Cardiac Manifestations of Systemic Diseases&Rheumatic Heart Disease Flashcards

Question

Clinical presentation and Signs of Hypothyroidism with Cardiac Manifestations of Thyopathy

Answer 1

Clinical presentation: Pathologically: Myofibrillar edema, interstitial fibrosis = ↓ CO ↓ CO → ↓ SV, ↓ Pulse pressure and ↓ HR Signs: Pericardial effusion develops subacutely, slower than acute Distant heart sounds Weak arterial pulses ECG: low voltage, sinus bradycardia and prolonged QT interval CXR: “water bottle” cardiac silhouette (pericardial effusion), cardiomegaly Hypercholesterolemia, high triglycerides

Answer 2

Hyperthyroidism: Ischemic heart disease symptoms/CHF occurs if underlying cardiac pathology is present Cardiac symptoms that develop due to hyperthyroidism will respond to Methimazole/Propylthiouracil (PTU) Hypothyroidism Angina pectoris is usually not experienced because of hypothyroidism low metabolic demands But, angina/MI can be precipitated once thyroid hormone tx is started. Must begin T4 (Levothyroxine) tx slowly but progressively

Answer 3

A chronic, systemic, inflammatory condition that affects: peripheral joints, muscles, vessels, ligaments and tendons primarily but, due to its systemic involvement, hematologic, neurologic, pulmonary and cardiac systems can be attacked as well.

Answer 4

Rheumatoid Factor + in 70% Anticyclic citrullinated peptide (anti-CCP) antibody + in 70-80% ESR or CRP

Answer 5

Cardiovascular Disease is most common cause of death Higher rate of carotid atherosclerosis Higher rate of CAD ``` Pericarditis is most common finding 10-50% will have pericardial effusion on echocardiogram Few Pts will progress to: Tamponade Constrictive pericarditis ``` Mitral/Aortic Valvular vegetations Granulomatous and inflammatory processes Can cause valvular insufficiency (regurgitation) CHF (systolic and diastolic) Occurs at 2x the rate in RA Pts than in the general public

Answer 6

``` NSAIDs DMARDs (disease modifying antirheumatic drugs) Glucocorticoids Anti-TNF Immuno-modulators: Abatacept, Rituximab ``` Urgent pericardiocentesis If Pt is “tamponading” (very rare for RA) Pericardiodectomy If there’s constrictive pericarditis (Very rare for RA)

Answer 7

An inflammatory, autoimmune disease with systemic damage of organs mediated by auto-antibodies and immune complexes. Systems involved: skin, renal, cardiac, joints, hematologic, neurologic

Answer 8

SLE can affect all layers of the heart Pericarditis most common complication Rarely leads to tamponade or constrictive pericarditis Myocarditis Associated with HF especially in the setting of HTN

Answer 9

``` Endothelial damage from: Autoimmune attack Chronic inflammation Oxidative damage to arteries Chronic glucocorticoid Use ```

Answer 10

Life style modifications: Smoking cessation Diet and exercise Statins (HMG-COA reductase inhibitors) ``` Give hydroxychloroquine (Plaquenil) (non-steroidal) vs. glucocorticoids when possible To reduced potential for hyperlipidemia, HTN, DM ``` Control HTN/CHF High dose glucocorticoids (in SLE) used for: Heart failure Embolic events Arrhythmias

Answer 11

Acute Rheumatic Fever is caused by Group A beta-hemolytic Streptococcus (GAS) Upper airway infection, such as in “strep throat.”

Answer 12

Seen in 60% of (Untreated or repeated infections) Acute Rheumatic Fever ``` Mitral/aortic Valvular disease is the “hallmark” of rheumatic carditis Stenosis or regurgitation can be seen Pancarditis Endocarditis Arrhthymias ``` ``` Dx: Throat swab, rapid strep test Serologic tests: Anti-streptolysin O (ASO) titer Anti-DNase B (ADB) titer ```

Answer 13

``` Clinical symptoms: Constitutional: Fever, malaise Joints: Arthralgias Skin: Scarlet fever rash w/ Strawberry tongue Chest Pain ``` ``` Clinical signs: Mitral/Aortic murmur Friction rub ECG: ↑PR interval, Afib ↑ CRP, ESR, WBC ```

Answer 14

ARF caused by →GAS → triggers autoimmune reaction → damage to cardiac structures: Endocarditis and valvular damage w/ vegetation deposit Mitral regurgitation and dilatation from ventricular backflow Myocardium With recruitment of “Ascoff” cells and myocarditis Pericardium Serofibrinous Pericarditis The acute inflammatory process can subside w/o Tx, but leaves behind damaged tissue

Answer 15

Valvular repair/replacement when heart failure (HF) cannot be treated conventionally ASA/NSAIDs have little effect on RHD related carditis Control HTN ``` Tx HF: Loop diuretics (furosemide) for fluid overload control (dyspnea/edema) ``` ACEi, Beta Blockers (bisoprolol, metoprolol XR) ARBs are not as effective as ACEi or cardioselective BB, but they are used in pts who cannot take ACEi, BB High dose, short course of glucocorticoids for Acute heart failure

Answer 16

Primary prevention Treat GAS infections Secondary Prevention: Long term strategy to prevent recurring GAS episodes Benzathine penicillin, for 5-10 years, sometimes for life, depending on cardiac disease severity Allergy alternatives: Erythromycin