5 Cardiac part 4

Question 1

Etiology of pericarditis

Answer 1

Viral, bacterial, fungal 
Secondary to autoimmune (rheumatic fever) 
Systemic or contiguous inflammatory processes
CT disease (RA)
Neoplasm
Uremia
MI, cardiac surg
Some drugs
Radiation therapy to chest

Question 2

Pericarditis pathogenisis

Answer 2

Inflammation of pericardium causes increased cap perm and exudate formation which is fibrin rich and scar tissue/adhesion results
Increase friction and restriction to cardiac filling

Question 3

Pericarditis pain presentation

Answer 3

Sharp chest pain over precordial with radiation to back neck abdo or side
Exacerbated by breathing coughing swallowing positional changes, tripod helps

Question 4

Pericarditis presentation aside from pain

Answer 4

Auscultated friction rub
Fever, chills, sweating (if caused by infection)
Ankle/feet/leg swelling
Anxiety
Dry cough
Fatigue
Orthopnea

Question 5

Amount of fluid needed for deficits from pericardial effusion

Answer 5

200mL

Question 6

Causes of pericardial effusion

Answer 6

Infection/inflammation
Neoplasm
Cardiac surgery/MI
Trauma
Dissected AA

Question 7

Patho of pericardial effusion

Answer 7

Decrease SV and CO as RV then LV effected and reduced diastolic filling from pressure backing up system (JVD)

Question 8

Clinical manifestations of pericardial effusion

Answer 8

JVD, decreased CO decreased SBP, narrow PP, muffled heart sounds and eventually decreased in end organ perfusion
Pulsus pardoxus
(decreased thoracic pressure during insp plus increased pressure on LV)

Question 9

ECG changes pericardial effusion

Answer 9

Global, decreased QRS voltage

Question 10

Constrictive pericarditis

Answer 10

Signifiant amounts of scar tissue in pericardial cavity, contraction of scar tissue causes overall impairment of diastolic filling results in systemic edema (especially ascites and JVD)

Question 11

Which disease causes Rheumatic fever

Answer 11

Group A streptococcal throat infection (3% with strep develop RF)

Question 12

Rheumatic Fever

Answer 12

Diffuse inflammatory disease caused by delayed immune response to pharyngeal infection

Question 13

Rheumatic fever presentation

Answer 13

Fever and inflammation in
Joints
Skin
CNS
Heart
Can be acute, recurrent, or chronic and if untreated scarring and deformity of tissues

Question 14

Pathogenesis theory of RF

Answer 14

GAS contains M protein (antigen) which either are similar to heart/skin/CNS/joints tissue or the M proteins are seeded onto those surfaces by GAS

Question 15

Aschoff bodies

Answer 15

Characteristic of RF.

Localized areas of tissue necrosis surrounded by immune cells

Question 16

Clinical presentation of RHD

Answer 16

A recent hx (takes 2-3 weeks) of strept with S&S of polyarthritis (migratory inflammation of large joints)
Carditis
Subq nodules
Erythema marginatum
Sydenham Chorea

Question 17

Subcutaneous nodules

Answer 17

From RF. Painless, freely moveable nodules on muscle of wrist, elbow, ankle, knee

Question 18

Erythema marginatum

Answer 18

Splotchy rash on trunk or inner aspects of thigh or arm (never on face)
Early on with RF and usually with subq nodules

Question 19

Sydenham Chorea

Answer 19

Usually in girls
Rarely after 20 y.o
Usually self limiting but can recur CNS events
Starts with irritability, crying, dropping things then spontaneous rapid purposeless jerking movements and facial grimaces

Question 20

Jones 5 major criteria of RF

Answer 20

Polyarthritis
Carditis
Erythema Marginatum
Chorea
Sub q nodules
(Last two start later)

Question 21

Carditis from RHD can involve which layers of the heart

Answer 21

Pancarditis - all three

Question 22

Endocarditis effects of RHD

Answer 22

Swelling of valve leaflets, vegetation deposited on valve tissue/chordae tendinae

Question 23

Vegetation of RHD and valvular outcomes

Answer 23

Vegetation (excresecences) are sterile wart like small clumps of platelets/fibrin
Scarring/shortening of structures with loss of elasticity.
More often L side
Can cause cardiomegaly and CHF if untreated

Question 24

Myocarditis from RHD

Answer 24

Aschoff bodies (bits of lymphocytes/macrophages around zone of fibroid necrosis)
Rarely cause contraction dysfunction but will cause dysrhythmia and conduction defects

