week 3- CV 3

Question 1

• What is Bundle Branch/Fascicular Blocks?

Answer 1

o No conduction past Bundle of His on one side or interruption in a hemifascicle of the bundle
o Often asx
o RBBB usu in otherwise healthy people, and in anterior MI, PE
o LBBB usu dt a structural heart d/o
o EKG: 2 R wave peaks b/c blocked ventricle is excited by delayed spread thru ventricular muscle. Hemiblocks have modest QRS widening.
o mb wide S2 split

Question 2

• What causes valve dzs? How are they diagnosed?

Answer 2

o congenital defects, infective endocarditis, syphilis, carcinoid, sclerosis, myxomatous degeneration, calcification, other heart dz
o Best dx w echo, st catheterization

Question 3

• What is aortic regurgitation?

Answer 3

o incompetent aortic valve → retrograde flow from aorta into LV in diastole
o Dt idiopathic valve degeneration, RF, myxoma, endocarditis, congenital bicuspid valve, syphilis, CT or rheumatologic dos. mb VSD in children
o → LVH and dilation

Question 4

• What are ssx of aortic regurgitation? Auscultation? Dx?

Answer 4

o Asx or DOE, fatigue, syncope, chest pain and ultimately arrhythmias, frank CHF or cardiogenic shock
o Ausc: High pitched decrescendo diastolic murmur; Loudest at 3rd-4th left ICS. Heard best w pt leaning forward, hold expiration.
o Dx: Hx, PE, confirmed w Doppler Echo

Question 5

• What is aortic stenosis?

Answer 5

o Narrow valve obstructs blood flow from LV to ascending aorta in systole
o Causes: Congenital bicuspid valve (most common), RF, or aging
o Classic sxs: syncope, angina and DOE, arrhythmias
o Auscultation: Loud rough systolic crescendo-decrescendo murmur at upper left sternal border, when pt leans forward radiates to right clavicle and neck w thrill
o Dx: Clinical, then Echo w Doppler to quantify degree of stenosis

Question 6

• What is mitral valve prolapse?

Answer 6

o Billowing of mitral valve leaflets into LA in systole
o Causes: idiopathic myxomatous degeneration. mb transient in pregnancy or severe dehydration. Seen in CT d/os
o Sxs: Usu asx. Sxs with high adrenergic tone. mb chest pain, palpitations, arrhythmias, dyspnea, fatigue, orthostatic hypotension, May result in MR
o Ausc: Late systolic murmur and midsystolic click
o Dx: echo, Holter, or ECG to see any assoc arrhythmias

Question 7

• What is mitral valve regurgitation? Ssx?

Answer 7

o Incompetent mitral valve causes flow from LV into LA in systole
o Common caused by RF, IE, papillary muscle damage, ruptured chordae tendinae, LV dilation, annular dilation.
o M>F
o May co-exist with MS or MVP
o Ssx: w progression, eventual LVH/LAH → fatigue, dyspnea, LV failure
o Ausc: blowing holosystolic murmur best heard at apex, pt in LLD

Question 8

• How is mitral valve regurgitation diagnosed? Tx?

Answer 8

o Dx: echo. ECG, CXR (esp if acute) to see if pulmonary edema, chamber hypertrophy or assoc arrhythmias
o Catheterization usu only if surgery required to repair/ replace valve
o Tx: only if severe and symptomatic. Natural therapies to strengthen CT and improve valve function always recommended

Question 9

• What is mitral stenosis?

Answer 9

o Narrowed orifice dt calcification, impeding blood flow from LA to LV
o Most common cause is RF
o Can result in PH, AFib, thromboebolism
o Sxs: when severe, DOE, FOE, tachycardia, fever, arrhythmia, w reduced CO. PND develops, and pulmonary edema.
o Ausc: opening snap, diastolic murmur, loud S1.
o Dx: echo. Notched or wide P waves on ECG dt LAH

Question 10

• What is Pulmonic regurgitation?

