Lecture 2

Question 1

Acute Pericarditis

Answer 1

1- Acute inflammation of the pericardium (< 2 Weeks)

Question 2

Acute Pericarditis causes

Answer 2

1- Infection by viral, bacterial or fungal
2- Autoimmune disease
3- Trauma
4- Drug Toxicity

Question 3

Acute Pericarditis Symptoms

Answer 3

1- Triad of chest pain
2- Friction rub (inflamed pericardial surface)
3- ECG changes

Question 4

Pericardial Effusion

Answer 4

accumulation of excess fluid (exudate) int he pericardial sac

Question 5

Effect that determine the severity of Pericardial Effusion on cardiac function

Answer 5

1- Rapidity of fluid accumulation

2- Elasticity of pericardium

Question 6

Types of Pericarditis

Answer 6

1- Serous Pericarditis

2-Fibrinous Pericarditis

Question 7

Serous Pericarditis associated with

Answer 7

1- Systemic lupus erythematous (SLE)

2- Rheumatic Fever

Question 8

Serous Pericarditis characterized by

Answer 8

-production of clear, straw-colored, protein rich exudate containing small numbers of inflammatory cells

Question 9

Fibrinous Preicarditis characterized

Answer 9

-Fibrin-rich exudate

Question 10

Fibrinous Pericarditis cause by

Answer 10

1- Uremia
2- Myocardial infraction
3- Acute rheumatic fever

Question 11

Types of Pericarditis

Answer 11

1- Purulent Pericariditis

2- Hemorrhagic pericarditis

Question 12

Purulent Pericariditis is characterized by

Answer 12

-grossly cloudy exudate

Question 13

Purulent pericarditis causes

Answer 13

bacterial infection

Question 14

Hemorragic pericarditis characterized by

Answer 14

bloody exudate

Question 15

Hemorragic pericarditis results from

Answer 15

1- Tumor invasion of the pericardium
2- Tuberculosis
3- Other bacterial infections

Question 16

Cardiac Tamponade

Answer 16

• Increase in pericardial sac pressure

- Medical Emergency

Question 17

Cardiac Tamponade caused by

Answer 17

accumulation of fluid or blood in the pericardial sac

Question 18

Cardiac Tamponade results in

Answer 18

reduced ventricular filling and subsequent hemodynamic compromise

Question 19

Cardiac Tamponade risk

Answer 19

1- death depends on the speed of the diagnosis, treatment provided and the underlying cause of the tamponade

Question 20

Pericardiocentesis

Answer 20

• performed in response to cardiac tamponade

- can be done using a subxiphoid approach or parasternal approach

Question 21

Myocardial Disease

Answer 21

disorders originating from within the myocardium, but not from cardiovascular disease

Question 22

Two types of Myocardial disease

Answer 22

1- Myocarditis

2- Primary cardiomyopathies

Question 23

Myocarditis

Answer 23

• inflammation of the heart muscles (and conduction system) without evidence of myocardial infraction
• Myocardium becomes thick and swollen

Question 24

Myocardium casuses

Answer 24

1- Viral (#1 cause)
2- drug toxicity (cocaine)
3-Autoimmune diseases

Question 25

Myocardium presents as

Answer 25

biventricular heart failure in young persons who do not have valvular, rheumatic or congenital heart disease

Question 26

Primary Cardiomyopathies

Answer 26

disease of the heart muscles that are non-inflammatory and are not assocaited with hypertension, congenital heart disease, valvular disease or coronary artery disease

Question 27

Primary Cardiomyopathies onset

Answer 27

Often is silent and symptoms do not occur until disease is well advances

Question 28

Primary Cariomyopathies my be detected

Answer 28

with PE (Particularly in athletes)

Question 29

Primary Cardiomyopathies diagnosis

Answer 29

when a young, previously healthy, normotensive person experiences cardiomegaly and heart failure

Question 30

Dilated Cardiomyopathy

Answer 30

1- Most common form 2- progressive cardia hypertrophy and dilation 3- impaired pumping ability in one or both ventricles 4- Mural Thrombi are common and may be a source of thrromboemboli

Question 31

Dilated Cardiomyopathy causes

Answer 31

1- idiopathic 2- Infectious myocarditis 3- Alcohol

Question 32

Most common initial manifestations of Dilated cardiomyopathy

Answer 32

-Related to heart failure

Question 33

Hypertrophic Cardiomyopathy characterized

Answer 33

- Ventricular hypertrophy | - Impaired diastolic ventricular filling

Question 34

Hypertrophic Cardiomyopathy is often inherited as

Answer 34

1- autosomal dominant | 2- several genes have been implicated in the genesis of this disorder

Question 35

Hypertrophic Cardiomyopathy manifestations are

Answer 35

1- remain stable for many years and gradually acquire more symptoms 2- May result IN LEFT VENTRICULAR OUTFLOW OBSTRUCTION

Question 36

Left ventricular outflow obstruction

Answer 36

-places patient in danger of syncope and even sudden death, which often occurs unexpectedly in young athletes

Question 37

Restrictive Cardiomyopathy

Answer 37

1- least common of the primary cardiomyopathies | 2- Ventricular filling is restricted due to excessive rigidity and stiffness of the ventricular walls

Question 38

Restrictive Cardiomyopathy causes

Answer 38

- unknown | - may be associated with various infiltrations

Question 39

Infected Endocarditis (Bacterial Endocarditis)

Answer 39

- Relatively uncommon | - life threatening conditions of the endocardial surface of the heart and valves

Question 40

Infected Endocarditis require 2 independent factors

Answer 40

1- Damaged endocardial surface 2- A portal of entry by which the organism gains access to the vasculature. STAPHYLOCOCCUS AUREUS IS THE PATHOGEN 50% OF CASES. 3- Can also occur in normal hearts of IV drug abusers

Question 41

Infected Endocarditis characteristic

Answer 41

1- large, soft, friable, easily detached vegetations consisting of fibrin and intermeshed inflammatory cells and bacteria

Question 42

Infected Endocarditis may cause

Answer 42

1- Ulceration, often with perforation, of valve cusps or rupture of one of the chordae tendineae 2- mitral valve most frequently involved

Question 43

Distal embolization occurs

Answer 43

1- when vegetation fragment | 2- can occur almost anywhere in the body and can result in septic infracts in the brain or in other organs

Question 44

Infective endocarditis antibiotic

Answer 44

``` Amoxicillin Patients that are allergic can be treated with 1- cephalexin 2- azithromycin 3- clarithromycin ```