Car 22 - Other Cardiac Pathology

Question 1

What is Rheumatic Heart Disease?

Answer 1

A consequence of bacterial infection but it is an autoimmune phenomenon (type II hypersensitivity).

Question 2

What are the 4 non-suppurative complications of Group A strep infection?

Answer 2

Scarlet fever (toxin mediated). Post-strep glomerulonephritis (type III hypersensitivity, causing hematuria, proteinuria, renal insuff, 1-6 wks following infection). Acute rheumatic fever (type II hypersens,2-4wks following pharyngitis). Streptococcal toxic shock syndrome (usually follows skin or vaginal infections).

Question 3

What are the five Major criterion in Jones criteria of Rheumatic fever?

Answer 3

[JoNES] Joints (migratory polyarthritis). Heart (pancarditis). Nodules (Subcutanepus). Erythema marginatum (serpiginous skin rash). Sydenham chroea (AKA St. Vitus dance: chorea of the face, tongue, upper-limb).

Question 4

What are the four Minor criterion of Jone criteria of rheumatic fever?

Answer 4

Arthralgia. Fever. Elevated ESR or CRP. Prolonged PR interval on EKG.

Question 5

How is rheumatic fever diagnosed?

Answer 5

Evidence of a group A strep infection, elevated anti-streptolysin O titter and two major criteria and one minor criteria of Jones criteria.

Question 6

What are the symptoms of Rheumatic heart disease?

Answer 6

Myocarditis. Damage to valves (more likely on mitral than aortic). Causes Aschoff bodies (inflammatory nodules in the myocardium of fibrillary necrosis infiltrated by lymphocytes and necrosis and multinucleate giant cells). Can have Anitschkow cells (activated histiocytes w/ an owl eye appearance).

Question 7

What are three causes of Fibrinous pericarditis?

Answer 7

Uremia. Rheumatoid arthritis. Dressler syndrome (pericarditis several weeks post MI).

Question 8

What are the two causes of Serous pericarditis

Answer 8

A non-infectious inflammatory diseases. Can be caused by Lupus and Rheumatic fever.

Question 9

What is the cause of suppurative pericarditis?

Answer 9

Infection of pericardium.

Question 10

What are two causes of hemorrhagic pericarditis?

Answer 10

TB. Melanoma.

Question 11

What are the symptoms of acute pericarditis?

Answer 11

Pleuritic chest pain (sharp, worse w/ inspiration, better w/ sitting up and leaning forward). Distant heart sounds. Friction rub. Diffuse ST elevation. Also may cause diffuse ST depression. Can resolve w/o scarring or lead to chronic constrictive pericarditis.

Question 12

What is Kussmaul sign?

Answer 12

JVD w/ inspiration.

Question 13

What is one of the most common causes of Chronic constrictive pericarditis?

Answer 13

Lupus.

Question 14

What is a symptom of chronic constrictive pericarditis that does not present in acute pericarditis?

Answer 14

Kussmaul sign: Jugular venous distention w/ inspiration.

Question 15

What is Cardiac Tamponade?

Answer 15

Excessive fluid b/w myocardium and pericardium, preventing the heart from expanding and filling during diastole. Decreases cardiac output and equilibration of diastolic pressure in all 4 chambers.

Question 16

What are the symptoms of Cardiac tamponade?

Answer 16

Hypotension. Increased venous pressure and JVD. Increased HR. Pulsus paradoxus.

Question 17

What is Pulsus paradoxus?

Answer 17

Exaggerated decrease in the amplitude of the systolic BP during inspiration (decrease in systolic BP by more than 10 mmHg during inspiration).

Question 18

What are 6 causes of pulsus paradoxus?

Answer 18

Cardiac tamponade. Asthma. Croup. Obstructive sleep apnea. COPD. Pericarditis.

Question 19

What is the difference b/w Kussmaul’s sign vs Pulsus paradoxus?

Answer 19

Kussmaul: It is JVD during inspiration, caused by decreased capacity of Right ventricle, seen more likely in constrictive pericarditis than tamponade. Pulsus paradoxus: Decreased SBP by more than 10mmHg during inspiration, caused by decreased capacity of LV filling, seen much more on cardiac tamponade than pericarditis.

Question 20

What is the classic EKG finding in tamponade?

Answer 20

Electrical Alternans: Alternating amplitude QRS complex (beat to beat). Very specific to tamponade but not sensitive to detect.

Question 21

What can Syphilitic heart disease cause?

Answer 21

Disruption of vas vasorum. Dilation of aorta and aortic valve ring. Aortic regurgitation. Aortic stenosis. Thoracic aortic aneurysms. Calcification of aorta (tree-bark appearance).

Question 22

What is the most common cardiac tumor?

Answer 22

Metastatic tumor from somewhere else: melanoma, lymphoma.

Question 23

What is the most common primary tumor of the heart In adults?

Answer 23

Myxoma. Most commonly occur in left atrium.

Question 24

What is one symptom of cardiac myxoma and why?

Answer 24

Since it most commonly occurs in the left atrium as a ball stuck to the wall, it can cover the mitral valve, causing syncopal episodes. They can also flop over into the left ventricle, causing early diastolic sound called a “tumor plop”.

Question 25

What is the most common primary cardiac tumor in children?

Answer 25

Rhabdomyoma.

Question 26

What are the three tumors associated w/ Tuberous sclerosis?

Answer 26

Rhabdomyoma. Astrocytoma. Angiomyolipoma.

Question 27

What heart pathology fits the following statement: Focal myocardial inflammation w/ multinucleated giant cells.

Answer 27

Achoff bodies. Seen in Rheumatic heart disease.

Question 28

What heart pathology fits the following statement: chest pain and course rubbing heart sounds in patients w/ Cr of 5.0.

Answer 28

Uremic pericarditis.

Question 29

What heart pathology fits the following statement: tree-barking of the aorta.

Answer 29

Tertiary syphilis.

Question 30

What heart pathology fits the following statement: child w/ fever, join-pain, cutaneous nodules 4 weeks after a throat infection.

Answer 30

Acute rheumatic fever.

Question 31

What heart pathology fits the following statement: ST elevation in all EKG leads.

Answer 31

Pericarditis.

Question 32

What heart pathology fits the following statement: EKG shows electrical alternans.

Answer 32

Cardiac tamponade.

Question 33

RFF: Granulomatous nodules in the heart.

Answer 33

Aschoff bodies (rheumatic heart disease).

Question 34

RFF: Most common primary cardiac tumor in adults.

Answer 34

Left atrial Myxoma.

Question 35

RFF: Most common primary cardiac tumor in children.

Answer 35

Rhabdomyoma.

Question 36

RFF: Most common cause of constrictive pericarditis.

Answer 36

USA: Lupus. Developing countries: TB.