Answer 10

o Incompetent pulmonic valve → blood flow from pulm artery into RV in diastole
o Cause: pulm artery dilation w PH
o Sxs: Usu asx, or if severe, signs of RCHF.
o Ausc: high pitched diastolic murmur, upper left sternal border
o Dx: echo. mb RV enlargement on ECG, PH on CXR

Question 11

• What is pulmonic stenosis?

Answer 11

o Narrow pulmonic outflow tract obstructs blood flow from RV to pulm artery in systole
o Usu congenital, affects mostly children
o Ssx:: Usu asx, then mb syncope, angina, dyspnea.
o Mb RVH. RV heave or thrill
o Ausc: Wide S2 split (prolonged pulmonic ejection), mb early systolic click. Harsh crescendo-decrescendo murmur at left 2nd parasternal ICS w no radiation, louder w inspiration.
o Dx: Echo. ECG may show RVH or RBBB

Question 12

• What is tricuspid regurgitation?

Answer 12

o Insufficient tricuspid valve causes blood flow from RV to RA in systole
o Causes: 1st or 2nd to Afib or RV dilation
o Usu asx. May lead to RV and RA enlargement, JVD, HM, ascites, signs of RCHF
o Ausc: pansystolic blowing murmur loudest on inspiration, best heard at R&L lower sternal border
o Dx: Echo. ECG may show RV overload signs with tall peaked P waves in RAH

Question 13

• What is tricuspid stenosis?

Answer 13

o Narrow tricuspid orifice obstructs blood flow from RA to RV
o Cause: RF but mb congenital
o Ssx: Seen w mitral stenosis and tricuspid regurg, sxs of RCHF, w HTN/edema
o Ausc: short, scratchy diastolic, ↑ w inspiration. Heard best in lower R&L parasternal borders

Question 14

• What are the types of endocarditis?

Answer 14

o Infective (IE)
o Subacute bacterial (SBE)
o Acute bacterial (ABE)
o Non-infective

Question 15

• What is infective endocarditis?

Answer 15

o infection of endocardium, usu w bacteria or fungi
o Predisposing factors: abnormality of endocardium, microorganisms in blood stream
o Specifically, congenital heart defects, rheumatic valve dz, bicuspid or calcified aortic valves, MVP, HCM
o Strep viridans cause 50% of community-acquired native valve IE that isn’t from IV drug use. Cutaneous abscess, UTI, implanted device, drug injection site, catheter site, dental origin. Strep and Staph cause 80-90% of cases.
o 80-90% on left side of heart
o IV drug users have higher incidence of right sided IE (30-70%)

Question 16

• What are consequences of IE?

Answer 16

o myocardial abscess, conduction abnormalities, sudden valve regurg, heart failure, death.
o Systemic problems: dt embolization of infective material (lung, kidneys, spleen, CNS)

Question 17

• What are the abx prophylaxis guidelines for IE?

Answer 17

o Prosthetic valve replacements or repairs
o Previous IE
o Certain types of congenital heart dz
o Cardiac transplant recipients w valvulopathy

Question 18

• What are ssx of IE?

Answer 18

o Suspect when: fever w no obvious infectious source, w heart murmur, (+) blood cultures in pts w/ valve dz, IV drug users
o Right sided: cough, chest pain, hemoptysis w septic pulmonary emboli. TC murmur common

Question 19

• How is IE diagnosed?

Answer 19

o Hx & PE
o Tests: 3 serial blood cultures in 24 hr period (mb neg if Abx were given)
o Echo
o mb anemia; hi WBC, ESR, CRP

Question 20

• what is subacute bacterial endocarditis (SBE)?

Answer 20

o usu dt strep, less often Staph
o Insidious onset
o Sxs: Vague: lo fever, night sweats, fatigability, malaise, weight loss, arthralgias, valve insufficiency
o PE: normal, or pallor, fever, change in existing murmur, new murmur, tachycardia. Petechiae, st Osler’s nodes on digits, Roth spots in eye, Janeway lesions, splinter hemorrhages on nails. 35% show CNS effects: TIA, stroke, encephalopathy

Question 21

• What is acute bacterial endocarditis (ABE)?

