cardiac pathology Flashcards
What is hypertrophic cardiomyopathy ?
cardiomyopathy -disease of the heart muscle (often leads to progressive heart failure )
Hypertrophic
0 most common form of primary cardiomypathy
CAUSES
0 acquired or inherited -mostly inherited.
Primary
- mutation in myosin gene codes for sarcomere proteins
Secondary
- Chronic hypertension (increased afterload- LV has to pump against higher pressure ) - ventricles thicken in response
- Aortic stenosis
-
What rheumatic fever
- common in developing countries but not so much developed.
W
Definition
Acute rheumatic fever
0 autoimmune disease that may occur following group A streptococcal throat infection. / usually a throat infection scarlet fever
0 can effect multiple organ systems,
o the joints,
o heart,
o brain,
o skin.
(* Only the effects on the heart can lead to permanent illness;
Chronic rheumatic heart disease - chronic changes to the heart valves.
- mitral valve involvement - most common
- carditis can occur - inflammation of heart (preganacy may precipitate repeat carditis )
No treatment —————-> rheumatic fever ———————–> chronic heart valvular disease.
SECONDARY PROPHYLAXIS
0
can improve the prognosis of established rheumatic valvular disease.
0 Without long-term penicillin secondary prophylaxis, acute rheumatic fever can recur ——————————> cumulative damage to the cardiac valvular tissue
SYMPTOMS
0 Fever.
0 Painful and tender joints, most often the ankles, knees, elbows or wrists.
0 Pain that moves from joint to joint.
0 Red, hot or swollen joints.
0 Small, painless nodules under the skin.
0 Chest pain.
- palpitation
0 Heart murmur.
0 pericardial rub - heard on listening
0 Fatigue.
0 shortness of breath
0 Flat or slightly raised painless rash. - sandpaper like blanching rash
0 heart failure can be present - with severe presentations.
0 Chorea - like movements - movement disorder -irregular , unpredicatble muscle movement
Management of scarlet efever
phenoxymethylpenicillin for 10 days first-line.
If not tolerated amoxcillin
True penicillin allergy - azirth romyocin
Management of suspected or confirmed scarlet fever should include:erythrocyte sedimentation rate (ESR)
CRP
WBC count
blood cultures
Arrangingurgent hospital admissionif a person has severe symptoms or a suspected serious complication (or is at risk of serious complications).
Prescribingappropriate oral antibiotics promptly, regardless of the severity of illness, such asphenoxymethylpenicillin for 10 days first-line.
Notifying the local health protectionteam promptly.
Advisingthe person or family/carers about appropriate self-care measures, and strategies to reduce the risk of cross-infection.
Arranging follow up if symptoms worsen or have not improved after 7 days.
Considering seeking local health protection teamadvice if a person is a high-riskcontact.
Treatment of rheumatic fever?
Antiobiotic treatment - remove remaing streptococci
0 benzathine benzylpenicillin - 1st line
phenoxymethylpenicillin - 2nd line
or
erythromycin - 2nd line
Antibiotics continued after for secondary prophylaxis to prevent complications e.g chronic Rheumatic valve disease.
NSAIDS or salicylate therapy - noninflammatory & pain relief (FOR ATHRITIS)
0 Aspirinn - need to try and limit time on this
reduction in dose can cause joint symptoms to come back - rebound phenomenon - not rheumatic fever re occurrence.
should be treated with another dose of short course high dose aspirin
0 Naproxen
0 Ibuprofen
If heart failure present
0 diuretic + ACE Inhibitor
- Furosemide
Spiralactone - potassium sparing - don’t use ace - risk of potassium toxicity
If AF present (add amiodarone or digoxin to antibiotics)
If valve leaflet / chordinae tendinae rupture (assess for emergency valve surgery + antibiotics)
severe carditis / Heart failure can be indications for surgery.
in capsule - it said benzyl penicillin IM followed by penicillin orally - 10 day course
Difference btw scarlet fever & rheumatic fever ?
Scarlet fever develops in people wh
Sore throato a streptococcus throat- it is a bacterial illness
Rheumatic fever occurs 2 -3 weeks after scarlet fever usually
Test for .
1.
Rheumatic fever ?
