Flashcards in Chapter 290e - Cardiac Manifestations of Systemic Disease Deck (29):
What syndrome can explain the concomitant failure of the pulmonic and tricuspid valves?
One of the following doesn't cause dilated cardiomiopathy - Diabetes, Protein-calorie malnutrition, thiamine deficiency and HIV. Identify it.
Which thyroid alteration can explain symptomatic bradycardia?
What is the explanation for the association between diabetes and coronary artery disease?
"(...) its pathogenesis involves endothelial dysfunction, increased lipoprotein peroxidation. increased inflammation, a prothrombotic state, and associated metabolic abnormalities."
How do you define an anginal equivalent? Name them.
An anginal equivalent is an atypical ischemic symptom. It comprises nausea, vomiting, dyspnea, pulmonary edema, arrythmias, heart block, or syncope, and are more frequent in diabetic patients.
What is the percentage of "silent ischemia" in diabetic patients?
What coronary intervention improves survival more significantly in multivessel disease in diabetic patients?
Surgical bypass is superior to percutaneus coronary intervention.
Which mecanisms explain edema in protein deficiency?
Reduced serum oncotic pressure and myocardial dysfunction.
How to differentiate pathophisiologically Kwarshiorkor from marasmus?
Kwarshiorkor is due to protein malnutrition while marasmus occurs in the presence of calorie malnutrition.
What mecanisms explain malnutrition in advanced heart failure?
"(...) patients with severe cardiac failure in whom gastrointestinal hypoperfusion and venous congestion may lead to anorexia and malabsorption."
Thiamine deficiency is more frequent in risk groups. Name them.
"this hypovitaminosis may occur (...) particularly in East Asia, where polished rice deficient in thiamine may be a major dietary component. In Western nations where the use of thiamine-enriched flour is widespred, clinical thiamine deficiency is limited primariy to alcoholics, food faddists, and patients receiving chemotherapy."
How to explain the thiamine deficiency in patients with chronic heart failure?
"reduced dietary intake and a diuretc-induced increase in the urinary excretion of thiamine."
What ECG abnormalities are expected in beriberi?
"The electrocardiogram (ECG) may reveal decreased voltage, a prolonged QT interval, and T-wave abnormalities."
When are inotropics and diuretics important in relantionship to the replenishment of thiamine in beriberi? Is it after or before this replenishment? Justify yourself.
"these agents may be important after thiamine repletion, since the left ventricle may not be able to handle the increased work load presented by the return of vascular tone."
Since hyperhomocysteinemia is an atherosclerotic risk and probably most of the cases are explained by the deficiency of vitamin B6, vitamin B12 and folate, the replenishment of these reduces the cardiovascular risk.
True or False?
"however, the clinical cardiovascular benefit of normalizing elevated homocysteine levels has not been proved."
In obese patients, the eccentric hypertrophy and dilation of the left ventricle is, in part, explained by the volume overload.
True or False?
"In part as a result of chronic volume overload, eccentric cardiac hypertrophy with cardiac dilation and ventricular diastolic and/or systolic dysfunction may develop."
What is the single most efficacious measure to treat cardiac disease associated with massive obesity? Is there any dangerous outcomes related to this measure?
"rapid weight reduction may be dangerous, as cardiac arrhythmias and sudden death owing to electrolyte imbalance have been described."
How many cases of hyperthyroidism are accompanied with sinus tachycardia and atrial fibrilation?
~40% and ~15% of the cases, respectively.
How many cases of hypothyroidism are accompanied with pericardial effusion?
What do you expect to find in an ECG from a patient with myxedema?
"The ECG generally reveals sinus bradycardia and low voltage and may show prolongation of the QT interval, decreased P-wave voltage, prolonged AV conduction time, intraventricular conduction disturbances, and nonspecific ST-T-wave abnormalities."
What conditions might be associated with a pathologically pale heart?
Kwarshiorkor, marasmus and hypothyroidism.
Carcinoid syndrome might have cardiac envolvement. Which structures are normally affected by this condition? How many patients might be affected?
"Some 50% of patients with carcinoid syndrome have cardiac involvement, usually manifesting as abnormalities of the tricuspid or pulmonic valves."
"Carcinoid heart disease most often presents as tricuspid regurgitation, pulmonic stenosis, or both."
Carcinoid syndrome with cardiac envolvement occurs without hepatic metastasis.
True or False?
"These patients invariably have hepatic metastases that allow vasoactive substances to circumvent hepatic shunt."
Since carcinoid syndrome occurs due to secretion of vasoactive amines, the use of somatostatin analogues ammeliorates valvular abnormalities.
True or False?
"Treatment with somatostatin analogues (e.g., ocreotide) or interferon alpha improves symptoms and survival in patients with carcinoid heart disease but does not appear to improve valvular abnormalities."
What characterizes the hypertension in a patient with acromegaly?
"Hypertension occurs in up to one-third of patients with acromegaly and is characterized by suppression of the renin-angoitensin-aldosteron axis and increases in total-body sodium and plasma volume."
What manifestation of rheumatic arthritis is more associated with pericardial effusion?
How extensive might be the aortic inflammation in the seronegative arthopathies? How common is it?
"The aortic inflammation usually is limited to the aortic root but may extend to involve the aortic valve, mitral valve, and ventricular myocardium, resulting in aortic an mitral regurgitation, conduction abnormalities, and ventricular dysfunction. One-tenth of these patients have significant aortic insufficiency, and one-third have conduction disturbances; these are more common in patients with peripheral joint involvement and long-standing disease."
Aortic regurgitation might precede the onset of arthritis in young male patients who have a seronegative arthropathy.
True or False?