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
What process does homocysteine trigger?
formation of atheromas (atherogenic) –> creates endothelial oxidative stress –> prothrombotic
What is the replacement tx for folate?
1-5mg/d x 3 mo until levels normalize
What is the replacement tx for B12?
1000mg/d x 3 mo until levels normalize
What is the replacement tx fo B6?
according to age & sex until levels normalize
Approx what % of US adults are overweight?
> 68%
What is obesity associated with?
elevated glucose intolerance, DM, HTN, atherosclerosis, CAD, decreased adiponectin and HF
What are the cardiac manifestations of obesity?
pts have greater central & total body volume, heart is over burdened in attempts to address excess adipose tissue
In obesity, greater blood volume leads to…?
Increased CO, increased R & L ventricular filling pressure in attempt to support blood demand of excess adiposity
In obesity, what does chronic blood volume overload lead too?
HTN RVH, LVH and dilation Poor exercise resistance d/t overworked cardiopulmonary system even at rest Poor cardiac reserves = HF pulm congestion
What is the treatment approach to obesity? What does this lead too?
Weight reduction
Decreased blood volume, CO, HTN, hypertrophy
What is the role of thyroid hormone in metabolic activity?
It is an essential determinant of metabolic activity:
O2 consumption
Increase/decrease cardiac workload, exerts effect on cardiac activity: inotropic, chronotropic, dromotropic
What is the clinical presentation of hyperthyroidism?
Sinus tachycardia, palpitations, afib, HTN, fatigue
What are the clinical signs of hyperthyroidism?
Hyperdynamic precordium, widened pulse pressure, Loud S1 (MT), Pleuropericardial friction rub
What is the treatment of hyperthyroidism?
Methimazole/PTU
What is the clinical presentation of hypothyroidism?
Myofibrillar edema, intersitial fibrosis –> decreased CO –> decreased SV, PP HR
What are the clinical signs of hypothyroidism?
Pericardial effusion (slowly develops), distant heart sounds, weak arterial pulses, hypercholesterolemia, hypertriglycerides
What will be seen on ECG for hypothyroidism?
Low voltage, sinus bradycardia, & prolonged QT interval
What will be seen on CXR for hypothyroidism?
Water bottle sign (effusion), cardiomegaly
What is the treatment for hypothyroidism?
Levothyroxine (watch for onset of angina & MI)
What is Rheumatoid Arthritis (RA)?
chronic, systemic, inflammatory condition that affects: joints muscles vessels ligaments tendons hematologic neurologic pulmonary cardiac can all be attacked too
What are cardiac manifestations of RA?
CVD = MCC of death d/t higher rate of carotid atherosclerosis and CAD Pericarditis = MC finding pericardial effusion - echo Mitral/aortic valvular vegetations CHF (2x rate > non RA)
What are the diagnostic labs associated w RA?
Rheumatoid factor, anti-CCP antibody, elevated ESR/CRP
What are the treatments for RA?
NSAIDs DMARDs (methotrexate) glucocorticoids anti-TNF immuno-modulators (abatacept) pericardiocentesis (if tamponad) pericardiodectomy (if constrictive)
What is Systemic Lupus Erythematosus (SLE)?
inflammatory, autoimmune dz w systemic damage of organs mediated by auto-antibodies & immune complexes
Affects skin, renal, cardiac, joints, hematologic, neurologic
What are the cardiac manifestations of SLE?
can affect all layers of the heart
MC complication - pericarditis (rare tamponade or constrictive)
Myocarditis (assoc w HF in HTN pts)
fibrinous endocarditis (valvular abnl, leads to mitral or aortic regurg)
Accelerated atherosclerosis
What causes accelerated atherosclerosis in SLE pts? What does this put the pt at greater risk for?
D/t endothelial damage from: -autoimmune attack -chronic inflammation -oxidative damage to arteries Chronic glucocorticoid use
Higher risk for MI
What are the treatments for cardiac dz in relation to SLE?
Lifestyle modifications (smoking cessation, diet/exercise)
Statins
Hydroxychloroquine vs glucocorticoids when possible
Control HTN/CHF
What causes rheumatic heart dz (RHD)?
Acute Rheumatic Fever (ARF) - caused by GABHS - upper airway infection (strep throat)
Seen in 60% of untreated or recurrent infections
What are the clinical symptoms of RHD?
fever, malaise, arthralgias, scarlet fever rash with strawberry tongue and chest pain (pericarditis)
What are the possible heart diseases that can result from RHD?
mitral/aortic valve dz = hallmark of rheumatic carditis
Pancarditis, endocarditis, arrhythmias
How can you dx RHD?
Throat swab, rapid strep test, ASO titer, ADB titer
What is the pathophys of ARF?
caused by GABHS - triggers autoimmune reaction and damages cardiac structures.
endocarditis & valve damage w vegetation deposit (mitral regurg and dilation from back flow)
myocardium (recruit of Ascoff cells and myocarditis)
pericardium (serofibrinous pericarditis)
What are the treatments for RHD?
Acute inflammatory process can subside w/o tx but leaves behind damaged tissue
Valve repair/replacement
ASA/NSAIDs (little effect on RHD related carditis)
control HTN
Tx HF (loop diuretics, ACEI, BB, high dose, short course glucocorticoids for AHF)
What is the prevention for RHD?
Treat GABHS
long term strategy to prevent recurring episodes = PCN for 5-10yrs
allergy = erythromycin
