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Cardio Flashcards

1
Q

MiocarditeCele mai frecvente virusuri care determina miocardita in Europa si America de Nord

A

EnterovirusuriAdenovirusuriVirusul herpetic uman 6Parvovirus B19VHCCMVEBV

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2
Q

MiocarditeCu ce ar putea fi asociata miocardita cu celule gigante?

A

SarcoidozaTimoameBAI

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3
Q

MiocarditeCauze virale de miocardita (tabel)

A

CoxsackieAdenovirusEchovirusCMVHIVHepatitaPolioGripa

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4
Q

CMpCea mai frecventa cauza de MSC la tineri

A

CMH

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5
Q

CMpCele mai frecvente cauze de CMH

A

Mutatia lantului greu al miozinei beta (MYH7)Mutatia proteinei C de legare a miozinei (MYBPC3)

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6
Q

CMpBoli de depozit ale glicogenului care determina hipertrofie cardiaca

A

FabryPompeDanon

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7
Q

CMpCati pacienti cu CMH prezinta obstructie dinamica de TEVS?

A

1/4 = 25%

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8
Q

CMpCaracteristici clinice in functie de mutatie in CMH

A

Mutatia lantului greu al miozinei beta - hipertrofie marcataMutatia troponinei T - hipertrofie mai usoara, dar risc crescut de MSCMutatia proteinei de legare a miozinei - se poate manifesta tardiv (decada 6 sau mai tarziu)

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9
Q

CMpSimptome CMH

A

Durere toracicaDispneeSincopa/presincopa (predominant la efort)AritmiiMS

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10
Q

CMpIn ce derivatii apar undele Q patologice in CMH?

A

Infero-laterale (D1, D2, D3, aVF, aVL)

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11
Q

CMpTipuri de gene afectate in CMH genetica mendeliana

A

SarcomericeAMPKLAMP2GLA

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12
Q

CMpCMD dobandita - tipuri (poza)

A

Deficiente nutritionaleToxice si medicamenteMiocarditeBoli endocrineBAIPeripartum

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13
Q

CMpTipuri de gene afectate in CMD genetica

A

SarcomericeLaminina A/CComplex de distrofinaDisc Z

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14
Q

CMpTipuri de gene afectate in CMAVD genetica

A

Proteine desmozomaleTMEM43

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15
Q

CMpFactori de risc de MSC in CMH

A

HVS masiva > 30mm la ecoAPP de MSC < 50 aniTVNS la HolterAHC de sincopa inexplicabilaRaspuns anormal al TA la efort (raspuns plat/hipotensiv)

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16
Q

CMpOptiuni terapeutice in CMH

A

2+ factori de risc = ICD1 factor de risc/niciunul = amiodaronaDurerea toracica - betablocante, verapamil, ambeleObstructia de TEVS - disopiramidaObstructie semnificativa de TEVS + simptome - stimulator bicameralDezobstructie TEVS - ablatie cu alcool (nechir), rezectie chirurgicala a miocardului septalNU VD

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17
Q

CMpComplicatii CMAVD

A

Precoce - aritmii V, risc de MSCTardiv - insuficienta de VD/biventriculara

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18
Q

CMpCu ce gene se asociaza CMAVD AD?

A

Gene care codifica proteine desmozomale:* Receptorul de rianodina RyR2 - determina TVPC (TV polimorfa catecolaminergica)* Desmoplakina (NU sindromul Carvajal - e AR)* Plakophilina-2Mutatii care altereaza secventele reglatorii ale genei TGF-beta

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19
Q

CMpFormele AR ale CMAVD

A

Boala Naxos = keratoderma plantara + par lanos + CMAVD -> prin mutatia plakoglobinei jonctionaleSindrom Carvajal -> prin mutatia desmoplakinei

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20
Q

CMpCaracteristici ECG in CMAVD

A

Inversare unda T in precordialele drepte (V1-V3)Unde epsilon (potentiale de amplitudine mica la sfarsit de QRS)BRD complet/incompletECG cu semnal mediat - potentiale tardive, depolarizare intarziata a miocitelor individualeHolter - ESV frecvente din VD, episoade de TVNS

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21
Q

CMpDx clinic in CMAVD

A

Anomalii structurale de VD si TEVD - dilatare, miscari parietale anormale - eco/RMInlocuire fibro-grasoasa a miocitelor - biopsieAnomalii de repolarizare si de conducere - ECG de repaus/ECG cu semnal mediatTV/ESV - HolterAHC de CMAVD la ruda de grad 1/2MS prematura (<35 ani) prin CMAVD

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22
Q

CMpOptiuni terapeutice CMAVD

A

Betablocante - aritmii neamintatoare de viataAmiodarona/sotalol - aritmii simptomaticeICD - aritmii amenintatoare de viataTransplant - aritmie netratabila/IC

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23
Q

CMpProteine miocitare implicate in CMD + localizare (poza)

A

Din membrana celulara - complex de glicoproteina asociata distrofinei (sarcoglican alfa, metavinculina)Din membrana nucleara - laminina A/CProteine sarcomericeProteine din citoschelet - actina citoscheletala, distrofinaDin membrana Z - desmina

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24
Q

CMpGene implicate in CMD familiala (AD)

A

Gene care codifica proteine miocitare citoscheletale sau asociate acestora:* Distrofina - CMp X-linkata* Actina* Desmina* Troponina T* Lantul greu al miozinei beta* Sarcoglicani* Vinculina* Laminina A/C

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25
Q

CMpCu ce se mai asociaza CMD familiala?

