythmias, pericarditis, biventricular CHF, MV regurgitation

236

What are the lab findings in myocarditis?

Myocarditis: ↑CK-MB, troponin I/T

237

Describe the etiology of most cases of pericarditis.

Pericarditis: most cases are idiopathic

238

What are the clinical findings in pericarditis?

Precordial friction rub; pain relieved by leaning forward; worse when leaning back

239

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

241

What is the pericardial effusion triad?

Effusion triad: muffled heart sounds, neck distention on inspiration, pulsus paradoxus on inspiration

242

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

247

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

252

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

261

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