CARDIO Flashcards
Common causes of HFpEF
Aging
Obesity
Hypertension
High cardiac output, low SVR HF causes
Thiamine deficiency
occurs when there is normal or increased cardiac function and low systemic vascular resistance, but the heart is unable to supply the body’s demands.
High output failure
Concentric hypertrophy: A.
Eccentric Hypertrophy: B
A. Pressure Overload (HPN, AS)
B. Volume overload (MR, AR)
Potent vasoconstrictors
Aldosterone
Angiotensin II
Vasodilators
Bradykinin
Nitric Oxide
Natriuretic Peptides
Inactivates bradykinin
Neprilysin
MOA of Diuretics in HF
Decreasing pressure within the abdominal compartment, improving renal perfusion
alternatingly strong and weak pulse resulting from variation in the left ventricular stroke volume with every cardiac cycle because of incomplete LV recovery.
Pulsus Alternans
exaggerated fall in a patient’s blood pressure during inspiration by greater than 10 mm Hg seen in cardiac tamponade and constrictive pericarditis,
Pulsus Paradoxus
weak pulse seen among patients with aortic stenosis.
Pulsus parvus et tardus
increased pulse with double systolic peak seen in aortic regurgitation.
Pulsus bifriens
Indicates severe biventricular heart failure and is a marker of poor outcome.
Kussmaul’s sign
- rise in JVP with inspiration
indicates right-sided heart failure, without necessarily involving the left side.
Hepatojugular reflex
Loud P2 component of S2 is seen in patients with
Pulmonary Hypertension
Echo findings:
asymmetric hypertrophy of the septum, with the mitral valve moving anteriorly towards it during systole.
HOCM
Echo
Pseudonormalization of the mitral inflow velocity pattern
Diastolic dysfunction
Echo
billowing of the mitral valve leaflets into the left atrium during systole
MVP
Micro infarcts consistent with small vessel ischemia and thrombosis secondary to endothelial dysfunction is a classic histopathology findings
Stimulant-induced cardiomyopathy
a typical viral syndrome occurs without cardiac symptoms but with elevated biomarkers
Possible sub clinical myocarditis
a typical viral syndrome occurs with cardiac symptoms but with elevated biomarkers
Probable Acute Myocarditis
Pericarditis happens after a myocardial infarction
Dressler’s syndrome
Main therapeutic agent for Prinzmetal angina
Nitrates
CCB
Hemodynamic evidence of systolic function appears when contraction is impaired by _______, whereas infarction of _______% leads to shock.
A. 10-25%
B. >40%
Chemo therapeutic agent according to their myocardial damage
Recurrent coronary spasm leading to decreased myocardial contractility
5FU, cisplarion, other alkylating agents
Chemo therapeutic agent according to their myocardial damage
cause myocardial damage via mitochondrial damage and inhibition of DNA repair
Anthracyclines (doxorubicin)
Chemo therapeutic agent according to their myocardial damage
blocks the normal HER2 action on the cardiomyocytes.
Trastuzumab
Chemo therapeutic agent according to their myocardial damage
endoplasmic reticulum stress and inflammation among myocytes.
Tyrosine Kinase İnhibitors
click and murmur of MVP occur earlier and intensify with
standing
strain phase of the Valsalva maneuver and
any intervention that decreases LV volume (preload)
Click and murmur of MVP is delayed, moves away from S1 or even disappears with
squatting
isometric exercises, and
passive leg raising which increase LV volume
Hemodynamic hallmark of MS
Abnormally elevated left ateioventricular pressure gradient
> elevated pulmonary venous and arterial wedge pressures
increased pulmonary vascular resistance, leading to elevation in the right ventricular end-diastolic pressure
LV diastolic pressure is normal in isolated MS.
