5 Cardiac part 4 Flashcards
Etiology of pericarditis
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
Pericarditis pathogenisis
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
Pericarditis pain presentation
Sharp chest pain over precordial with radiation to back neck abdo or side
Exacerbated by breathing coughing swallowing positional changes, tripod helps
Pericarditis presentation aside from pain
Auscultated friction rub Fever, chills, sweating (if caused by infection) Ankle/feet/leg swelling Anxiety Dry cough Fatigue Orthopnea
Amount of fluid needed for deficits from pericardial effusion
200mL
Causes of pericardial effusion
Infection/inflammation Neoplasm Cardiac surgery/MI Trauma Dissected AA
Patho of pericardial effusion
Decrease SV and CO as RV then LV effected and reduced diastolic filling from pressure backing up system (JVD)
Clinical manifestations of pericardial effusion
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)
ECG changes pericardial effusion
Global, decreased QRS voltage
Constrictive pericarditis
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)
Which disease causes Rheumatic fever
Group A streptococcal throat infection (3% with strep develop RF)
Rheumatic Fever
Diffuse inflammatory disease caused by delayed immune response to pharyngeal infection
Rheumatic fever presentation
Fever and inflammation in Joints Skin CNS Heart Can be acute, recurrent, or chronic and if untreated scarring and deformity of tissues
Pathogenesis theory of RF
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
Aschoff bodies
Characteristic of RF.
Localized areas of tissue necrosis surrounded by immune cells
Clinical presentation of RHD
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
Subcutaneous nodules
From RF. Painless, freely moveable nodules on muscle of wrist, elbow, ankle, knee
Erythema marginatum
Splotchy rash on trunk or inner aspects of thigh or arm (never on face)
Early on with RF and usually with subq nodules
Sydenham Chorea
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
Jones 5 major criteria of RF
Polyarthritis Carditis Erythema Marginatum Chorea Sub q nodules (Last two start later)
Carditis from RHD can involve which layers of the heart
Pancarditis - all three
Endocarditis effects of RHD
Swelling of valve leaflets, vegetation deposited on valve tissue/chordae tendinae
Vegetation of RHD and valvular outcomes
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
Myocarditis from RHD
Aschoff bodies (bits of lymphocytes/macrophages around zone of fibroid necrosis) Rarely cause contraction dysfunction but will cause dysrhythmia and conduction defects
Pericarditis from RHD
Only in severe cases
Definition of infection endocarditis
Direct infection of inner surface of heart due to colonization of microbial agents Staphylococci Streptococci Enterococci Causing vegetation
Causes of infectious endocarditis
Bacteremia Mitral valve prolapse Congenital Defects Prosthetic valves Pacemaker Internal defibs Immunodeficiency Neoplasms IV drug use
Endocarditis not from RHD
Vegetation NOT sterile
Greater number of vegetations than RHD
Risk of thrombi forming from vegetations
Clinical manifestations from endocarditis
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
Definition of cardiomyopathies
Group of diseases causes mechanical or electrical cardiac defects either primary or secondary in nature
Genetic primary cardiomyopathies
Hypertrophic cardiomyopathy
Arrhythemogenic RV cardiomyopathy
LV noncompaction
Ion channelopathies
Hypertrophic cardiomyopathy
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
Arrhythmogenic RV cardiomyopathy
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
LV noncopaction
Congenital condition with no “trabecular compaction” of myocardium during embryonic development leading to spongy and ineffective tissue
Primary mixed cardiomyopathies are
Dilated cardiomyopathy
Primary restrictive cardiomyopathy
Dilated cardiomyopathy
Genetically linked or caused by ETOH (long term)
enlarged and atrophied cardiac cells, most frequently manifests as HF
Primary restrictive cardiomyopathy
Genetic, or linked to fibrosis from radiation therapy
Diastolic filling reduced due to excessive rigidity and thickness of ventricular atrial walls
Acquired cardiomyopathy
Myocarditis usually from viral infetion
Secondary cardiomyopathies
Drug use The BEETIES Muscular dystrophy Autoimmune Cancer treatments
Mitral valve stenosis
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
Mitral valve regurg
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
Mitral valve prolapse
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
Aortic stenosis
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
Aortic valve regurg
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
RHD valves
Rigidity and thickening of valves from RF causes issues with both opening and closing
Cardiac tamponade
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)
Cardiac contusion
Blunt injury to anterior chest via sternum, presents same as MI
Valve rupture
Pericardial tamponade
Cardiac rupture
