Cardiac Pathologies 1 Flashcards
Aortic Dissection
Risk factors: HYPERTENSION, bicuspid aortic valve, Marfan syndrome
SX: tearing chest pain that radiates to the back, markedly unequal BP in the arms, mediastinal widening on the CXR
Result: cardiac tamponade, death, aortic rupture
Type A: surgery
Type B: b-blockers, then vasodilators
Aortic Aneurysm Causes
Abdominal: athlerosclerosis, male, inc. age, tobacco use
Thoracic: cystic medial degeneration, Hypertension, bicuspid aortic valve, marfan, and 3” syphyilis (obliterative endarterities of the vasa vasorum)
Dressler syndrome
post infarction Autoimmune phenom: results in fibrinous pericarditis (several weeks post MI)
SX: chest pain, pericardial rub, fever
Dilated Cardiomyopathy
Causes:
Alcohol abuse, wet beriberi, Cocaine use, chagas, cocksackie B, Doxorubicin (daunorubicin), hemochromatosis, sarcoidosis, peripartum cardiomyopathy
Findings:
- HF (heart cannot contract)
- S4
- enlarged balloon heart on CXR, dilated heart on echo
- systolic regurgitant murmur
- systolic dysfunction ensues
- apical impulse is displaced laterally
TX: limit Na, anti-hypertensives, digitalis (inc. contraction), Diuretics, B-blocks
Hypertrophic Cardiomyopathy
Familial: defect in B-myosin heavy chain, associated with Friedrich ataxia
Findings
- enlarged ventricle wall
- S4
- syncope and death during exercise (death to arrythmia)
- Mitral valve regurg b/c the valve cannot close (enlarge heart impedes closure)
- Systolic murmur- louder during valsalva (dec. preload) and dec. with squatting (inc. preload)
- Diastolic dysfunction
- myofibrillar disarray and fibrosis
tx: b-blockers, NDHP ca2+ channel blockers (slow heart and inc. filling time)
Obstructive Hypertrophic cardiomyopathy
asymmetric septal hypertrophy and systolic anterior motion of the mitral valve –> impedes the outflow tract –> dyspnea and possbile syncope
Restrictive/infiltrative cardiomyopathy
"LEASH is Restrictive" Loffler syndrome (endomyocardial fibrosis with eosinophilic infiltrate) Endocardial fibroelastosis Amyloidosis Sarcoidosis Hemochromatosis post Radiation fibrosis
Findings: diastolic dysfunction, low voltage ECG despite thick myocardium
Systolic Heart Failure
Associated with: dilated cardiomyopathy
- Dec EF
- Dec contractility
- Inc. EDV
- secondary to ischemia event (MI, dilated myopathy)
Diastolic Heart Failure
- preserved EF
- Normal EDV
- Dec compliance
Rheumatic Fever
Caused by GABHS Type 2 hypersensitivity via molecular mimicry: antibodies to M protein on strep cross react with self antigens Findings: - Aschoff Bodies: large multinucleated cells in granuloma - Large macrophages with wavy ovoid (rod like) nuclei (anitschkow cells) - Strepolysin O titers inc. SX: J: joint (migratory polyarthritis) Carditis (pan) N: subcutaneous nodules E: erythema marginatum S: sydenham chorea: tongue, eyes UE
Acute pericarditis
Sx: sharp pain aggravated by laying down and inspiration, relieved by sitting up and learning forward.
Presents with a friction rub
Elevated ST segment or depressed PR segment
Causes: Idiopathic (viral), viral (cocksackie), neoplasm, autoimmune (SLE), uremia, Cardiovascular (Dresslers, or STEMI), radiation therapy
Cardiac Tamponade
Dec. in CO due to fluid (effusion, or blood) in the pericardium surrounding the heart
Equilibration of all chambers of the heart
Findings:
Becks triad: hypotension, distended neck veins, distant heart sounds
Depressed ECG voltage and electric alterations
Inc. in heart rate
Pulsus Pardoxus
Syphilitic heart disease
Attaches the vasa vasorum (disrupts) –> dilation and atrophy of the aorta or large vessels –> calcification of the aorta and the valve ring –> tree bark appearance
result in aorta aneurysm, insufficiency