A

Miopatie scheletalaBoala sistemului de conducere

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26
Q

CMpCauze de CMD sporadica

A

Evolutie din miocarditaToxice - alcool, chimioterapice, metale (Co, Pb, Hg, As)BAIBoli endocrineBNM

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27
Q

CMpMiocardite care evolueaza spre CMD

A

BacterieneFungiceMycobacterieneParazitare - ChagasVirale* Coxsackie* Adenovirusuri* Eritrovirusuri* HIV

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28
Q

CMpManifestari CMD

A

IC sistolicaAritmiiTulburari de conducereEvenimente emboliceMS

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29
Q

CMpCe include evolutia naturala a NCVS?

A

ICCTromboembolismAritmiiMS

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30
Q

CMpBoli asociate cu CMR

A

Amiloidoza - cel mai frecventSarcoidozaEndocardita Loffler - fibroza miocardica si endocardica + eozinofilieFibroza endomiocardica - fibroza miocardica si endocardica + eozinofilie

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31
Q

CMpExamen clinic in CMR

A

PVJ (puls venos jugular) accentuatColaps diastolic (semnul Friedreich)Presiune venoasa crescuta in inspir (semnul Kussmaul)HepatomegalieAscitaEdeme decliveZ3, Z4

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32
Q

CMpAspect eco in amiloidoza cardiaca

A

Miocardul apare stralucitor (tipic)Cu ingrosare radiala absentaAspect caracteristic de sine de tramvai la eco mod M

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33
Q

CMpFiziopatologie Takotsubo

A

Exces tranzitor de catecolamineVasospasm coronarianAnomalii de microcirculatie coronarianaHipertrofie de sept bazal

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34
Q

EndocarditaCe structuri cardiovasculare sunt interesate in endocardita?

A

ValveleEndocardul A, VVasele intratoracice mariCorpii straini intracardiaci - proteze valvulare, sonde de pacemaker, sunturi chirurgicale

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35
Q

EndocarditaFactorii dependenti de pacient care determina bacteriemie

A

Igiena dentara deficitaraCDIVInfectii de parti moi

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36
Q

EndocarditaFactorii asociati cu diferite proceduri care determina bacteriemie

A

Tratamente stomatologiceCateterizare endovascularaChirurgie cardiacaCardiostimulare permanenta

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37
Q

EndocarditaAgenti etiologici ai EI din cavitatea orala

A

Streptococi viridans alfa-hemoliticiS. mutansS. sanguisS. oralisS. milleri

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38
Q

EndocarditaGrupul HACEK

A

H = HaemophilusA = Actinobacillus actinomycetemcomitansC = Cardiobacterium hominisE = Eikenella corrodensK = Kingella kingae

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39
Q

EndocarditaMicroorganisme tipice pentru EI

A

S. aureus comunitarEnterococcusS. viridansS. bovisHACEKAbiotrophiaGranulicatella

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40
Q

EndocarditaCriteriile Duke majore

A
  • 2 hemoculturi (+) cu izolarea unui microorganism tipic pentru EI in lipsa unei localizari primare* Hemoculturi persistent (+)* Test serologic de IF (+) pentru febra Q cu IgG de faza 1 in titru > 1:800* Dovezi eco de afectare endocardica* Dehiscenta partiala de proteza nou documentata* Regurgitare valvulara nou documentata
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41
Q

EndocarditaCriteriile Duke minore

A

Factori predispozanti - leziuni cardiace predispozante, CDIVFebra > 38Fenomene vasculare* Embolii arteriale majore* Infarcte pulmonare septice* Anevrsme micotice* Hemoragii intracraniene* Hemoragii conjunctivale* Leziuni JanewayFenomene imunologice* GN* Noduli Osler* Pete Roth* FRDovezi microbiologice = hemocultura (+) dar fara sa fie criteriu major SAU dovada serologica de infectie cu microorganism tipic pentru EIEco - elemente sugestive de EI dar fara sa fie criteriu major

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42
Q

EndocarditaCe microorganisme dau EI si sunt detectabile pe serologie?

A

BrucellaBartonellaCoxiella burnetiiChlamydiaLegionella

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43
Q

EndocarditaDx cert de EI

A
  1. Microorganism intr-o cultura din vegetatie/material embolic/abces intracardiac2. EI activa confirmata prin histologie din vegetatie/abces intracardiac3. Criteriile Duke = 2M sau 1M + 3m sau 5m
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44
Q

Endocardita

Caracteristici clinice in EI

A

Stare generala alterata = 95%
Sufluri = 90%
Pirexie = 90%
Hematurie = 70%
IC = 50%
Petesii = 50%
Splenomegalie = 40%
Artralgii = 25%
Emboli cerebrali = 20%
Noduli Osler = 15%
Degete hipocratice = 10%
Hemoragii in aschie = 10%
Anevrisme micotice = 10%
Leziuni Janeway = 5%
Pete Roth = 5%
Hemoragii conjunctivale in aschie = rare

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45
Q

EndocarditaCu ce trebuie sa se asocieze febra pentru a putea fi suspicionata EI?