Answer 21

o Usu dt strep and Staph
o Abrupt development and rapid progression
o mb dt fungi after valve replacement surgery
o Sxs: Fever, toxic appearance, heart murmur; ssx like SBE, but more rapid

Question 22

• What is non-infective endocarditis?

Answer 22

o sterile plt and fibrin thrombi on cardiac valves, and adjacent endocardium in response to trauma, circulating immune complexes, vasculitis, hypercoagulable state.
o Etio: catheter injury to valves, SLE immune complexes, anti-phospholipid syndrome
o Sxs generally of underlying do
o Dx: Echo (vegetations) and blood cultures (-)

Question 23

• What is pericarditis? Etio? Results?

Answer 23

o Inflammation of pericardium, often w effusion
o Etio: Idiopathic, mb dt infection, MI, trauma, tumor, metabolic do
o Mb acute or chronic (> 6mos).
o May result in Cardiac tamponade

Question 24

• What is constrictive pericarditis? Ssx?

Answer 24

o uncommon, unknown etio
o Dt thickening and stiffening pericardium
o Early sxs: mb JVD, HM, early S2 on inspiration. Then, dyspnea, orthopnea, mb severe fatigue

Question 25

• What are ssx of acute pericarditis?

Answer 25

o chest pain, pericardial friction rub, st w dyspnea, 1st sign mb tamponade o hypotension, shock or pulm edema. o Pain, like ischemia, may radiate similarly o Worse w thoracic motion, cough, breathing o Better sitting up, leaning forward o Fever, chills, weakness

Question 26

• What are ssx of pericardial effusion with pericarditis? Cardiac tamponade?

Answer 26

o PE: Muffled heart sounds, pericardial rub, mb decreased breath sound and crackles o CT: like cardiogenic shock, ↓CO, lo arterial pressure, tachycardia, dyspnea. BP may fall, pulse may disappear (pulsus paradoxus). Muffled heart sounds

Question 27

• How is pericarditis diagnosed? Pericardial effusion?

Answer 27

o P: ECG, Elevated ST (no pathologic Q waves as in MI). Echo shows pericardial effusion or thickened pericardium. Hx and PE. Hi WBC and ESR o PE: CXR enlarged cardiac silhouette, ECG ↓QRS voltage, alternating voltages of P, QRS, T waves (dt variations in cardiac position)

Question 28

• How are tamponade and constrictive pericarditis diagnosed?

Answer 28

o T: Low voltage or electrical alternans on ECG, echo if time. Otherwise, immediate pericardiocentesis for dx and Tx. o CP: ECG non-specific, low QRS voltage, abn T waves. Afib or flutter in 1/3 of pts. CXR pericardial calcification. Echo non specific, elevated filling pressures. Catheterization confirms abn hemodynamics

Question 29

• What are aneurysms? Congenital?

Answer 29

o Abn dilated artery dt weakened arterial wall o any artery, often abdominal and thoracic aorta o Congenital: intracranial arteries, called berry aneurysms, assoc w other abnormalities of arteries causing subarachnoid hemorrhage

Question 30

• What is an abdominal aortic aneurysm (AAA)? Causes and risk factors?

Answer 30

o 3/4 of AA. M:F 3:1 o Diameter > 3 cm. mb lined w thrombi. o Risk: Atherosclerosis, smoking, HTN, older age (70-80), FHx, Caucasian, male

Question 31

• What are sxs of AAA? PE? Tests?

Answer 31

o Sxs: Usu asx. Or deep, boring back or abdominal pain. o PE may reveal pulsatile mass in abdomen or bruit o Testing: US or CT to dx.

Question 32

• What are thoracic aneurysms?

