Cardiac Manifestations Of Systemic Disease Flashcards
Cor pulmonale
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
Symptoms and signs of cor pulmonale
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
ECG and imagining findings of cor pulmonale
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
Cardiac tumors
Cardiac myxomas
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
Symptoms and signs of cardiac myxomas
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
Typical Cardiovascular changes in the 1st trimester in pregnancy
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
Typical Cardiovascular changes in the 2nd trimester in pregnancy
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
Symptoms specific to cardiac tumors in endocardium
Thromboembolisms in the following
- cerebral
- coronary
- pulmonary
Cavity obliteration
Outflow tract obstruction
Valve obstructions/damage
Symptoms specific to cardiac tumors in pericardium
- Pericarditis (always presents)
- Pericardial effusion and/or tamponade
- Pericardial constriction
Symptoms specific to cardiac tumors in the myocardium
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
Typical Cardiovascular changes in the 3rd trimester in pregnancy
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
General changes at term in pregnancy
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)
Normal diagnostic findings in pregnancy (not pathogenic)
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
Cardiac manifestations seen in patients w/ hyperthyroidism
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
Cardiac manifestations in patients w/ hypothyroidism
Decreased in
- cardiac output
- decreased contractility
- Brady cardia
Increased
- PVR
Predisposes patients to ventricular arrhythmias and accelerated atherosclerosis
Hyperthyroidism signs and symptoms
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
General Hypothyroidism signs and symptoms
Tiredness/weakness
Dry skin
Feeling cold
Hair loss
Constipation
Poor memory/difficulty concentrating
Weight gain w/ poor appetite
Dyspnea
Hoarse voices
Impaired hearing
How does diabetes mellitus affect patients cardiovascular wise?
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
Estrogens effect on cardiovascular symptoms
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
Cardiovascular signs and symptoms w/ anemia
Dyspnea
Fatigue
- both are worsened w/ exertion
Signs
- tachycardia
- systolic murmurs
Cardiac manifestation of SLE
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
Cardiac manifestations of RA
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*
Cardiac manifestations of scleroderma
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
Cardiac manifestations of ankylosing spondylitis
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
Cardiac manifestations of polymyositis/dermatomyositis
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
Cardiac manifestations of mixed connective tissue disease
Most common is pericarditis and pericardial effusions and pulmonary diseases
Mitral valve prolapse is unusually high prevalence (30%)
Cardiac manifestations of sleep apnea (OSA)
Significantly increases the risk of
- CAD
- Atherosclerosis
- HFpEF
- atrial/ventricular arrhythmias
proper treatment of OSA decreased these risks, so treatment