A

Proteza intracardiacaAlti factori de risc pentru EI - CDIVFactori predispozanti sau proceduri recente cu potential de bacteriemie semnificativaLeziuni cutanate (Osler, Janeway) sau oculare (Roth)Prima manifestare a ICCAritmii V sau tulburari de conducere nou documentateAbcese periferice (renale, splenice, spinale) cu punct de plecare necunoscutHC (+) pentru microorganism tipic

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46
Q

EndocarditaSemne de raspuns la tratament in EI

A

In primele 48h:Remisia febreiAmeliorare clinica (a simptomelor sistemice de infectie)Regresia probelor inflamatorii

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47
Q

EndocarditaCauze de febra persistenta in EI

A

Extensie paravalvulara si formare de abcesRA la medicamenteInfectie nosocomiala (de la locul de punctie sau ITU)Embolie pulmonara (EI de cord drept sau prin spitalizare prelungita)

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48
Q

EndocarditaFactori decizionali pentru chirurgia din EI

A

Particularitatile pacientului* Varsta* Comorbiditati NON-cardiace* Prezenta de proteze intracardiace* ICParticularitatile bolii* Agentul etiologic* Dimensiunile vegetatiei* Extensia paravalvulara a infectiei* Embolizarea sistemica

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49
Q

EndocarditaRecomandari pentru toti pacientii cu boala valvulara

A

Consulturi stomatologice periodiceDezinfectarea ranilor si eradicarea portajului cronic bacterian (cutanat, urinar)Asanarea focarelor infectioase prin ABterapieInterzicerea automedicatiei cu ABControl strict al infectiilor in timpul procedurilor cu riscEvitarea piercingurilor si tatuajelorUtilizare limitata a cateterelor de perfuzie si utilizarea preferentiala a CVP (schimbate la 3-4 zile)

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50
Q

EndocarditaCand suspicionam EI cu Staph?

A

CDIVDispozitive intracardiaceChirurgie cardiaca recentaInfectie acuta (EBA)

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51
Q

ResuscitareLantul supravietuirii cuprinde:

A

Recunoasterea rapida a stopului cardiacAlertarea rapida a serviciilor de urgentaResuscitarea imediataDefibrilarea rapida si ALSIngrijirea post-resuscitare

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52
Q

PericarditeCauze pericardita infectioasa

A

Virsuri* Coxsackie* Echovirus* Herpes* HIV* OreionBacterii* Stafilococ* Streptococ* Pneumococ* Meningococ* H. influenzae* Mycoplasma* Chlamydia* BorreliaTBFungi* Candida* Histoplasma* Coccidioides

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53
Q

PericarditeMedicamente care determina pericardita

A

IzoniazidaHidralazinaDoxorubicinaProcainamidaCiclofosfamida

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54
Q

PericarditeTratament pericardita acuta

A

Aspirina 750-1000 mg x3/zi SAU ibuprofen 600-800 mg x3/zi 1-2 saptamani+Colchicina 0.5 mg x2/zi 3 luni

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55
Q

PericarditeCe pacienti cu pericardita necesita spitalizare?

A

Febra >38Debut subacutRevarsat mareTamponadaLipsa de raspuns la terapie

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56
Q

PericarditeManifestari pericardita TB

A

Febra cronica discreta vesperalaAsociaza semne de pericardita acuta (durere toracica, frecatura pericardica, revarsat, ECG sugestiv)Scadere ponderalaTranspiratii nocturneDispneeSlabiciune

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57
Q

PericarditeCate cazuri de pericardita acuta sunt autolimitate?

A

Majoritatea (70-90%)

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58
Q

PericarditeCauze de pericardita constrictiva

A

TBInfectii bacterieneHemopericardBoala cardiaca reumaticaTardiv dupa chirurgie pe cord deschisAgonisti dopaminergici - cabergolina, pergolida

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59
Q

PericarditeSemne si simptome in pericardita constrictiva

A

Reducerea umplerii ventriculare* Semn Kussmaul* Semn Friedreich* Puls paradoxalCongestie venoasa sistemica* Ascita* Edeme declive* H-megalie* Cresterea PVJ = jugulare turgescenteCongestia venelor pulmonare* Dispnee* Ortopnee* DPN* Tuse

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60
Q

PericarditeSemne si simptome mai rare in pericardita constrictiva

A

Scaderea DC* Fatigabilitate* hTA* Tahicardie reflexaUmplere ventriculara rapida* Clacment pericardic in protodiastola - in portiunea inferioara a marginii stangi a sternuluiDilatare atriala -> FiA (30% cazuri)

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61
Q

PericarditeDDx CMR - pericardita constrictiva

A

Biopsie endomiocardica

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62
Q

ICIncidenta creste cu varsta si afecteaza aproximativ …

A

26 milioane de persoane

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63
Q

ICIncidenta globala in Marea Britanie a IC

A

2/1000

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64
Q

ICRata mortalitatii in IC

A

50% decedeaza la 5 ani

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65
Q

ICCauzele principale de IC (cu procente)

A

BCI = 35-40%CMD = 30-34%HTA = 15-20%

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66
Q

ICMedicamente care determina IC

A

Chimioterapicele trastuzumab si imatinib

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67
Q

ICCirculatia hiperdinamica se intalneste in

A

AnemieTireotoxicozaHemocromatozaBoala Paget

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68
Q

ICCauze de IC dreapta

A

IMA de VDEPHTPBPOC

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69
Q

ICCu ce se coreleaza nivelul circulant de PNA?

