Cardio 4 Flashcards
What is acute pericarditis and what are its causes?
Acute pericarditis is inflammation of the pericardial sac, leading to chest pain and other systemic symptoms.
Causes:
β’ Idiopathic (post-viral): Often follows a viral infection, such as coxsackievirus, echovirus, or adenovirus.
β’ Infectious: Bacterial (e.g., tuberculosis), fungal, and parasitic.
β’ Acute MI: Can occur within the first 24 hours after a myocardial infarction (post-MI pericarditis).
β’ Uremia, collagen vascular diseases (SLE, RA), neoplasms, and radiation.
What are the clinical features of acute pericarditis?
Chest pain: Retrosternal, radiates to the neck and back, worsens with inspiration and coughing, and is relieved by sitting forward.
Fever and leukocytosis.
Pericardial friction rub: Best heard during expiration, a hallmark sign but not always present.
How is acute pericarditis diagnosed and treated?
Diagnosis:
β’ ECG: Diffuse ST elevation in all leads and PR depression (more specific).
β’ Echocardiography: May show pericardial effusion.
Treatment:
β’ NSAIDs (e.g., aspirin or ibuprofen) for pain and inflammation.
β’ Colchicine to reduce recurrence.
β’ Glucocorticoids if there is no response to NSAIDs.
β’ Bed rest during the acute phase.
What is constrictive pericarditis and its causes?
Constrictive pericarditis occurs when the pericardium becomes thickened and fibrotic, restricting the heartβs ability to fill during diastole.
Causes:
β’ Any cause of pericarditis that leads to chronic inflammation and fibrosis (e.g., tuberculosis, post-viral infections).
What are the clinical features and signs of constrictive pericarditis?
Symptoms: Signs of right heart failure (RHF), including peripheral edema, distended JVP, ascites, and hepatomegaly.
Signs:
β’ Kussmaulβs sign: JVP increases paradoxically on inspiration.
β’ Pulsus paradoxus.
β’ Pericardial knock: An extra heart sound during diastole from restricted filling.
How is constrictive pericarditis diagnosed and treated?
Diagnosis:
β’ CXR: Normal heart size with pericardial calcifications.
β’ CT/MRI: Shows pericardial thickening and calcification.
Treatment:
β’ Diuretics for symptom control.
β’ Surgical excision of the pericardium (pericardiectomy) for severe cases.
What is pericardial effusion and its causes?
Pericardial effusion refers to the accumulation of fluid in the pericardial sac.
Causes:
β’ Acute pericarditis.
β’ Salt and water retention in conditions like CHF, cirrhosis, nephrotic syndrome, or trauma.
What are the symptoms and signs of pericardial effusion?
Symptoms: Muffled heart sounds and chest discomfort.
Signs:
β’ Dullness at the left lung base.
β’ Pericardial friction rub may be heard if the fluid is minimal.
How is pericardial effusion diagnosed and treated?
Diagnosis:
β’ Echocardiography: The procedure of choice.
β’ CXR: Cardiomegaly with a flask-shaped appearance.
Treatment:
β’ Most cases resolve spontaneously.
β’ Pericardiocentesis may be required if the effusion does not resolve or is symptomatic.
What is cardiac tamponade and its clinical features?
Cardiac tamponade is a medical emergency where rapid accumulation of fluid in the pericardial space impairs the heartβs ability to fill, leading to decreased cardiac output.
Clinical features:
β’ Pulsus paradoxus: A decrease in pulse strength during inspiration, with a >10 mmHg drop in systolic BP.
β’ Tachypnea, tachycardia, hypotension, and elevated JVP.
β’ Beckβs triad: Muffled heart sounds, jugular venous distention (JVD), and hypotension.
What are the causes of cardiac tamponade?
β’ Trauma (e.g., penetrating injury).
β’ Iatrogenic: During central line placement or pericardiocentesis.
β’ Pericarditis: Inflammation or infection of the pericardium.
β’ Post-myocardial infarction (post-MI) tamponade due to rupture of the free wall or septum.
β’ Aortic dissection: Can lead to tamponade if the aorta ruptures into the pericardium.
How is cardiac tamponade diagnosed and treated?
Diagnosis:
β’ Echocardiography: The most sensitive and specific test for diagnosing cardiac tamponade, showing diastolic collapse of the right atrium and right ventricle.
β’ CXR: Enlargement of the cardiac silhouette.
β’ ECG: Electrical alternans (alternating amplitudes of QRS complexes).
β’ Catheterization: Shows equalization of pressures in all heart chambers during diastole.
Treatment:
β’ If hemodynamically unstable: Immediate pericardiocentesis to remove the fluid and relieve pressure.
β’ If hemorrhagic tamponade (e.g., trauma): Emergency surgery is required.
β’ If stable and renal failure is present: Dialysis may help manage the tamponade.
What is myocarditis and its causes?
Myocarditis is inflammation of the myocardium, often leading to heart failure and arrhythmias.
Causes:
β’ Viral: Most commonly caused by Coxsackievirus B, parvovirus B19, or human herpesvirus 6 (HHV6).
