Cardiac Manifestation of Systemic Disease Flashcards
What type of cardiac manifestations can you see from systemic diseases?
- coronary heart disease
- cardiomyopathy
- myocarditis
- pericardial heart disease
What is the most serious cardiac problem associated with Diabetes Mellitus?
It is associated with what variable?
Describe the quality of the cardiac problem
- Independent risk factor for coronary artery disease
- both are inflammatory processes
- most common cause of death in adults with diabetes melitus
- Related to duration of illness
- Tend to have large infarct area
- up to 90% ischemic events are silent (don’t present with chest pain)
- must have lower threshold for diagnostic testing
- more likely to atypical ischemic symptoms
- up to 90% ischemic events are silent (don’t present with chest pain)
Why is it so important to consider diabetes a cardiovascular risk factor equivalent?
non diabetics without a prior MI and diabetics without a prior MI have very similar mortality rates
However, diabetics with a previous MI drastically increases the rate of mortality as compared to nondiabetics with a previous MI
In addition to coronary artery disease, what other cardiac problems are associated with diabetes?
- Restrictive cardiomyopathy
- without evidence of epicardial artery disease
- abnormal relaxation
- hypertension
- Interstial fibrosis
- increased collagen, glycoprotein, triglycerides, and cholesterol in interstitium
- increase risk of clinically symptomatic heart failure
What is the treatment for diabetics with coronary artery disease and cardiovascular disease?
- Aspirin
- control blood sugars
- HbA1c < 7.0%
- control hypertension
- has become a well studied and “contorversial” topic
- ACEI or ARB (reduce incidences of cardiomyopathy)
- control lipids
- statins
- LDL <70
What are the 3 features of cardiometabolic syndrome?
Hypertension
dyslipidemia (low HDL, high TG)
glucose intolerance
Why does obesity lead to eccentric cardiac hypertrophy with ventricular dilation?
increased circulating blood volume
increased cardiac output
increased left ventricular filling pressures
What heart problems can occur when obese patients lose weight very quickly?
arrhythmias
sudden dealth due to electrolyte abnormalties
What hormone is the master of body metabolism?
What effects does it have?
Thyroid hormone
- Effects
- incrases oxygen consumption
- direct iontropic and chronotropic effects on the heart
- increase synthesis of myosin adn N-K-ATPase
- Increase # of beta adrenergic receptors
What cardiac problems can occur with hyperthyroidism?
- palpitations
- forceful contraction (esp when laying on left side)
- sinus tachycardia
- atrila fibrillation
- Systolic hypertension
- Fatigue
- Pulmonary hypertension
- angina
- heart failure
What will you see upon a physical cardiac exam on persons with hyperthyroidism?
- hyperdynamic precordium
- widened pulse pressure
- systolic hypertension but reduced diastolic pressure
- increased first heart sound
- incrased LV mass and LV hypertrophy
- 3rd heart sound
- blood hitting ventricular wall that you can auscultate
There is a direct relationship between levels of thyroid hormone and what condition?
atrial fibrillation
How do we treat cardiac disease in patients with hyperthyroidism?
- Beta-blockers to contorl symptoms
- propranolol (120-160 mg/day)
- decrease the conversion of T4 to T3
- takes 7-10 days
- atenolol (50 mg/day)
- propranolol (120-160 mg/day)
- Anticoagulation for patients in a-fib
- Heart failure
- diuretics (to decrease volume, esp if have pulmonary hypertension)
- digitals
- Treat hyperthyroidism
- radioactive iodine
- anti-thyroid (PTU, mmithimazol)
Hypothyroidism can cause what type of cardiac effects?
- Decreased cardiac output
- bradycardia
- decreased stroke volume
- Hypertension
- increased in systemic vascular resistance
- Fatigue
- Decreased exercise tolerance
- Dyspnea on exertion
- Heart failure and angina in patients with heart disease
In addition to cardiac symptoms, what other condition can occur wiht hypothyroidism?
What is the treatment for hypothyroidism?
- pericardial effusions
- hypercholesterolemia
- hyperhomocysteinemia (inflammatory condition - increased rates CAD)
- lower extremity edema
- treatment
- T4 replacement
- Caution of iatrogenic hyperthyroidism
What is the classic triad of symptoms for pheochromocytoma?