A

Clasa functionalaPrognosticulStatusul hemodinamic

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70
Q

ICCu ce se coreleaza nivelele serice de BNP si NT-pro-BNP?

A

Stresul din peretele ventricularSeveritatea IC

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71
Q

ICCine stimuleaza secretia de ET din tesuturi?

A

HipoxiaCatecolamineleAT II

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72
Q

ICCu ce se coreleaza nivelurile mari de ET?

A

Severitatea tulburarilor hemodinamice

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73
Q

ICEfecte ET

A

VCHVSStimulare SActivare SRAA

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74
Q

ICCauze de DSVD

A

Boli cronice de cord stangHTP primara si secundaraIMA de VDCMAVDBCC ale adultului

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75
Q

ICDx de IC

A

AnanmnezaExamen FizicPeptide natriuretice sericeDate obiective ale disfunctiei cardiace (eco)

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76
Q

ICValoare normala peptide natriuretice

A

< 100 pg/mL

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77
Q

ICDaca eco este anormala ce se investigheaza ulterior?

A

EtiologiaGradul ICFactorii precipitantiTipul de disfunctie Teste suplimentare unde e necesar

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78
Q

ICInvestigatii utile in Dx IC

A

Analize sanguineRx toracicaECGEcoEco de stresCardiologie nucleara - ARN (angiografie cu radionuclizi), SPECT/PETIRM cardiacCateterismBiopsieTest de efort cardiopulmonar/test de mers 6 minuteHolter ECG

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79
Q

ICAnalize sanguine utile in Dx IC

A

Hemograma completaCrElectrolitiTeste hepaticeEnzime cardiace - Tn (in acut)BPN, NT-pro-BNPFunctie tiroidiana

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80
Q

ICObservatii pe Rx in IC

A

CardiomegalieCongestie venoasa pulmonara - redistributia circulatiei catre lobii superioriRevarsat pleural in scizuriLinii Kerley BEdem pulmonar

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81
Q

ICCe presiuni sunt masurate prin cateterism cardiac?

A

Presiunea din APPresiunea din AS = PCBPTD din VS

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82
Q

ICModificarile fiziopatologice in IC

A

Dilatare ventricularaHipertrofie miocitaraAlterarea expresiei genei miozineiAlterarea densitatii ATP-azei sarcoplasmatice Ca-dependente = SERCASinteza crescuta de colagenSecretie crescuta de PNARHSStimulare SVCp

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83
Q

ICEfectele cardiotoxice ale stimularii simpatice cronice

A

Apoptoza miocitaraActivare neurohormonala suplimentara

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84
Q

ICCele mai frecvente cauze de IC cu FEVS redusa

A

BCI - cea mai frecventaValvulopatiiHTA

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85
Q

ICObiective tratament IC

A

Ameliorarea simptomelorPrevenirea si controlul bolii de bazaIncetinirea progresiei ICImbunatatirea calitatii si duratei vietii

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86
Q

ICMasuri pentru prevenirea IC

A

Renuntare la fumat, alcool sau droguriTratamentul HTA, DZ si hipercolesterolemieiTerapia farmacologica post-IMA

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87
Q

ICExercitii de anduranta de nivel scazut

A

Mers pe jos 20-30 min x3-5/saptamanaMers cu bicicleta 20 min x5/sapt pana la 70-80% din FC maxima

88
Q

ICElemente esentiale ale monitorizarii in IC

A

Capacitatea functionala - clasa NYHA, testul de toleranta la efort, ecoStatus fluidic - greutate, evaluare clinica, Cr, electrolitiFC - ECG, Holter

89
Q

ICEchipa multidisciplinara in ingrijirea IC

A

Cardiolog/medic specializat in ICAsistenta de ICDieteticianFarmacistTerapeut ocupationalFizioterapeutConsilier in ingrijiri paliative

90
Q

ICRA IECA

A

TusehTAHiperKDisfunctie renala

91
Q

ICCI IECA

A

Stenoza de artera renalaSarcinaAPP de angioedem

92
Q

ICFactori de luat in considerare la recomandarea de interventie chirurgicala de revascularizare

A

SimptomeleVarstaComorbiditatileIschemie reversibila dovedita

93
Q

ICTehnici de identificare a miocardului hibernant

A

Eco de stresImagistica nuclearaIRMPET

94
Q

ICBeneficii CRT

A

Poate reversa remodelarea ventricularaPoate reduce regurgitarea mitrala functionalaPoate imbunatati functia VS

95
Q

ICEfectele denervarii cardiace

A

Creste frecventa cardiaca de repausSe pierde variabilitatea diurna a TAEste afectata reglarea SRAA

96
Q

ICDe ce este provocat sindromul de inima rigida?