Answer 32

o same causes as AAA, more symptomatic. o 1/4 of AA. M=F o may dissect, compress adjacent structures, leak, rupture, or cause thromboembolism.

Question 33

• What are ssx of TAA?

Answer 33

o chest or back pain, cough, dyspnea, dysphagia, hoarseness o Hemoptysis, Thromboembolism may cause stroke, abd pain, extremity pain o May see Horner’s (dt compression of sympathetic ganglia), tracheal deviation

Question 34

• How is TAA diagnosed? Px?

Answer 34

o Dx: Hx and PE, CXR (often first found incidentally on CXR), CTA or MRA. TEE (transesophageal echo) shows ascending, but not descending aorta. o Px: enlarge ~5mm/yr. Tend to rupture at 6-7cm. non-tx mortality 65% at 1 yr and 20% at 5 yrs. universally fatal if ruptured

Question 35

• What are aortic branch aneurysms?

Answer 35

o much less common than AAA or TAA o Same risk factors. Sxs vary o Most not dx’d before rupture, but mb seen incidentally on x-ray if calcified

Question 36

• What is an aortic dissection? Predisposition? Prevalence? Complications?

Answer 36

o Surging blood thru tear in aortic intima w separation of intima and media → false lumen. Vessels may rupture. o risk factors for atherosclerosis (cocaine, smoking, HTN, dyslipidemia), CT dos (acquired and congenital), iatrogenic, trauma. >2/3 related to atherosclerosis o Highest risk pts: African-Americans, men, elderly, HTN o Present in 1-3% of autopsies o Comp: compromised blood supply to tributary arteries, aortic valve dilation and regurg, heart failure, fatal rupture of aorta

Question 37

• What are ssx of aortic dissection?

Answer 37

o usu sudden severe pain, sharp, may mimic MI, syncope, cardiac tamponade o Pulses may wax and wane. Limb BPs may differ by >30 mmHg o Aortic regurg murmur in 50% w proximal dissection, and rarely, heart failure

Question 38

• How is aortic dissection diagnosed?

Answer 38

o Consider in any pt w chest pain, thoracic back pain, unexplained syncope, abdominal pain, stroke, acute-onset HF, esp if pulses and BPs unequal o CXR (wide mediastinal shadow). ECG (not diagnostic) o If CXR suggests AD: TEE, CTA or MRA done immediately o CK-MB and Troponin differentiate from MI. anemia, hi WBC, LDH o If suspect AD, consult cardiothoracic surgeon immediately!

Question 39

• What is px of AD?

Answer 39

o Up to 80% survival w timely surgical repair | o w/o tx mortality 1-3%/hr in first 24 hrs, 30% at 1 wk, 80% at 2 wks, 90% at 1 yr

Question 40

• what is aortitis? Cause, sxs, dx?

Answer 40

o Inflamed aorta, may → aneurysm or ischemia o Common causes: CT dos and infections (syphillis, IE, fungal) o Sxs and dx differ depending on etio

Question 41

• What is abdominal aortic branch occlusion? Ssx?

Answer 41

o Dt atherosclerosis, fibromuscular dysplasia, other conditions that produce ssx of ischemia or infarction. o Ssx: pain, organ failure, necrosis; depends on location; dt ischemia

Question 42

• What are the peripheral arterial d/os?

