Cardiac Manifestations of Systemic Dz Flashcards
How can systemic dz affect the heart?
By increased demands on heart, can cause arrhythmias, & enable coronary artery dz (leads to ischemic heart dz). It can also distort cardiac structure (pericardium, myocardium, and endocardium (valves)).
Diabetes is an independent risk factor for which diseases?
CAD, PAD, CV heart dz and MI
What is the MC cause of death in DM T1 & T2?
CAD
Why is the prognosis of CAD worst for DM pts?
Because they have a larger infarct size, greater CAD burden, and greater post-infarct complications (CHF, death)
Why do DM pts have a greater risk for MI?
D/t CAD burden
Need to have a high level of suspicion of an MI in DM pts
What are the post-infarct complications d/t greater CAD burden?
HF
Shock
Death
Why dose DM result in an atypical ischemic presentation?
d/t autonomic dysfunction.
Neuropathy leads purkinje fibers, AV node do not work as well
What are the symptoms of a Silent Heart Attack (DM presentation of MI)?
Nausea Dyspnea Pulm edema Arrhythmias Heart block Syncope
Why does CAD happen (in relation to DM pts)?
Increased insulin resistance –> elevated Pai-1 –> elevated coagulation & thrombosis formation & platelet dysfunction
Why does cardiomyopathy happen (in relation to DM pts)?
increased intraventricular collagen/fibrosis/inflammation –> decreased mechanical compliance during diastole –> decreased myocardial relaxation –> diastolic HF seen in early failure
What is the treatment approach to DM?
Maintain A1c - 7% tx dyslipidemia w Statin tx HTN w ACEi/ARB, subsequently add HCTZ, BB, CCB BP goal <130/80 tx CAD - revasularization (PCI or CABG)
What are the 3 populations seen with Thiamine deficiency?
HF pts
Alcoholics
Anorexia nervosa
Why are many HF pts thiamine deficient?
D/t diuretic induced renal excretion & decreased PO intake
Why is thiamine deficiency common in alcoholics?
Malnutrition
Malabsorption
imparied cellular B1 utilization & decreased tissue oxygenation
What is the clinical presentation of thiamine deficiency?
tachycardia, high out-put HF (increased CO w/o meeting metabolic needs), wide pulse pressure, S3, apical systolic murmur
What syndrome is the MC complication of alcohol related thiamine (B1 deficiency)
Wernike-Korsakoff syndrome
What are the symptoms of Wernike-Korsakoff syndrome?
Encephalopathy, oculomotor, ataxia then anterograde-retrograde amnesia
What are the 3 cofactors in metabolism of homocysteine?
B6, B12, folate
What can you eat to get folate?
leafy green vegetables
What is B6 and how can you get it?
It is a co-factor in >100 enzymes involved in AA metabolism, it is present in all food groups
What are the causes of B12 deficiency and when do clinical signs appear?
D/t chronic gastric atrophy, auto-antibody formation to gastric intrinsic factor, gastrectomy.
Clinical signs will be seen after a year or more
What is elevated homocysteine an independent risk factor for?
Atherosclerotic vascular disease