A

Rejet de grefaDenervare cardiacaLeziuni ischemice din timpul recoltarii si implantarii cordului

97
Q

ICComplicatiile transplantului cardiac legate de imunosupresie

A

InfectiiCancerHTAHiperlipidemie

98
Q

ICPrincipala cauza de insuficienta a grefei cardiace pe termen lung

A

ATS coronariana a allogrefei

99
Q

ICDe ce este determinata ATS allogrefei?

A

Rejet vascularHTAHiperlipidemie

100
Q

ICCI absolute de transplant cardiac

A

HTPCancer activ

101
Q

ICInvestigatiile initiale utile in ICA in UPU

A

ECG 12 derivatiiRxAnalize de sangeBNP, NTproBNPETT

102
Q

ICCe se poate identifica la ECG in caz de ICA?

A

SCAHVSBRSFiAValvulopatii

103
Q

ICCe poate identifica Rx toracica in caz de ICA?

A

CardiomegalieEdem pulmonarRevarsate pleuraleBoala non-cardiaca

104
Q

ICAnalize de sange utile in ICA

A

HemogramaGlicemieCrElectrolitiPCRD-dimeriEnzime cardiace

105
Q

ICValori plasmatice BNP si NTproBNP sugestive pentru IC

A

BNP > 100 pg/mLNTproBNP > 300 pg/mL

106
Q

ICManifestari IC dreapta

A

DC scazutPVJ crescutaHmegaliehTA

107
Q

ICCaracteristici soc cardiogen

A

TAs < 90Tam scade cu > 30Diureza < 0.5FC > 60

108
Q

ICCaracteristici ICA hipertensiva

A

TA crescutaFunctie VS pastrataEdem pulmonar

109
Q

ICCaracteristici EPA

A

TahipneeOrtopneeRaluri subcrepitanteSaO2 < 90% AAEdem pulmonar

110
Q

ICCand se folosesc cu prudenta IECA/ARA?

A

Cr > 250 mcmoli/L (2.83 mg/dL)TA < 90 mmHg

111
Q

ICFactori de prognostic nefavorabil in IC acuta

A

Cresterea PCB > 18 mmHgHiponatremieCresterea VTDVS la ecoScaderea consumului miocardic de O2

112
Q

ICComplicatii VAD

A

TromboembolismInfectiiSangerariDefectiuni dispozitiv

113
Q

ICTeritorii in care produc VD dozele mici de dopamina

A

CerebrovascularCoronarianRenalSplanhnic

114
Q

ICMedicamente in ICA ce cresc diureza

A

FurosemidDobutaminaDopamina doza mica

115
Q

ICMedicamente in ICA ce dau VD

A

MorfinaNitratii, nitroprusiat, BNPFurosemid doza micaDopamina doza micaDobutaminaMilrinonaLevosimendan

116
Q

ICMedicamente in ICA ce dau VC

A

AdrenalinaNoradrenalinaDopamina doza mare

117
Q

BCCauze de obstructie mecanica a coronarelor

A

ATSTromboza supraadaugataVasospasmEmbolieStenoze ostialeVasculite - LES

118
Q

BCCauze de scadere a fluxului coronarian de sange oxigenat

A

AnemieCOHbhTA - scaderea presiunii de perfuzie

119
Q

BCDecese prin BCV

120
Q

BCDecese prin boala coronariana

121
Q

BCFactori determinanti ai leziunii/disfunctiei endoteliale initiale din ATS

A

Stres mecanic de forfecare (HTA severa)Modificari biochimice (crestere LDL, DZ)Factori imunologici (fumatori - radicali liberi)InflamatieAnomalii genetice

122
Q

BCComponente stria lipidica

A

Macrofage cu LDL oxidate in citoplasma = celule spumoase

123
Q

BCDin ce e formata placa de tranzitie?

A

Provine din stria lipidicaLDL ajung extracelular subendotelial=> celule spumoase + LDL extracelular

124
Q

BCComponente placa fibroasa avansata

A

Celule inflamatoriiLipide extracelulareCelule musculare netedeColagen

125
Q

BCCum se formeaza placa complicata?

A

Ulcerarea sau tromboza placii fibroase avansate cu ocluzie acutaSau prin cresterea progresiva a placii fibroase avansate pana la obstructia lumenului

126
Q

BCComponente miez lipidic

A

Depozite lipidiceCelule spumoaseLimfociteFagociteCMNV

127
Q

BCComponente capison fibros

A

CMNVColagen

128
Q

BCFactori de risc nemodificabili in boala coronariana

A

VarstaSex MAHCRasaDeletia polimorfismului genic al genei DD a ECA

129
Q

BCFactori de risc potential modificabili in boala coronariana

A

SedentarismAlcoolism cronicFumatHTAHiperlipidemieObezitateDZGutaHiperhomocisteinemiePCR crescutaFactori de coagulare - crestere fibrinogen, crestere f VIIRA medicamentoase - coxibi; rosiglitazona, contraceptive orale, inhibitori de nucleozideDuritatea redusa a apei

