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PHTH 536 - Body Systems > Cardiac Pathologies: -itises - Lecture #2 > Flashcards

Cardiac Pathologies: -itises - Lecture #2 Flashcards

1
Q

What are the presenting sx in the patient hx?

A
  • onset of progression, nature, any aggravating or alleviating sx
  • chest pain with SOB and heart palpatations
  • Overall fatigue
  • syncope and dizziness
  • hx of smoking, alcohol and drug use
  • risk factors for CVD
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2
Q

What are we looking for in the chart review?

A
  • diagnostic tests, imaging, procedures
  • any lab values and ABGs (arterial blood gas)
  • PMH/PSH and hospital course
  • any medications and diet
  • social hx, any cognitive and language ability and learning ability
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3
Q

What should we be checking for examinations?

A
  • General observation: patient posture, how they breath and are they able to cough
  • skin = blueish, are they pale, somewhat washed out and sweaty (within limits)
  • pulses = are they off and how do they feel
  • vitals
  • heart and lung sounds
  • Chest wall motion and palpation
  • How is the rhythm (EKG)
  • Checking circulation and lympathic system (which includes the peripheral vascular system)
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4
Q

What is pericarditis?

A

Inflammation of the pericardium (usually serous pericardium) or the pericardial fluid

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5
Q

What is the most common causes of pericarditis?

A

viral infection
- other infection: bacterial, uremia, acute MI and pericardiotomy (has to do with cardiac surgery, TB, malignancy, drug and toxin induced)

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6
Q

What are the other causes of pericarditis?

A

Systemic disease:
- autoimmune disorders (CT diseases)
- other inflammatory disorders (eg. sarcoidosis, amyloidosis, inflammatory bowel disease)
- drug toxicity
- chest irradiation
- hypothyroidism

Trauma

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7
Q

Can pericarditis have sx?

A

May not present with any signs or sx

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8
Q

What are the sx of acute pericarditis?

A
  • retrosternal chest pain that is sharp, stabbing right behind the breastbone on the left side of the chest (or can be dull and achy)
  • that pain can go to the back and left middle trap area
  • dyspnea (with no exercise), cough and hoarseness
  • general fatigue and fever
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9
Q

What makes acute pericarditis worse?

A

gets worse by coughing
deep breathing
supine

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10
Q

What makes acute pericarditis better?

A

helps when they sit up or lean forward

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11
Q

What is the EKG results of acute pericarditis?

A

abnormalities not common
- if there is = it will diffuse ST segment elevation

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12
Q

What populations do we see acute pericarditis?

A

seen in young and healthy because of a viral and idiopathic causes
- COVID 19 vaccinations

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13
Q

What do we hear when we’re auscultating?

A

Theres usually a friction rub because of the inflammed pericardial layers rubbing against one another

Usually best heard when the patient is leaning forward during an exhale

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14
Q

What do the labs say for acute pericarditis?

A

The labs will show acute inflammation
- increased levels of WBCs
- erythricyte sedimentation rate (sed rate)
- C-reactive protein
- May have mild elevated troponins indicating that myocardium is inflammed (will not continue to increase so might be MI)

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15
Q

how do we evaluate for acute pericardial effusion?

A

echocardiography

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16
Q

What the usualy timeline for acute pericarditis?

A

A self-limited disease around 1-3 weeks

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17
Q

How is acute pericarditis managed?

A

through rest, pain relief usually via anti-inflammatory drugs or sometimes steroids

Since it can be highly infectious or bacterial
- high dose of antibiotics through IV
- or pericardial drainage

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18
Q

What is constrictive pericarditis?

A

its a form of chronic pericarditis or pericardial effusion which ends up with thickening and scarring of the pericardium

19
Q

What are the sx of constrictive pericarditis?

A
  • dyspnea and fatigue because of decreased cardiac output
  • LE and abdominal swelling
  • Dizziness or syncope
  • Vague retrosternal chest pain
  • Jugular venous distention
20
Q

How much fluid is in the pericardial effusion?

A

15-50 mL of fluid

20
Q

What is the medical workup for constritive pericarditis?

A

chest x-ray
echo
CT
cardiac catherization

21
Q

What is pericardial effusion?

