Quiz 2 Flashcards
Three major categories of cardiomyopathies?
Dilated (90%), Hypertrophic, & Restrictive
Most common cause of non-ischemic dilated cardiomyopathy (DCM) in the US:
chronic alcoholism (Thiamine & carnitine deficiency, as well as alcohol toxicity to tissues)
Dilated cardiomyopathy is characterized by enlargement of which chamber(s)?
All four - becomes rounder, basketball shaped
Hypertrophic cardiomyopathy primarily affects which chamber(s)?
Due to?
Left ventricle (classically the ventricular septum) Genetic [NOT d/t HTN]
The most common cause(s) of restrictive cardiomyopathy?
amyloidosis & hemochromatosis
Restrictive cardiomyopathy is caused by:
infiltration of normal tissue, which results in impaired motion and abnormal contraction and relaxation
Endocarditis is:
What area is affected most? Side?
inflammation of the valve leaflets, potentially also lining of atria and ventricles. Leads to vegetations.
Tends to begin at area of greatest pressure = lines of closure.
L>R
Atrial side of AV valves / Vent side of semilunar valves
Most common cause of infectious endocarditis?
BACTERIA (staph aureus - 30-50% of community acquired cases, and 60-80% of nosocomial cases [MRSA])
Marantic endocarditis is:
non-bacterial thrombotic endocarditis, deposition of small, pink, embolizing, sterile vegetations on valve leaflets [marantikos = wasting away]; d/t hypercoagulable state known as Trousseau’s syndrome.
Portals of entry of endocarditis include:
IV drug use
poor dental health, recent procedure, infection
GU infections or instrumentation (catheter)
skin infections (impetigo)
pulmonary infection
Acute vs. sub-acute endocarditis:
Acute - rapidly developing, destructive, usually d/t infection, 50% mortality within days, abscess in ring of tissue below leaflets common.
Subacute - slower development, less severe, typically d/t previous valvular damage, infection by less virulent organism, likely recovery, vegetations that embolize common.
Microemboli in the fingernail beds are called:
In the skin:
In the retina:
Splinter hemorrhages
Petechiae
Roth’s spots
Risk factors for endocarditis:
IV drug use alcoholism artificial valves / vascular grafts immunocompromised (steroids, RA drugs, etc) in-dwelling catheters
Most common cause of infectious endocarditis in native valves, perhaps damaged, & main cause of subacute endocarditis?
Strep viridans (alpha hemolytic)
Organism associated with endocarditis in pts with prosthetic valves:
Staph epidermidis
Organism associated with IV drug users endocarditis:
Staph aureus
Organism associated with alcoholics with endocarditis:
anaerobes & oral cavity bacteria
Organism associated with endocarditis after procedures (cytoscopy, prostatectomy, indwelling catheters):
E coli & other gram negative
Organism associated with endocarditis in pts with carcinoma of the colon:
strep bovis (so if found => colonoscopy needed to r/o CA)
Endocarditis associated with SLE is called:
Libman-Sacks endocarditis (flat spreading vegetations on mitral valve surface & chordae tendineae)
Myocarditis results from:
infection of the heart autoimmune phenomena: Rheumatic heart dz (common worldwide, less in US - abx) collagen vascular dzs - SLE, RA drugs transplant rejection
Most common infectious agent of myocarditis:
Coxsackie virus
Others include Lyme’s, CMV, HIV, typhus, Chaga’s, meningococcus, toxoplasmosis, trichinosis, etc
Compare valvular stenosis & insufficiency:
Valvular stenosis is a failure to open completely, impeding forward flow.
Valvular insufficiency is a failure to close completely, allowing reverse flow (regurg)
The most frequent valvular abnormalities that account for 2/3 of all valvular dz:
acquired stenosis of the aortic and mitral valves