130
Q

BCSuspiciune hiperCho familiala

A

Cho > 7.5 mmoli/LAHC de BC precoce

131
Q

BCModificari stil de viata in BCV

A

Grasimi totale < 30% caloriiGrasimi saturate < 7% caloriiCho < 300 mg/ziGrasimile saturate inlocuite cu mono/poli nesaturate(ulei de rapita/masline)Limitare la dulciuri si alimente cu zaharuri rafinate (fructoza)Minim 5 portii de fructe si legume/zi2 portii de peste/sapt4-5 portii de nuci, seminte, legume nesarate/saptEfort fizic saptamanal 150+ min intensitate moderata sau 75 min intensitate crescutaIMC < 25 (normoponderal)Maxim 14 masuri de alcool/sapt distribuite in mod egal in 3+ zileStop fumatControl HTA, DZ

132
Q

BCFactori de risc mortalitate in BC

A

HTADZHiperlipidemieObezitateSedentarismFumatAHC

133
Q

BCInvestigatii initiale in angina stabila

A

Teste de laboratorECG 12 derivatiiEcoHolter ECGRx

134
Q

BCTeste de laborator in angina stabila

A

HLGGlicemie bazala, HbA1cProfil lipidic a jeunRFGTn in angina frecventaHh tiroidieni

135
Q

BCImagistica anatomica a cordului

A

CoronarografieAngio-CT coronarian

136
Q

BCImagistica functionala a cordului

A

SPECTIRM de stresEco de stres

137
Q

BCCand este mai probabila durerea toracica non-anginoasa?

A

ContinuaNelegata de efortAccentuata de respiratieAsociata cu ameteli, palpitatii, disfagie

138
Q

BCComplicatii PCI la locul de punctie arteriala

A

HemoragiiHematoameDisectii arterialePseudoanevrisme

139
Q

BCComplicatii majore PCI

A

IMA - 2%Deces - 1%AVC - 0.4%

140
Q

BCRisc de restenoza la stenturi metalice

A

20-30% in primele 6-9 luni de la PCI

141
Q

BCCaracteristici individuale care decid intre CABG si PCI

A

Comorbiditati severeSperanta de viataAorta de portelanNecesar de interventie pe Ao ascendenta sau pe valve

142
Q

BCSimptome atipice in SCA

A

IndigestieDurere pleuriticaDispnee

143
Q

BCBoli cu simptome similare fata de SCA

A

Disectie de aortaEPBoala ulceroasa

144
Q

BCElemente de prognostic negativ la examenul clinic in SCA

A

hTARaluri de staza (subcrepitante)Zgomot de galopSufluri cardiace

145
Q

BCBeneficii IECA, statine in SCA

A

Stabilizeaza placa de ateromAmelioreaza remodelarea vasculara si miocardicaReduc evenimentele CV succesive

146
Q

BCPacientii cu risc foarte inalt la PCI, coronaro

A

Angina persistenta/recurenta care nu raspunde la medicamenteICInstabilitate hemodinamicaSoc cardiogenAritmii ventriculare maligne - TV, FiV

147
Q

BCPacientii cu risc inalt la PCI, coronaro

A

Crestere progresiva de TnModificari in dinamica de ST si TScor GRACE crescut (>140)

148
Q

BCPacientii cu risc moderat/intermediar la PCI, coronaro

A

DiabetDisfunctie renala (eGFR < 60)FEVS < 40% sau ICCAngina precoce post-IMAAPP de PCI/CABGScor GRACE = 109-140 (mediu)

149
Q

BCCauze de IM tip 2

A

Spasm coronarianEmbolie coronarianaAnemie severaAritmiihTAHTA

150
Q

BCCe include scorul GRACE?

A

VarstaFCTAsCrClasa Killip la prezentare+APP de ICC, IMAEnzime cardiace crescuteSubdenivelare de STPCI in spital sau nu

151
Q

ValvulopatiiEvolutie SM

A

Ingrosarea valvelorFuzionarea cuspelorAparitia depozitelor de Ca cu imobilizarea progresiva a cuspelorIngustarea severa (stenoza) orificiului valvular

152
Q

ValvulopatiiETT in SM

A

Dimensiunile ASIngrosarea cuspelorCalcificarea cuspelorMobilitatea cuspelorGradul fuziunii comisurale

153
Q

ValvulopatiiScorul Wilkins

A

Mobilitatea cuspelorIngrosarea cuspelorGradul de calcificare a cuspelorIngrosarea aparatului subvalvularPentru evaluarea ecografica a valvei mitrale in SM

154
Q

ValvulopatiiUtilizari CW Doppler

A

AVMPHTGradient presional transvalvular mediuEstimarea PAP (velocitatea maxima a anvelopei jetului de regurgitare tricuspidiana)