A

accumulation of fluid within that pericardial space

22
Q

What can lead to pericardial effusion?

A

pericarditis or other pathologies or even trauma

23
Q

What is the mechanism of the pericardium which can be affected by effusion?

A

Since the pericardium is already stiff - it doesn’t tolerate well to large changes of fluid in a short time period

24
Q

What are sx of pericardial effusion?

A

A very serious condition which can result in death
- feeling of fullness in chest
- has a cough
- hoarseness
- dysphagia (hard time swallowing)
- but can be asymptomatic

25
Q

What is the medical work up for pericardial effusion?

A
  • muffled heart and lung sounds
  • dullness to percussion of the left lung at the angle of the scapula
  • chest radiograoh can show big cardiac silhouette
  • echo
26
Q

What is the treatment for pericardial effusion?

A

Pericardiocentesis to drain the fluid

27
Q

What is cardiac tamponade?

A

over accumulation of fluid in the pericardial space which increases the pressure on the heart - **a medical emergency **
- any pericarditis can progress

28
Q

What is the most common progression towards cardiac tamponade?

A
  • neoplastic
  • post viral
  • blunt or penetrating chest trauma
  • dissecting aortic aneurysm
29
Q

What are the sx of cadiac tamponade?

A

Poor filiing of the heart = decreased BP
Hypotension, shock and possibly death
Decreased CO signs: dyspnea, fatigue, syncope or dizziness
- theres also coughing, tachycardia and tachypnea
Jugular vein distentionw/ pulsus paradoxus (abdnormal drop in systolic BP during inspiration)
Decreased heart sounds (Beck’s triad)

30
Q

What is the medical work up and treatment?

A
  • echo
  • when its an emergency, treated with pericardial (or cardiac) window = cutting a hole in the fibrous pericardium to let fluid drain or relieve pressure
  • pericardiocentesis = inserting a fluid to draw out the fluid
31
Q

What is endocarditis?

A

infection of the endocardium from a bacteria or fungi

32
Q

What is the cause of endocarditis?

A

Usually travels from one part of the body (usually from dental work or GI/urinary procedures)
- caths, tattoos, IV drug use
- Rheumatic fever

33
Q

How is endocarditis treated?

A

With long term antibiotic since if left untreated can lead to destructive of valves and is often fatal
cardiac supportive measures
possible valve replacement

34
Q

What are the sx of endocarditis?

A

Flu like sx
pain with breathing
SOB
swelling
fever
- quick onset of flu sx
- can possibly hear the mitral valve regurgitation on auscultation

35
Q

How are at most at risk with endocarditis?

A

artificial heart valves reservoir for germs
damaged valves or congenital heart defect

36
Q

What are the complications of endocarditis?

A

bacterial vegetation can travel to other areas of the body
- heart valve damage
- abscesses
- PE
- kidney and spleen

37
Q

What is the medical workup for endocarditis?

A

labs:
- sed rate
- C-reactive proteins
- WBCs
- blood cultures to isolate organism
EKG
Echo/TEE

38
Q

What is the prevention of endocarditis?

A
  • prophylactic antibiotic before dental work
  • Upper respiratory procedures that has to do with incisions or biopsies
  • GI/GU procedures if an effection is there
39
Q

What is myocarditis?

A

Otherwise known as inflammatory cardiomyopathy

It’s an infection or inflammation of the heart wall/muscle
Generally viral or bacterial infection; rare: drug induced
- streptococcal which is the most common
- rheymatic fever

affects both pump and electrical conduction

40
Q

What is the sx of myocarditis?

A
  • diffuse chest pain
  • fatigue
  • SOB
  • edema
  • arrhythmias
  • fever
  • general weakness
41
Q

What does myocarditis do for the pump?

A

Weakens pump action (diffusion chest pain, fatigue, SOB, edema) and arrhythmias

42
Q

What does a decreased pump action result in?

A

Heart failure because of damaged cardiac muscle

43
Q

If left untreated, what can myocarditis lead to?

A

Heart failure
MI or CVA because of the poor pump action which leads to pooling in the ventricles
Arrythmias (sudden cardiac death) because of the decreased electrical effienciency

PHTH 536 - Body Systems (5 decks)

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