ESR
FBC
0 CRP
0 WBC
0 BLood cultures
0 echocardiogram - can show valve leaflet , chorda thickening , mitral valvular dilation or valve proplaspe
0 electrocardiogram - can show increased PR interval or heart block
0 throat culture
0 anti - streptolysin O titre -
0 anti - deoxyribonulease B titre
elevated levels indicated immunological response to group A streptococci infection.
0 rapid monuclear test
0 chest x -ray
What is Infective endocarditis ?
Infection of parts of the heart e.g :
o endocardial surface
o valves
o chordae tendineae
o sites of septal defects
o mural endocardium
usually bacteria - spreptococci , staphlococci
SYMPTOMS
- Fever
- Chills
- night sweats
- malasise
- fatigue
- anoxeria
- weight loss
- myalgias
- shorteness of breath
uncommon but possible
cutaneous manifestations
- janeway lesion
- osler nodes
splinter hemorrhages - found under finger nails.
conjunctival hemorrhages - found in conjunctiva of eye.
roth spots - bright spot surrounde dby haemorrages.
RISK FACTORS -
0 types of congenital heart D 0 Prosthetic valves 0 post heart transplant 0 prior history of IE 0 cardiac implants electronic device / intravascular catheters 0 mitral velave prolaspe 0 IV drug use 0 Hypertrophic cardiomyopathy 0 degenerative valve disease
Test for infective carditis ?
FBC
- anaemia , leukocytosis
0 Blood cultures
- bacteraemia , fungaemia
0 ECG
- prolonged PR interval - AV block - non specific ST-T wave abnormalities
0 echo cardiogram
0 urinalysis - used to check for septic emboli - common complication
0 serum chemistry panel with glucose -
normal or elevated urea
( vegetation - abnormal growths containing collection on bacteria - grow and damage heart - can be found abnormally on heart valve )
Treatment of Infective endocarditis ?
Antibiotics
betalactam with or without Gentamcin
or Vancomycin
there are so my combinations - not going to bother learning.
What is viral pericarditis ?
inflammation of pericardium - caused by infection
Acute
Subacute - occur within weeks to months of incident
Chronic - more than 6 months
SYMPTOMS
o chest pain - can radiate to neck and shoulders
o pericardial rub
o dyspnea
o pericardial effusion - can lead cardiac
tamponade
o trichordial or systolic and diastolic prehrodial friction rub - if not heard when sitting down -may be heard with pateit on all fours.
can cause constrictive pericarditis
- peripheral odeama , neck vein distention
pericarditis - can have may other causes -e.g. MI , trauma , tumors etabollic disorders etc.
tests for viral pericarditis ?
0 ECG
0 pericardial / blood cultures
0 serum troponin - elevated
0 ESR
0 CRP
0 WBC - leukocytosis
0 Chest x-ray - can see pericardial effusion - waterbottle enlarged cardiac silhouette
0 echocardiogram
0
What are diagnostic critera for Rheumatic fever?
Jones criteria - for moderate -high risk population
Major critera 0 Athritis - any type 0 Carditis 0 Chorea 0 Subcanteous nodules 0 Erythema marginatum (pink macular rash - commonly affects limbs & trunk - rare sign but does happen)
Minor critera
0 monoarthraliga (not used athritis present)
0 Fever
0 Raised inflammatory markers e.g ESR , CRP, WCC
0 Prolonged RP interval (not used if carditis present)
TO diagnose need evidence of recent Group A streptococcal infection + (2 major or 1 major + 2 minor)
*For low risk population - everything is the same apart from Athritis in the major critera having to be specifically polyathritis for it to count and polyathralgia in minor criteria.
Atherosclerosis ?
if atherosclerosis does not affect the whole circumference of the artery - epicentric thickening.
sometimes the artery can become completely blocked , if the person survives this (unlikely) - multiple can open up in the blockage after as the heart remodels. (MOST PEOPLE WOULD HAVE DIED FROM AN MI )
STENOSIS ——> DECREASED BLOOD FLOW ——> ISCHEMIA ——> SYMPTOMS (Angina )———->ischaemic damage (fibrosis - body response to dead heart cells) ————–> Myocardial infarction (as fibrosis part of heart can no longer function)
Hyperlipidemias
Metablic disorders.
TOXICOLOGY SCREEN - COCAINE , AMPHETAMINES - these put people at much higher risk of developing atherosclerosis. —-> may lead to arrthymia .
compliactions of MI , arrythmias , dresslers syndrome , rupture , aneurysm.