155
Q

ValvulopatiiIndicatii valvulotomie cu balon

A

Valve supleAfectare minima aparat subvalvularRegurgitare minima

156
Q

ValvulopatiiCI valvulotomie cu balon

A

Calcificari importanteRegurgitare mitrala > usoaraTromboza de AS

157
Q

ValvulopatiiIndicatii valvulotomie pe cord inchis

A

Valve mobileFara calcificariFara regurgitare

158
Q

ValvulopatiiCauze SM

A

RAASM congenitalaSdr Lutembacher = SM dobandita + DSACalcificarea inelului mitral - rar, mai frecvent la varstnici, BCR avansataTumori carcinoide cu metastaze pulmonare sau carcinoid bronsic primar

159
Q

ValvulopatiiCauze RM

A

Degenerare mixomatoasaBCIEIRAABAI - LESBoli de colagen - Marfan, Ehlers-DanlosCardiomiopatii - CMD, CMHMedicamente - inhibitori ai apetitului (fenfluramina), agonisti dopaminergici (cabergolina)

160
Q

ValvulopatiiCati pacienti cu RM fac HVS?

161
Q

ValvulopatiiCe este vena contracta?

A

Cea mai ingusta zona a jetului de regurgitare

162
Q

ValvulopatiiCum se masoara severitatea RM?

A

Diametru vena contractaAria jetului de regurgitareCalcularea ariei orificiului de regurgitareCalcularea volumului regurgitantCalcularea fractiei regurgitanteInformatii indirecte despre severitatea regurgitarii prin evaluarea functiei VS

163
Q

ValvulopatiiIndicatii chirurgie RM

A
  • RM severa simptomatica + FEVS >30% + VTDVS < 55 mm* RM asimptomatica + disfunctie VS (VTSVS > 45 mm si/sau FEVS <60%)* De luat in considerare la cei cu RM severa asimptomatica + functie VS pastrata + FiA si/sau HTP
164
Q

ValvulopatiiCu ce boli se asociaza PVM?

A

Boli de tesut conjunctiv* Marfan* Ehlers-Danlos* Pseudoxanthoma elasticum

165
Q

ValvulopatiiCaracteristici PVM

A

Cuspe cu tesut valvular in excesDilatare de inel mitralCordaje alungiteContractie dezordonata a muschilor papilari

166
Q

ValvulopatiiTratament medicamentos RM

A

DiureticeIECA+/- anticoagulant

167
Q

ValvulopatiiSimptome SA

A

DispneeDurere toracicaFatigabilitatePresincopaSincopa

168
Q

ValvulopatiiFactori de risc pentru BAVC

A

Varsta avansataSex MFumatHTADZNivel crescut de Lp(a)Nivel crescut de LDL

169
Q

ValvulopatiiCu ce se asociaza bicuspidia aortica?

A

Coarctatie de aortaDilatarea radacinii aorteiDisectie de aorta

170
Q

ValvulopatiiAlte cauze de SA

A

BCRBoala PagetExpunere la radiatii in antecedenteLES

171
Q

ValvulopatiiDDx SA

A

CMHStenoza subvalvulara - diafragm/pintene fibrosStenoza supravalvulara - sindrom Williams (diafragm fibros congenital + dificultati de invatare + hiperCa)

172
Q

ValvulopatiiSimptome SA moderat-severa

A

Sincopa indusa de efortAnginaDispnee

173
Q

ValvulopatiiConsecintele SA

A

Scade TACreste gradul de ischemie miocardicaInsuficienta ventricularaCreste riscul de aritmii

174
Q

ValvulopatiiParametri care evalueaza severitatea SA

A

Arie valvularaVelocitate maximaGradient maximGradient mediu

175
Q

ValvulopatiiCe pot detecta IRM, CT cardiac in SA?

A

Posibile anevrismeDisectie de aortaCoarctatie de aortaEvalueaza aorta toracica

176
Q

ValvulopatiiTAVI - rata de succes, mortalitate periprocedurala, mortalitate la 30 de zile

A

Rata de succes = 86%Mortalitate periprocedurala = 2%Mortalitate la 30 de zile = 12%

177
Q

ValvulopatiiIndicatii protezare valva A

A

SA simptomaticaBicuspidie + aorta ascendenta > 50 mm/cresterea diam aortei > 5 mm/anSA severa asimptomatica +* FEVS < 50%* Test de efort -> apar simptome/scade TA* Indicatie de CABG/chirurgie de aorta ascendenta/alta valvulopatie pe langa SA moderata/severa

178
Q

ValvulopatiiSemne rare de circulatie hiperdinamica

A

Semn QuinckeSemn de MussetSemn DuroziezArtere femurale “in foc de arma”

179
Q

ValvulopatiiSemnul Quincke

A

Pulsatii capilare in patul unghial

180
Q

ValvulopatiiSemnul de Musset

A

Miscarea capului sincron cu bataile cardiace

181
Q

ValvulopatiiSemnul Duroziez

A

Suflu continuu de tip “du-te vino” la auscultatia arterelor femurale comprimate distalSemn de RA severa

182
Q

ValvulopatiiArterele femurale “in foc de arma”

A

Zgomot intens aparut la auscultatia arterelor femurale la fiecare bataie cardiaca

183
Q

ValvulopatiiIn ce valvulopatii se face profilaxia EI?

