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Cardiology > Cardiac Manifestations Of Systemic Disease > Flashcards

Cardiac Manifestations Of Systemic Disease Flashcards

1
Q

Cor pulmonale

A

Pulmonary heart disease
- altered right ventricle
structure and/or function in the context contact of chronic lung disease

Most commonly triggered by pulmonary HTN

HFpEF and HRrEF are not included w/ cor pulmonale

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2
Q

Symptoms and signs of cor pulmonale

A

Dyspnea

Tachypnea

Ascites

Holosystolic murmur at the right/left sternal border and/or at the subxiphoid are
- this murmur is caused by tricuspid regurgitation

S3 gallop

RV palpations are felt along the left sternum

Elevated JVP

Hepatomegaly W/ pulsating

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3
Q

ECG and imagining findings of cor pulmonale

A

ECG:

1) Right axis deviation
2) RVH
3) Increased P wave amplitudes in ONLY lead 2
- typically matches the amplitude of the T wave

Imaging

  • right ventricle and atrium enlargement
  • may also show left ventricle enlargement but not always
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4
Q

Cardiac tumors

Cardiac myxomas

A

Very rare and requires biopsy to confirm

If present, will show a “tumor plop” sound which is heard just prior to S3 and after S2

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5
Q

Symptoms and signs of cardiac myxomas

A

Constitutional

  • fever
  • weight loss
  • arthralgia
  • night sweats
  • cachexia

Signs

  • lab values show the following
    1) increased ESR and CRP
    2) globulin
    3) TNF-a
  • are seen as masses in xrays/MRIs
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6
Q

Typical Cardiovascular changes in the 1st trimester in pregnancy

A

Increased

  • Blood volume
  • Heart rate
  • stroke volume
  • cardiac output
  • Pulse pressure
  • EDV and EDP
  • red blood cell mass

Decreases

  • systolic and diastolic BP
  • systemic vascular resistance
  • pulmonary vascular resistance
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7
Q

Typical Cardiovascular changes in the 2nd trimester in pregnancy

A

Strong Increases

  • Blood volume
  • Heart rate
  • stroke volume
  • cardiac output
  • Pulse pressure
  • EDV and EDP

Small increase
- RBC masses

major Decreases

  • diastolic BP
  • systemic vascular resistance
  • pulmonary vascular resistance

Small decreases
- systolic blood pressure

this is the term with the greatest changes since the baby is developing the most at this time

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8
Q

Symptoms specific to cardiac tumors in endocardium

A

Thromboembolisms in the following

  • cerebral
  • coronary
  • pulmonary

Cavity obliteration

Outflow tract obstruction

Valve obstructions/damage

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9
Q

Symptoms specific to cardiac tumors in pericardium

A
  • Pericarditis (always presents)
  • Pericardial effusion and/or tamponade
  • Pericardial constriction
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10
Q

Symptoms specific to cardiac tumors in the myocardium

A

Arrhythmias (almost always presents)
- can be ventricle or atrial

Conduction abnormalities
- usually AV or SA blocks but can also be bundle branches

Left ventricular dysfunction

Coronary artery involvement

  • unstable angina
  • infarction

ECG changes

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11
Q

Typical Cardiovascular changes in the 3rd trimester in pregnancy

A

Strong Increases

  • Blood volume
  • Heart rate
  • Pulse pressure
  • EDV and EDP

Small increase

  • RBC masses
  • stroke volume
  • cardiac output

major Decreases
- systemic vascular resistance

Small decreases

  • diastolic BP
  • pulmonary vascular resistance

No changes

  • EDV and EDP
  • systolic BP

Most of the dramatic changes seen in the 2nd trimester get closer to normal in the 3rd trimester

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12
Q

General changes at term in pregnancy

A

Increased blood volume (30-50%)

Increased Heart rate (generally 15-20bpm)

Increased cardiac output (30-50%)

Increased RBC mass (15-20%)

Decreased in systolic blood pressures (5-10 mmHg on average)

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13
Q

Normal diagnostic findings in pregnancy (not pathogenic)

A

ECGs

  • sinus tachycardia
  • QRS axis deviation (usually left but can be right also)
  • increased R wave amplitude
  • ST segment depressions and T wave amplitude increases
  • small Q waves

Echos

  • mild increases Biatrially
  • increased by ventricular dimensions
  • mild increases in LV systolic functions
  • small pericardial effusions
  • increased tricuspid valve diameter
  • may show mild regurgitation