Answer 42

``` o Acrocyanosis o Erythromelalgia o Fibromuscular dysplasia o Peripheral arterial aneurysms o PAD/PVD o Raynaud’s o Thromboangiitis obliterans ```

Question 43

• What is acrocyanosis? Ssx?

Answer 43

o Persistent, painless, symmetric cyanosis of hands, feet, face, dt vasospasm of small vessels of skin in response to cold. o F>M, mostly hands. risk factors: cold climate, low BMI, outdoor occupation. More prevalent in young ppl o Not assoc w atherosclerosis o not easily reversible (like Raynaud’s), but will eventually o Ssx: affected area persistently cold, bluish, sweats profusely, may swell o check for central cyanosis; if present, look for causes of hypoxia

Question 44

• what is erythromelalgia?

Answer 44

o paroxysmal vasodilation of small arteries in feet, hands,less common face, ears, knees o Rare, very distressing o Mb primary (idiopathic) or secondary (MPDs, HTN, venous insufficiency, DM, SLE, RA, LS, gout, spinal cord dos, or MS)

Question 45

• What are ssx of erythromelalgia? Dx? Ddx?

Answer 45

o Ssx: Burning pain, heat, redness in feet, hands; mins to hrs. Trigger: warmth, relieved by cold/ice. range from mild to severe o Dx: Hx and PE. Tests to determine causes (CBC) o DDX: post-traumatic reflex dystrophies, shoulder-hand syndrome, peripheral neuropathy, causalgia, Fabry’s dz (X-linked lysosomal storage dz), cellulitis

Question 46

• What is fibromuscular dysplasia?

Answer 46

o heterogenous group of non-atherosclerotic, non-inflammatory arterial changes, causing some degree of vascular stenosis, occlusion, or aneurysm. o Cause unknown, mb genetic, smoking mb risk factor. more common in ppl with certain CT dos o More common in women 40-60. o Medial dysplasia most common type. Alternating thick and thin collagen ridges along media or by extensive collagen deposition in outer half (perimedial dysplasia) o usu affects renal arteries, carotids, intracranial arteries, less often intra-abdominal and external iliac arteries.

Question 47

• What are ssx of fibromuscular dysplasia? Dx?

Answer 47

o Ssx: Usu asx, mb claudication depending on location. MB dec femoral pulses, secondary HTN, TIA, stroke, aneurysms, abdominal pain o Dx: Angiogram, beaded appearance in medial dysplasia, or concentric band or long smooth narrowing in other forms

Question 48

• What is peripheral arterial aneurysm?

Answer 48

o abn dilations of peripheral arteries dt weak arterial wall o 70% are popliteal, 20% iliofemoral, often w abdominal aneurysms o M:F (20:1), avg 65 o Common causes: atherosclerosis, popliteal a entrapment, septic emboli

Question 49

• What are ssx of peripheral arterial aneurysm? Dx? Px?

Answer 49

o Ssx: usu asx. If dt thromboemboli or rupture, mb painful, cold, pale, pulseless extremities. Mb large pulsatile artery if popliteal. o Dx: US, MRA, CT o Px: low risk of rupture.

Question 50

• What is peripheral arterial dz (peripheral vascular disease, PVD)?

Answer 50

o Atherosclerosis → lower limb ischemia o 12% of ppl in US, M>F o Risk factors same as atherosclerosis o Severity of pain depends on degree of occlusion and collateral circulation, O2 needs of tissues

Question 51

• What are ssx of PVD? PE?

Answer 51

o Sxs: pain on exertion relieved by rest (intermittent claudication), numbness, tingling, in severe cases ulceration o PE: pulses mb reduced or absent in foot, severely ischemic feet are cold, blue, painful, numb. Usu no edema o Eventually → ulcers, esp after local trauma. mb painful unless also have peripheral neuropathy

Question 52

• How is PVD diagnosed?

Answer 52

o Ankle-brachial index <0.90. Start w bilateral ankle and arm systolic BP (can use Doppler probe if unable to palpate pulse) to get ratio of ankle to arm systolic BP o Doppler US o Angiography can localize extent of stenosis or occlusion (can also do MRA, CTA) o Also (risk factors): lipid levels, CRP-hs, homocysteine, fibrinogen, BT

Question 53

• What is Raynaud’s Phenomenon/Dz? Ssx?

Answer 53

o Vasospasm esp in digits, nose, w intermittent reversible pallor, redness, cyanosis of skin o mb 1st (>80%) or 2nd to other systemic conditions: CT dz, endocrine, hematologic, vascular, neurologic dos, drug use, neoplasms, infections, trauma o Prevalence: 3-5%, F>M o Ssx: attacks of vasospasm; dt cold, emotion. Pain, paresthesias. May progress to ischemia, esp in 2nd dz o Warming helps, restores coloration

Question 54

• How is raynaud’s diagnosed?

Answer 54

o Primary: 30 at onset, severe painful attacks mb unilateral, ischemic lesions, hx and PE suggest underlying do, nail fold capillaroscopy shows enlarged and tortuous capillaries, abn ESR and AI blood tests o There are associations bw Raynaud’s and migraine, variant angina, PH, suggesting common pathway

Question 55

• What is thromboangiitis obliterans?

Answer 55

o Aka Buerger’s dz; type of PVD aggravated by tobacco | o Produces segmental inflammation in small and medium-sized arteries. If acute may → occlusive thrombi

Question 56

• What are the peripheral venous and lymphatic d/os?

Answer 56