β’ Bacterial: Group A beta-hemolytic streptococcus, Lyme disease, and Mycoplasma pneumonia.
β’ Autoimmune diseases: Systemic lupus erythematosus (SLE).
β’ Medications: Sulfonamides, adriamycin.
What are the symptoms of myocarditis?
β’ Fatigue.
β’ Chest pain: Similar to a heart attack.
β’ Arrhythmias: Palpitations or irregular heartbeat.
β’ Heart failure symptoms: Shortness of breath, swelling in the legs.
β’ Some patients may be asymptomatic, especially in mild cases.
How is myocarditis diagnosed and treated?
Diagnosis:
β’ ECG: Sinus tachycardia, low voltage, electrical alternans, or ST elevation.
β’ Cardiac enzymes: Elevated levels of troponin.
β’ Chest X-ray: May show cardiomegaly.
β’ Echocardiography: May show decreased ejection fraction (EF).
β’ Endomyocardial biopsy: The gold standard for diagnosis, but not routinely performed.
Treatment:
β’ Bed rest and management of heart failure with beta-blockers and ACE inhibitors.
β’ NSAIDs and steroids are generally contraindicated in viral myocarditis as they may worsen the condition.
What is coarctation of the aorta and its pathophysiology?
Coarctation of the aorta is a congenital narrowing of the aorta, typically just distal to the insertion of the ductus arteriosus.
The narrowing increases the resistance to blood flow, leading to hypertension in the upper body (e.g., arms and head), while the lower body (e.g., legs) receives less perfusion.
What are the clinical features of coarctation of the aorta?
β’ Hypertension in the upper extremities and low blood pressure in the lower extremities.
β’ Radio-femoral delay: A delay in the pulse when comparing the arms and legs.
β’ Chest pain and murmur, typically systolic.
β’ CXR: Shows rib notching due to collateral vessels eroding the ribs.
How is coarctation of the aorta diagnosed and treated?
Diagnosis:
β’ Echocardiogram: Can confirm the narrowing of the aorta.
β’ CXR: Shows rib notching and post-stenotic dilation.
Treatment:
β’ Surgical repair: In infants or young children with severe coarctation.
β’ Balloon angioplasty: An alternative for older patients or those with recurrent stenosis.
β’ Beta-blockers or ACE inhibitors may be used to control blood pressure.
What is pulmonary heart disease (cor pulmonale) and its causes?
Pulmonary heart disease (cor pulmonale) refers to right-sided heart failure due to pulmonary hypertension, which results from diseases affecting the lungs or pulmonary vessels.
Causes:
β’ Chronic obstructive pulmonary disease (COPD).
β’ Pulmonary hypertension due to left heart failure, lung diseases, or recurrent pulmonary emboli.
β’ Pulmonary stenosis or other pulmonary vessel abnormalities.
What are the clinical features of pulmonary heart disease?
β’ Exertional dyspnea.
β’ Fatigue and lethargy due to decreased cardiac output.
β’ Right-sided heart failure (RHF): Edema, hepatomegaly, and JVP elevation.
β’ Loud P2: Increased intensity of the second heart sound due to pulmonary hypertension.
How is pulmonary heart disease diagnosed and treated?
Diagnosis:
β’ Right heart catheterization: To measure pulmonary artery pressure (PAP).
β’ CXR: Shows right heart enlargement.
β’ ECG: May show right ventricular hypertrophy (RVH) or right atrial enlargement.
Treatment:
β’ Oxygen therapy: To improve oxygenation and reduce pulmonary hypertension.
β’ Diuretics: To relieve fluid retention.
β’ Anticoagulation: If there is a history of pulmonary embolism.
β’ Treat underlying lung disease: COPD management, pulmonary embolism treatment.
What is hypertension and its causes?
Hypertension is defined as a systolic blood pressure (SBP) β₯140 mmHg or diastolic blood pressure (DBP) β₯90 mmHg based on two separate readings.
Causes:
β’ Primary (essential) hypertension: No known cause, but often linked to genetics, obesity, and lifestyle factors.
β’ Secondary hypertension: Caused by other conditions such as renal parenchymal disease, renovascular disease, pheochromocytoma, or Cushingβs syndrome.
What are the risk factors for hypertension?
β’ Modifiable: Obesity, high salt intake, excessive alcohol use, lack of exercise, smoking, and stress.
β’ Non-modifiable: Age (older age increases risk), family history, and gender (men are at higher risk before age 55, women after menopause).
What is the treatment approach for hypertension?
β’ Lifestyle changes: Weight loss, increased physical activity, reduced salt intake, alcohol reduction, and smoking cessation.
β’ Medications:
β’ First-line: ACE inhibitors, angiotensin receptor blockers (ARBs), or calcium channel blockers (CCBs) for patients under 55; CCBs or thiazide-like diuretics for those above 55 or of African descent.
β’ Combination therapy: If monotherapy fails, combinations of ACE inhibitors, ARBs, CCBs, or diuretics are often used.
