Acquired Heart Disease (Rheumatic, Kawasaki, Endocarditis)

Question 1

Cath findings for constrictive pericarditis

Answer 1

RAP = PCWP
RVEDP = LVEDP within 4 mmHg
RVSp usually < 50 mmHg

Question 2

Cath findings for restrictive cardiomyopathy

Answer 2

PCWP and LVEDP may exceed RAP and RVEDp by > 4 mmHg
RVSp often > 50 mmHg

Question 3

EKG findings in constrictive pericarditis vs. restrictive cardiomyopathy

Answer 3

Constrictive pericarditis have low voltage QRS, don’t usually have LVH/RVH and may or may not have atrial enlargement

Restrictive cardiomyopathy usually have LVH/RVH and nearly always have atrial enlargement

Question 4

What are Libman Sacks lesions

Answer 4

• Seen in endocarditis
• Verrucous non bacterial lesion in lupus on the mitral valve
• On echo they are irregular lesions less than 0.5 cm in diameter on the valve or chordal apparatus

Question 5

Major criteria for Rheumatic fever

Answer 5

• Polyarthritis
• Carditis
• Sydenham’s chorea
• Erythema marginatum
• Subcutaneous nodules

Diagnosis needs 2 major criteria plus preceding strep infection

Question 6

3 cardiac findings in anorexia patient

Answer 6

• Mitral valve prolapse - midsystolic click with late systolic murmur
• Bradycardia
• EKG findings: AV block, prolonged QT, ST depression, T wave inversion

Question 7

Antiplatelet/anticoagulation management for Kawasaki patients based on coronary Z scores

Answer 7

• Z < 2 - antiplatelet for 4-6 weeks with counseling
• Z 2.5-5 - low dose aspirin for first 6 weeks
• Z 5-10 - long term antiplatelet
• Z > 10 or absolute > 8 mm - long term antiplatelet plus anticoagulant and possible beta blocker pending blood pressure