``` o DVT o Chronic venous insufficiency and postphlebitic syndrome o Superficial Venous Thrombosis o Varicose veins o Idiopathic telangectasias o AV fistula o Lymphedema ```

Question 57

• What is DVT? risk factors?

Answer 57

o Blood clot in deep vein of extremity (usu calf or thigh) or pelvis o Risk: > 60yo, smoking (and 2nd), HF, Virchow's triad, immobile, catheters, limb trauma, obesity, malignancy, nephrotic syndrome, OCP/HRT (hormones), prego, prior DVT, sickle cell, recent surgery

Question 58

• What are ssx of DVT? PE?

Answer 58

o Ssx: usu → venous insufficiencymb asx or pain over area w edema, erythema, superficial vein prominence, stasis pigmentation (blue vein), dermatitis, mb ulcer. Most concerning complication is PE. o PE: mb pain on deep leg palpation, erythema, pitting edema. Check calf circumference, if >3 cm difference, suspect DVT o Mb positive Homan’s sign, but not sensitive or specific (calf pain on hard dorsiflexion, knee ext) o Mb hard cord palpated over vein in popliteal fossa or femoral triangle

Question 59

• How is DVT diagnosed?

Answer 59

o US w/ Doppler: sees venous lumen, impaired venous flow o D-dimer (less likely w/o elevation) o Fibrinogen, BT: throughout tx

Question 60

• What is ddx of DVT?

Answer 60

o venous insufficiency, superficial phlebitis, lymphatic obstruction, cellulitis, ruptured Baker’s cyst, muscle or tendon tears.

Question 61

• What is Chronic venous insufficiency and postphlebitic syndrome? Cause and risks?

Answer 61

o impaired venous return → tissue edema, inflammation, hypoxia o etio: DVT, valve insufficiency, ↓muscular contraction, venous HTN o Risk: trauma, obesity, older age

Question 62

• What are ssx of Chronic venous insufficiency and postphlebitic syndrome? Dx?

Answer 62

o Mb asx, but always causes signs o Sense of fullness, heaviness, aching, cramps, tiredness, paresthesias in legs o Usu worse standing/walking, relieved by rest and elevation. o No change → varicose veins → stasis dermatitis → mb ulceration o Mb Edema, unilateral (BL more likely dt systemic do) o Dx: Hx and PE. US to exclude DVT

Question 63

• What is Superficial Venous Thrombosis?

Answer 63

o clot in superficial vein of extremity o usu dt IV catheter in arm, or varicose veins in leg o Can arise over hrs-days o usu self limited in few weeks

Question 64

• what is found on PE for superficial venous thrombosis? Dx?

Answer 64

o PE: palpated as linear indurated cord, mb local inflammation o Mb tenderness, erythema, mottling, warmth; may look like lymphedema o Dx: Hx and PE

Question 65

• What are varicose veins?

Answer 65

o dilated superficial veins in legs o dt congenitally absent or incompetent valves of veins o FHx often positive o Start out taut → visibly dilated

Question 66

• What are ssx of varicose veins? PE?