- sweating
- tachycardia
- episodic headache
Pheochromocytoma can cause what other associated problems?
- paroxysmal hypertension
- orthostatic hypotension
- decreased plasma volume
- dilated cardiomyopathy
- toxic effect of catecholamines
- secondary erthocytosis
What causes acromegaly?
Acromegaly is associated with what other cardiac conditions?
Treatment?
Acromegaly: too much growth hormone
- Hypertension
- suppression of RAS
- increase in total body sodium and plasma volume
- LV hypertrophy
- Cardiomyopathy
- diastolic dysfunction
- arrhthmias
- Increased prevalence of valvular heart disease
- Treatment
- (octreotide) does improve some of the cardiocascular effects
What cardiac problems are associated with rheumatoid arthritis?
- increased risk of coronary artery disease
- inflammation
- casculitis
- increased risk of heart failure
- pericardiditis
- usually clinically silent
- pericardial effusion found on echo in 10-50%
- treatment with prednisone can help reduce symptoms if NSAIDS do not work
- tamponade is rare
- Myocarditis
- inflammatory granulomas
- possible cause of heart failure
What cardiac diseases are common in people with systemic lupus erythematosus?
- Pericardial
- Myocardial
- Coronary artery disease
- Valvular heart disease
What valvular diseases are associated with systemic lupus erythematosus?
- Systolic murmurs
- structural
- anemia
- fever
- tachycardia
- Mtrial valve is most commonly effected
- mitrial valve prolapse
- valvular vegetations
- balbular regurgitation
- valvular stenosis
- Libman-Sacks endocarditis (verrucous endocarditis)
What is Libman-Sacks endocarditis?
Describe the complexes it forms?
Symptoms?
How is it diagnosed?
Treatment?
- Most common aortic mitral valves
- usually near the edge
- consist of immune complexes, monocytes, fibrin, platelets
- can break off and cause systemic emboli
- healing results in scar formation
- Diagnosis with negative blood cultures (new murmur) and echocardiogram (trans-esophageal is more sensitive)
- Antibiotic prophylaxis is recommended in patients with SLE valvular disease
- Terat with valve replacement in those with severe disease
What are the characterisitcs of pericarditis caused by systemic lupus erythematosus?
Presentation?
Treatment?
- Most common cause of symptomatic cardiac involvement
- occurs at some point in over half of patients
- usually asymptomatic
- may present with sub-sternal chest pain
- pericardiocentesis needed if signs of tamponade are present
- fluid may be positive for ANA and immune complexes
- testing fluid is not helpful in diagnosis
- treat with NSAIDs and steroids
What are the characterisitcs of myocarditis caused by systemic lupus erythematosus?
Presentation?
- Rare
- May cause conduction abnormalities
- Presentation
- often asymptomatic
- suspect if there is a resting tachycardia with unexplained cardiomegaly (usually patients will not have fever)
- systolic and/ or diastolic dysfunction
- may present with heart failure symptoms
What conduction abnormalities occur in systemic lupus erythematosus?
- First degree heart block; often transient
- Higher degrees of heart block and arrhythmias are uncommon in adults
- Congenital heart block as part of neonatal lupus
- presents of antibodies in mothers of infants
- recommended testing for antibodies in pregnant women with SLE
- anti-Ro and anti-La
What malnutrition syndromes can cause cardiac problems?
- Severe protein calorie malutrion
- weakened, hypokinetic heart muscle
- generalized edema from decreased oncotic pressure
- AIDS, anorexia nervosa, heart failure patients
- Thiamine deficiency
- Beriberi
- high-out frilure, tachycardia, and elevated ventricular filling pressures
- Rapid response to thiamine replacement
- Vit b6, B12, Folate deficiency
- Hyperhomocyteinemia
- increased atheroscleotic vascular risk
- Hyperhomocyteinemia
Presentation of High Output Cardiac Failure?
Physical findings?
Causes?
- Elecated Cardiac index
- low systemic vascular resistance
- Causes
- systemic arteriovenous fistulas
- hyperthyrodism
- anemia, includign anemia of renal failure
- beriberi
- dermatologi disorders
- renal disease
- hepatic disease
- skeletal disorders (paget’s disease, multiple myeloma)
- Hyperkinetic heart syndrome