Chest X-rays
- increased lung markings

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14
Q

Cardiac manifestations seen in patients w/ hyperthyroidism

A

Increases

  • cardiac output
  • tachycardia
  • preload

Reduces PVR

Predisposition to atrial fibrillation and symptomatic HF (increased heart rate and oxygen demand on the heart)
- A fib is the most common by far

BBs work very well on hyperthyroid patients

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15
Q

Cardiac manifestations in patients w/ hypothyroidism

A

Decreased in

  • cardiac output
  • decreased contractility
  • Brady cardia

Increased
- PVR

Predisposes patients to ventricular arrhythmias and accelerated atherosclerosis

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16
Q

Hyperthyroidism signs and symptoms

A

Hyperactivity, irritability dysphoria

Heat intolerance and sweating

Palpation and tachycardia
- induces A. Fib quite common (especially if they say feeling A. Fib)

Fatigue and weakness

Diarrhea

Polyuria

Loss of libido

Tremors

Gaiters

Muscle weakness and proximal myopathy

17
Q

General Hypothyroidism signs and symptoms

A

Tiredness/weakness

Dry skin

Feeling cold

Hair loss

Constipation

Poor memory/difficulty concentrating

Weight gain w/ poor appetite

Dyspnea

Hoarse voices

Impaired hearing

18
Q

How does diabetes mellitus affect patients cardiovascular wise?

A

Increases incidence of CAD and MIs
- 2-5x more likely than normal patients

  • as likely or slightly more likely than patients who have previously had an MI, but no diabetes*

Heart disease presentation will often be atypical
- will often present more GI related pain, instead of chest pain

19
Q

Estrogens effect on cardiovascular symptoms

A

Oral contraceptives Increase risks for DVTs, MI and strokes

For women older then 35 and smoking, you cant use oral contraceptives for them

note estrogen therapies should NOT be used as prophylactic agent to prevent CHD

20
Q

Cardiovascular signs and symptoms w/ anemia

A

Dyspnea
Fatigue
- both are worsened w/ exertion

Signs

  • tachycardia
  • systolic murmurs
21
Q

Cardiac manifestation of SLE

A

Valvular heart diseases have VERY high incidence
- 50% of all SLE cases present w/ at least 1 episode of symptomatic pericarditis and/or valvular issues

Often have underlying primary myocarditis but may not present throughout life

Because of the increased chances of so many disorder, must focus on limiting other factors such as HTN, weight loss, diabetes, hyperlipidemia

Note: SLE is known as the great pretender disease, so it has numerous presentations

22
Q

Cardiac manifestations of RA

A

Slightly higher risk for the following

  • pericarditis
  • valvular disease
  • myocarditis
  • CAD
  • arrhythmias (especially a fib)
  • pulmonary HTN
  • strokes (from A fib)
  • more common to have pericarditis and small vessel CAD*
23
Q

Cardiac manifestations of scleroderma

A

Have 3x higher risk for developing CAD

  • most common cause is general recurrent intramyocardial ischemia leading to fibrosis
  • less common is acute inflammatory myocarditis

Increased chances of conduction defects (20%)

VERY common of pulmonary fibrosis or pulmonary HTN (80%)
- 50% of patients experiencing pulmonary issues will present w/ cor pulmonale

24
Q

Cardiac manifestations of ankylosing spondylitis

A

Most common in proximal aortitis
- may or may not also show w/ or without aortic regurgitation

Conduction disturbances are even more likely than in patients w/ scleroderma (30-35%)
- AV blocks are the most frequent conduction issues

2x increased in CAD chances

25
Q

Cardiac manifestations of polymyositis/dermatomyositis

A

Most common cardiac manifestations are myocarditis and pericarditis

Also 3x increased microvascular/structural CAD

NOT common to show the following:

  • arrhythmias
  • pericardial CAD
  • Valve diseases
  • pulmonary HTN
26
Q

Cardiac manifestations of mixed connective tissue disease

A

Most common is pericarditis and pericardial effusions and pulmonary diseases

Mitral valve prolapse is unusually high prevalence (30%)

27
Q

Cardiac manifestations of sleep apnea (OSA)

A

Significantly increases the risk of

  • CAD
  • Atherosclerosis
  • HFpEF
  • atrial/ventricular arrhythmias

proper treatment of OSA decreased these risks, so treatment

Cardiology (46 decks)

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