Favors a diagnosis of ASD over MS
Absence of left atrial enlargement and Kerley B lines
3 Major determinants of Myocardial Oxygen Demand
Heart Rate
Myocardial Contractility
Myocardial Wall tension
Determinant of adequate oxygen supply
Level of oxygen carrying capacity of blood: inspired O2, pulmonary fxn, hb concentration
Level of coronary flow
Contraindications to exercise stress testing
rest angina within 48 hrs
unstable rhythm,
severe aortic stenosis
acute myocarditis
uncontrolled heart failure
severe pulmonary hypertension and
active infective endocarditis.
most typical symptom is intermittent claudication, which is defined as a pain, ache, cramp, numbness, or a sense of fatigue in the muscles; it occurs during exercise and is relieved by rest.
PAD
buttock, hip, thigh, and calf discomfort occurs in patients with A?
whereas calf claudication develops in patients with B?
A. aortoiliac disease
B. femoral-popliteal disease.
Patients complain of rest pain or a feeling of cold or numbness in the foot and toes. Frequently, these symptoms occur at night when the legs are horizontal and improve when the legs are in a dependent position. When, rest pain may be persistent.
Critical Limb Ischemia
episodic digital ischemia, manifested clinically by the sequential development of digital blanching, cyanosis, and rubor of the fingers or toes after cold exposure and subsequent rewarming. A sensation of cold or numbness or paresthesia of the digits often accompanies the phases of pallor and cyanosis.
Raynaud’s Phenomenon
vasculitic disorder associated with exposure to cold wherein raised erythematous lesions develop most commonly on the toes or fingers in cold weather.
Pernio
characterized by burning pain and erythema of the feet more frequently than the hands.
Erythromelalgia
arterial vasoconstriction and secondary dilation of the capillaries and venules with resulting persistent cyanosis of the hands and, less frequently, the feet,
Acrocyanosis
Edema, stasis dermatitis, and skin ulceration near the ankle may be present if there is
Supervicial venous thrombosis
increased leg circumference, venous varicosities, edema, and skin changes.
Deep Venous insufficiency
combination of induration, hemosiderin deposition, and inflammation, and typically occurs in the lower part of the leg just above the ankle.
Lipodermatosclerosis
white patch of sear tissue, often with focal telangiectasias and a hyperpigmented border; it usually develops near the medial malleolus.
Atrophie blanche
Surgical revascularization in acute limb ischemia is indicated in patients with
Restroration of blood flow must occur within 24 hours to prevent limb loss
Symptoms of occlusion is present > 2 weeks
Amputation:
Limb is not viable (loss of sensation, paralysis, absence of Doppler detected blood flow in both arteries and veins
Findings indicative of high risk for intracradiac complications from IE
Congestive Heart Failure
New regurgitant murmur
New electrocardiographic conduction changes
Most common complication with aortic valve infection (10-15% with NVE, 45-60% with PVE)
Perivalvular extension
Antibiotics for Viridans group IE highly susceptible to Penicillin
Pen G
Ceftriaxone
Vancomycin
Pen G + Genta
*4 weeks
Early PVE (within 2 months) etiologies
S. Aureus
CoNs
Fac gram neg bacilli
Diphteroids
Fungi
Staph PVE MSSA antibiotics
Nafcillin, oxacillin, flu + Genta + Rif
MRSA:
Vanco + Genta + Rif
- 6-8 weeks
Major indication for cardiac surgery in IE
Mod to Severe HF
Lake Louise Criteria for mycoarditis (MRI)
2 out of 3
- Abnormal T2
- Early gd enhancement
- Late gd enhancement
Revise Criteria
Both
1. T2 with edema
2. T1 with inflammation
Most commonly non-infectious inf affecting the myocardium
Granulomatous myocarditis (inc sarcoidosis and giant cell myocarditis)
Doppler ultz of tamponade
> tricuspid and pulmonic valve flow velocities increase markedly during inspiration
pulmonic vein, mitral, and aortic flow velocities decrease.
In tamponade,
> there is diastolic inward motion (collapse) of the right ventricular free wall and the right atrium.