Answer 66

o Ssx: not dependent on size; aching, fatigue, sense of heat, all better elevation o PE: Assess when pt is standing; Check for diabetic neuropathy, ulcerations o Look for other sources of the pain: hip, knee, lumbar problems, arthritis o check for arterial insufficiency and intermittent claudication

Question 67

• how are varicose veins diagnosed? Complications?

Answer 67

o Dx: obvious on PE. o Comp: edema, eczema, pigmentation, painful ulcers (uncommon) o Mb thin walled blowouts of affected vessels

Question 68

• What are Idiopathic telangiectasias?

Answer 68

o fine, dilated intracutaneous veins o Usu asx, st burning pain o Clinically insignificant, often unsightly to pt

Question 69

• What is an Arteriovenous fistula?

Answer 69

o abn communication bw artery and vein o congenital or acquired via trauma or erosion of aneurysm into vein. o → arterial or venous insufficiency, ulceration with emboli, ischemia o swollen, warm, distended, pulsating superficial veins o thrill palpable over fistula

Question 70

• what is lymphedema? Tx?

Answer 70

o excess lymph fluid and swelling of subQ tissues dt destruction, obstruction, hypoplasia of lymph vessels o Tx: compression stockings, increasing circulation

Question 71

• What are the 2 types of lymphedema?

Answer 71

``` o primary (hypoplasia): uncommon, but F>M, mb congenital o Secondary: dt surgery, trauma, radiation therapy, tumors, infection, chronic venous insufficiency (mild) ```

Question 72

• What are ssx of lymphedema? Stages?

Answer 72

o Aching, heaviness, fullness, swelling; worse heat, prolonged dependency o usu unilateral, painless o Stages: pitting edema → non-pitting, chronic soft-tissue inflammation, early fibrosis → irreversible edema, skin changes (hyperkeratosis, hyperpigmentation, verrucae, fungal infections)

Question 73

• What are complications of lymphedema? How is it diagnosed?

Answer 73

o lymphangitis dt bacterial infiltration thru cracks in skin dt fungal infxn. Limb feels red and hot, with red streaks from point of entry. o Dx: Obvious via PE

Question 74

• What is sudden cardiac death in athletes?

Answer 74

o 1/200,000 apparently healthy young athletes o abrupt-onset V-fib, die suddenly. M:F 9:1 o usu dt undetected HCM o Screening: PM and FHx, PE, mb ECG or Echo

Question 75

• What is Athletic Heart Syndrome?

Answer 75

o Many cardiac changes in ppl who train > 1 hr most days o Intensive training → physiologic adaptations o ↑LV pressure and volume, ↑LV muscle mass, chamber size o ↑CO, lower resting HR and longer filling times

Question 76

• What are ssx of athletic heart syndrome? Dx? Px?

Answer 76

o Asx; bradycardia, laterally displaced PMI, ejection murmur, additional heart sounds o Dx: ECG, Echo, exercise stress testing o Px: unknown if benign or not

Question 77

• What are the 3 types of cardiac tumors?

Answer 77

o Benign primary o Malignant primary o Metastatic

Question 78

• What are benign primary cardiac tumrors?

Answer 78

o 50% myxoma; F>M o Usu LA, pedunculated, prolapse thru mitral o If friable, inc risk embolism

Question 79

• What are Malignant primary cardiac tumors?

Answer 79

o Sarcomas (most common), pericardial mesothelioma, primary lymphoma o avg 41 o Usu start in RA, involve pericardium o mb →obstruction, tamponade, metastases to lung

Question 80

• What do metastatic cardiac tumors come from? Ssx? Dx?

Answer 80

o Usu from lung, breast, soft tissue sarcoma, renal CA o Ssx: like heart failure signs, stroke, CAD depending on location, size, friability o Dx: usu delayed since signs look like other dos. Echo, bx. TEE for atrial tumors. o anemia, hi WBC, ESR, CRP. ECG atrial enlargement, CXR calcifications