Question 25

Pericarditis from RHD

Answer 25

Only in severe cases

Question 26

Definition of infection endocarditis

Answer 26

``` Direct infection of inner surface of heart due to colonization of microbial agents Staphylococci Streptococci Enterococci Causing vegetation ```

Question 27

Causes of infectious endocarditis

Answer 27

``` Bacteremia Mitral valve prolapse Congenital Defects Prosthetic valves Pacemaker Internal defibs Immunodeficiency Neoplasms IV drug use ```

Question 28

Endocarditis not from RHD

Answer 28

Vegetation NOT sterile Greater number of vegetations than RHD Risk of thrombi forming from vegetations

Question 29

Clinical manifestations from endocarditis

Answer 29

``` Valve defects/decreased CO Systemic infection signs (fever, malaise, fatigue, positive blood values) S/S related to release of systemic emoblic Petechiae Dark red lines under nail beds Chest/abdo pain SOB/Cough Arthralgia, blindness, paralysis ```

Question 30

Definition of cardiomyopathies

Answer 30

Group of diseases causes mechanical or electrical cardiac defects either primary or secondary in nature

Question 31

Genetic primary cardiomyopathies

Answer 31

Hypertrophic cardiomyopathy Arrhythemogenic RV cardiomyopathy LV noncompaction Ion channelopathies

Question 32

Hypertrophic cardiomyopathy

Answer 32

Common cause of sudden cardiac arrest in young athletes Decreased diastolic filling and SV due to LVH, IV septum enlargement and decreased LV chamber size AMI, HF, A-fib, stroke

Question 33

Arrhythmogenic RV cardiomyopathy

Answer 33

Loss of myocytes in RV, replaced by fibrous or fatty tissue | Leads to R failure and formation of R-sided re-entrant circuit causing V-tach

Question 34

LV noncopaction

Answer 34

Congenital condition with no "trabecular compaction" of myocardium during embryonic development leading to spongy and ineffective tissue

Question 35

Primary mixed cardiomyopathies are

Answer 35

Dilated cardiomyopathy | Primary restrictive cardiomyopathy

Question 36

Dilated cardiomyopathy

Answer 36

Genetically linked or caused by ETOH (long term) | enlarged and atrophied cardiac cells, most frequently manifests as HF

Question 37

Primary restrictive cardiomyopathy

Answer 37

Genetic, or linked to fibrosis from radiation therapy | Diastolic filling reduced due to excessive rigidity and thickness of ventricular atrial walls

Question 38

Acquired cardiomyopathy

Answer 38

Myocarditis usually from viral infetion

Question 39

Secondary cardiomyopathies

Answer 39

``` Drug use The BEETIES Muscular dystrophy Autoimmune Cancer treatments ```

Question 40

Mitral valve stenosis

Answer 40

Most common cause is RF but it can be congenital Decreased ventricular filling Leads to diastolic murmur, decreased CO, pulmonary congestion, R HF, A-fib, emboli

Question 41

Mitral valve regurg

Answer 41

Most common cause is RF Can also be rupture of chordae, pap muscle dyfunction, valve perforation, LV dilation. Leads to systolic murmur, and manifestations to MVS but more pronounced

Question 42

Mitral valve prolapse

Answer 42

Complete reversal of valve into L atrium from genes or CT disorder Degen in leaflets causes them to be large and floppy, similar symptoms to mitral regurg

Question 43

Aortic stenosis

Answer 43

Increases resistance to ejection of blood from congenital defects or calcification (common cause is bicuspid aortic valve)) leads to systolic murmur, LVH, decreased CO and increased MVO2

Question 44

Aortic valve regurg

Answer 44

Incomplete aortic closure during diastole causing increased LV stroke volume From RF, congenital, aortic dissection, htn, trauma Leads to diastolic murmur, voluve overload, CO decrease and pulmonary backup Catechol response worsens regurg

Question 45

RHD valves

Answer 45

Rigidity and thickening of valves from RF causes issues with both opening and closing

Question 46

Cardiac tamponade

Answer 46

``` From penetrating injury, filling of pericardial sac with blood which compressed ventricles decreasing filling and CO Becks triad: Hypotension Distended neck veins Muffled heart soounds (pulsus paradoxus) ```

Question 47

Cardiac contusion

Answer 47

Blunt injury to anterior chest via sternum, presents same as MI Valve rupture Pericardial tamponade Cardiac rupture