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CMPP > Miscellaneous Cardiac Disease > Flashcards

Miscellaneous Cardiac Disease Flashcards

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1
Q

Bacterial or Fungal infection of the endocardium

A

infective endocarditis

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2
Q

what do patients have a history of when diagnosed with infective endocarditis?

A 
structural heart abnormality
   congenital
   valvular disease
   valve replacement
IV lines
IVDU
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3
Q

two subsets of infective endocarditis

A

left and right sided

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4
Q

what side is more common in infective endocarditis?

A

left

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5
Q

what side of infective endocarditis has systemic vascular involvement and why?

A

left side because there is bacteria in the blood stream

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6
Q

what side is associated with congenital and acquired valvular disease (prostetics and mitral regurg) in infective endocarditis?

A

left sided

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7
Q

is left sided infective carditis acute or chronic?

A

acute or subacute

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8
Q

what valve is most commonly affected in left sided infective endocarditis?

A

mitral valve

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9
Q

what are the most common pathogens in left sided infective endocarditis

A

strep. viridans

staph. aureus

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10
Q

what side has pulmonary vascular involvement in infective endocarditis

A

right side

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11
Q

what side is associated with IVDU in infective endocarditis?

A

right sided

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12
Q

is right sided infective endocarditis acute or chronic?

A

acute

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13
Q

what valve is most commonly affected in right sided infective endocarditis?

A

tricuspid

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14
Q

what is the most common pathogen in right sided infective endocarditis?

A

staph. aureus

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15
Q

when is the presentation of infective endocarditis acute?

A

sepsis and cardiac collapse

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16
Q

when is the presentation chronic for infective endocarditis?

A

fever, malaise, and weight loss

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17
Q

what does IVDU and new murmur signify?

A

ENDOCARDITIS until proven otherwise

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18
Q

4 physical findings (other than a murmur) in infective endocarditis

A

osler nodes
janeway lesions
splinter hemorrhages
roth spots

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19
Q

what are osler nodes?

A

tender nodules on pulp of fingers

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20
Q

what are janeway lesions?

A

non-tender hemorrhagic macules on palms and soles

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21
Q

what are splinter hemorrhages?

A

vertical hemorrhages under the nails

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22
Q

what are roth spots?

A

retinal hemorrhages

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23
Q

work up for infective endocarditis?

A

CBC
Sed Rate
CRP
Blood cultures (3 from 3 different sites)
ECHO (TEE over TTE)
CXR and EKG
admission to the hospital with ID consult

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24
Q

how do CXR and EKG typically look with Infective endocarditis?

A

unremarkable

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25
is pericarditis acute or chronic?
either
26
4 main features of pericarditis
chest pain friction rub EKG findings Pericardial effusion
27
how does chest pain present in pericarditis
sharp pain improved by tripoding | NO LEVINE'S SIGN
28
how does a friction rub present in pericarditis
scratcing heard along left lower sternal border
29
howcan you see a pericardial effusion in pericarditis?
ECHO
30
causes of pericarditis
``` infectious malignancy myocardial infarction systemic illness medications radiation idiopathic ```
31
types of infectious pericarditis
bacterial viral fungal Coxasackie A & B
32
types of malignant pericarditis
breast lung leukemia lymphoma
33
causes of MI induced pericarditis
acute MI | post-dressler's syndrome
34
what is dressler's syndrome and how will it present in pericarditis?
someone who had an MI in the past few weeks chest pain friction rub hypertension
35
types of systemic illness pericarditis
SLE (lupus) rheumatic fever scleroderma
36
medications that may cause pericarditis
anticoagulants (coumadin) hydralazine (preeclampsia) isoniazid (TB)
37
4 stages of pericarditis
1: diffuse ST segment elevation in all leads with PR depression 2: pseudonomalization of ST segments 3: ST segment depression 4: normalization of ST segments (back to baseline)
38
what types of pericarditis can be treated as an outpatient?
viral & idiopathic
39
who should be admitted for pericarditis
anyone with an underlying pathology
40
what do we use as pain control in pericarditis?
anti-inflammatories | motrin & naproxen
41
MOA of motrin
COX-1 and COX-2 inhibition
42
special note for motrin
do not exceed 2.4 gram/day
43
what is motrin best for?
pericarditis
44
MOA of Naproxen (Naprosyn)
COX-1 & COX-2 inhibition
45
Special note for naproxen
black box warning of increased cardiovascular thrombotic event
46
who should we use naproxen on
patients who can't take ibuprofen or tylenol
47
what is naproxen best for?
pericarditis
48
increase in pericardial fluid to the point that it creates an inflow obstruction to the ventricles
cardiac tamponade
49
normal amount of fluid in the pericardial sac
40-50ml
50
can the pericardial sac normally expant?
no
51
how many mls of fluid do you need the pericardial sac to produce symptoms of cardiac tamponade?
200ml
52
what are the most common causes of cardiac tamponade
neoplastic disease idiopathic pericarditis renal failure
53
what causes of accumulations of blood cause cardiac tamponade
post-op cardiac surgery trauma pericarditis + anticoagulants
54
what does beck's triad signify?
cardiac tamponade
55
what is in beck's triad?
hypotension: can not produce a good SV because it cannot contract against the surrounding fluid decreased/muffled heart sounds JVD
56
what is a drop greater than 10mmHg in BP with inspiration
pulsus paradoxus
57
what is pulsus paradoxus associated with?
cardiac tamponade
58
pathophys of pulsus paradoxus
inspiration > increased RV filling RV pushes intra-ventricular septum into LV decreased LV volume, decreased SV, lower BP
59
what is kussmal's sign associated with?
cardiac tamponade
60
what is kussmal's sign?
rise in central venous pressure seen in JVP during inspiration
61
EKG finding in cardiac tamponade
decrease in amplitude of QRS complexes | electrical alternanas
62
what is electrical alternans
beat to beat variation of QRS due to shifting of fluid and heart position
63
CXR findings in cardiac tamponade
chronic onset: water bottle cardiac shilouete | acute onset: normal
64
what is the gold standard of diagnosis for cardiac tamponade
ECHO
65
what is visualized on ECHO for cardiac tamponade
large hypoechogenic effusion (blackness) swinging motion of heart in sac diastolic collapse of RV
66
treatment for cardiac tamponade
2 large bore IVs with fluids inotropic support pericardiocentesis (EKG or US guided)
67
what is used for inotropic support in cardiac tamponade
pressors dopamine dobutamine
68
dopamine MOA
dose dependent stimulation (dopa, beta, alpha)
69
special note for dopamine
different dose with different effects
70
what is dopamine bets for?
pressor support for cardiac tamponade
71
dobutamine MOA
beta-1, beta-2, alpha-1 stimulation
72
special note for dobutamine
vasodilation
73
what is dobutamine best for
cardiac tamponade pressor support

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