184
Q

ValvulopatiiParametri care evalueaza severitatea regurgitarii aortice

A

Doppler color - marimea jetului de regurgitare, grosimea jetului de regurgitare la vena contractaDoppler spectral - reflux diastolic in aorta descendenta toracica, timpul de injumatatire a presiuniiCOROBORAT

185
Q

ValvulopatiiIndicatii protezare aortica in RA

A

RA severa acuta (EBA)RA cronica severa simptomatica (dispnee NYHA 2-4, angina)Asimptomatici + FEVS < 50%Asimptomatici + FEVS > 50% + dilatare VS (VTD >70 mm, VTS >50 mm)Cei care necesita* CABG* Chirurgie de aorta ascendenta* Chirurgie pentru alta valvulopatie asociata

186
Q

ValvulopatiiSemnele din RA se datoreaza:

A

Circulatiei hiperdinamiceRegurgitariiDilatarii secundare a VS

187
Q

ValvulopatiiCu ce se asociaza SP congenitala?

A

Tetralogie FallotSindrom NoonanRubeola congenitala

188
Q

ValvulopatiiIn ce valvulopatii apare unda a venoasa proeminenta?

189
Q

ValvulopatiiIn ce valvulopatii apare unda v proeminenta?

190
Q

ValvulopatiiCauze RT functionala

A

CPCIMAHTPPrin dilatare de cord drept

191
Q

ValvulopatiiCauze de RT organica

A

Boala reumatismalaEISindrom carcinoidBoala EbsteinAlte anomalii congenitale de valve AV

192
Q

ValvulopatiiCe valvulopatii asociaza frecvent FiA?

193
Q

ValvulopatiiInterventii pentru plastia valvei T

A

AnuloplastiePlicatura de inel

194
Q

ValvulopatiiFactori de risc suplimentari (pe langa tipul si pozitia protezei valvulare) de tromboembolism

A

Valvulopatie M/T/PAPP de tromboembolismFiADiametrul AS > 50 mmSMFEVS < 35%Status hipercoagulant (ex: sarcina)

195
Q

ValvulopatiiValve slab trombogene

A

Carbomedics (in pozitie aortica)Medtronic HallSt Jude Medical (fara St Jude Silzone)

196
Q

ValvulopatiiValve moderat trombogene

A

Bjork-ShileyAlte proteze bidisc

197
Q

ValvulopatiiValve inalt trombogene

A

Lillehei-KasterOmniscienceStarr-Edwards

198
Q

ValvulopatiiComplicatii protezare valvulara

A

Infectie -> vegetatii -> EITrombozaCalcificareDetasarea protezei de inel = regurgitare paraprotetica

199
Q

ValvulopatiiDegradarea valvei la femeile aflate la varsta fertila

A

50% la 10 ani90% la 15 ani

200
Q

ValvulopatiiDe ce reprezinta sarcina un status hipercoagulant?

A

Staza venoasaHTAScade activitatea proteinei SCresc* Fibrinogenul* Factorii VII, VIII, X

201
Q

ValvulopatiiRisc de embriopatie data de warfarina

A

5-12% in primul trimestru

202
Q

ValvulopatiiTinta nivel anti-Xa

A

0.8-1.2 U/mL la 4h dupa administrare

203
Q

Simptomatologie aritmii

A

Pot fi asimptomaticePot determinaMSICDurere toracicaPalpitatiiSincopa

204
Q

Ce determina cresterea automatismului secundar stimularii simpatice?

A

Tahicardie sinusalaRitmuri de scapareRitmuri AV (jonctionale) accelerate

205
Q

Factori agravanti ai postdepolarizarilor

A

CatecolamineDiselectrolitemiiHipoxieAcidozaMedicamenteCardiostimulare

206
Q

Aritmii care au ca mecanism activitatea declansata

A

Aritmiile atriale din intoxicatia digitalicaAritmiile ventriculare prin QT lung

207
Q

Aritmii care au ca mecanism reintrarea

A

Majoritatea tahicardiilor paroxistice regulate

208
Q

Cauze extrinseci de bradicardie sinusala

A

HipotermieHipotiroidismHTICIcter colestaticSindroame mediate neuralMedicamente- BB- Digitalice- Alte antiaritmice

209
Q

Cauze de fibroza a nodului sinusal (cauze de BNS)

A

IdiopaticaBCIMiocarditaCMp

210
Q

Reflexul Bezold Jarisch

A

Bradicardie (bradicardie sinusala, oprire sinusala, BAV) + VD periferica reflexa

211
Q

Medicamente ce pot determina sincopa (mai ales la varstnici)

A

Anti-HTAADTCNeuroleptice

212
Q

Cauze BAV grad 3 cu complexe largi

A

Boala LevBoala LenegreBCICMpMiocardita

213
Q

Patologii frecvent asociate cu BRD

A

BCC - DSA, DSV, SP, 4FEPHTPIMABNS (fibroza tesutului de conducere)Boala Chagas

214
Q

Cauze de BRS

A

SAHTAIMABC severa

215
Q

Cand afecteaza BRD axul electric?

A

Cand se asociaza cu HVD/supraincarcare de VDCand face parte din bloc bifascicular (cand se asociaza cu HBAS/HBPI)

Rezi FC (29 decks)

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