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Internal medicine > Cardio > Flashcards

Cardio Flashcards

1
Q

Dilated cardiomyopathy

Etiology/RF

A

Idiopathic: 50 %: thought to be viral (myocarditis)
Alcohol
Cocain
Positiv family history

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2
Q

Dilated cardiomyopathy

Ssx

A

May present as
CHF, systemic or pulmonic emboli
Arrhythmia
Sudden death

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3
Q

Dilated cardiomyopathy

Diagnosis

A 
Lab; electrolytes(low Na, low hco3) cbc, high creatinine high bnp, ck,troponins, high LFT, TSH, TIBC
ECG 
CXR: cardiomegaly signs of chf 
Echo 
Biopsy
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4
Q

Management

Dilated cardiomyopathy

A 
Treat underlying cause 
Treat CHF
Anticoagulantion 
Treat arrhythmia 
Immunise against influenza and s.pneumonia
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5
Q

Hypertrophic cardiomyopathy

Def and general

A

Unexplained ventricular hyper trophy (mc septal hypertrophy). Cause is thought to be due to a genetic defect involving one of the cardiac sardine roc proteins. Generally present in early adulthood

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6
Q

Ssx

Hypertrophic cardiomyopathy

A

ASYMPTOMATIC
SOB
angina, syncope, CHF, arrhythmia. SCD

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7
Q

Hypertrophic cardiomyopathy

Diagnosis

A

ECG:LVH, p wave abnormality, prominent q wave (I, aVL, V5, V6)
TTE+ echo: asymmetric septal hypertrophy

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8
Q

Hypertrophic cardiomyopathy

Treatment

A

B blocker verapamil, phenylephrine
AVOID: acei, nitrates, diuretics= may worsen symptoms

If drug refractory: surgical myomectomy, ICD placement, septal ethanol ablation, dual chamber pacing

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9
Q

Restricted cardiomyopathy

Def

A

Impaired ventricular filling with preserves systolic function in a non-dilated, non-hypertrophied ventricle secondary to factors that decrease myocardial compliance = fibrosis or infiltration

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10
Q

Causes

Restricted cardiomyopathy

A

Infiltrative: sarcoidosis and amyloidosis
Non-infiltrated: scleroderma idiopathic fibrosis
Storage disease: hemochtomatosis, fabrys, gaucher, glycogen storage disease

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11
Q

Restricted cardiomyopathy

Clinical

A

CHF: usually with preserved LV systolic function, arrythmias, elevated JVP, kussmauls sign, S3, MR,TR

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12
Q

Restricted cardiomyopathy

Diagnosis

A 
Ecg 
Echo
CXR 
Cardiac catheterisation: 
Biopsy
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13
Q

Restricted cardiomyopathy

Treatment

A

Exclude constrictive pericarditis
Treat underlying disease
Supportive care and tx for CHF, arrhythmia, anticoagulants if A. Fib, heart transplant

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14
Q

Dilated cardiomyopathy

Definition

A

Unexplained dilatation and impaired systolic function of one or both ventricles

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15
Q

Myocarditis

Ssx

A 
Constitutional symptoms 
Acute CHF
Chest pain 
Arrhythmia 
Systemic or pulmonic emboli 
Sudden cardiac death
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16
Q

Myocarditis

Diagnosis

A 
Ecg 
Blood: troponins ckmb LDH, AST 
BLOOD cultures 
CXR
ECHO: dilated hypokinietic segmental wall motion abnormalities 
Biopsy
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17
Q

Tx myocarditis

A

Supportive care + rest
Treat CHF arrythmias and anticoagulation
Treat underlying cause

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18
Q

Left ventricular failure: ethiopatho

A

any acute cause or decompensation of chronic heart failure, characterized by acute dyspnea, due to pulm edema, +- peripheral edema and hypoperfusion.

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19
Q

Clinical: Left ventricular failure

A

dyspne, orthopnea, paroxymal nocturnal orthopnea, cough ( frothy pink sputum), fatigue, poor exercise tolerance, weight loss wheezing, cold peripheries

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20
Q

Dx Left ventricular failure

A

ECG, CXR (kerley B lines, plum effusion, cardiomegaly, inc pulm vasc markings), echo, BNP, cardiac enzymes,

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21
Q

DDX Left ventricular failure

A

PE, asthma, pneumonia.

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22
Q

Tx Left ventricular failure

A

o2, diuretics, sodium restriction, nitro, dobutamine.

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23
Q

Aortic dissection

clinical picture

A

Aortic dissection is a tear in intima allowing blood to dissect into the media. Acute 2 w.
Clinical: Sudden onset chest pain radiating to back, Htn, asymmetric BP in arms, ischemic syndromes due to occlusion of aortic branches. New diastolic murmur, rupture into pericardium, peritoneum, pleura. syncope

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24
Q

Aortic dissection

dx and ddx

A

Dx: CT = gold standars, CXR (widened mediastinum, pleural cap), ECG, TEE, blood:amylase, troponin, lactate to rule out other causes.

25
Q

Aortic dissection

Tx

A

Pharmacologic: B blocker + ACEI if insufficient BP and HR control. Target is sBP 110 mmhg and HR

26
Q

Cardiac tamponade Def:

A

major complication of rapidly accumulating pericardial effusion or rapidly accumulating pericardial fluid. It is a clinical diagnosis characterized by; hyptension. tachycardia, inc JVP, pulsus paradoxus.

27
Q

Cardiac tamponade

symptoms

A

Disastolic filling of the heart gets mechanically impaired leading to decreased SV and CO. Clinical: JVD, narrow pulse pressure, pulsus paradoxus (inspiratory fall in sBP >10 mmHg during quiet breathing), distant muffeled heart sounds, tachycardia, tachypnea, dyspnea, hypotension, evt leading to cardiogenic shock.

28
Q

Cardiac tamponade

etiology

A

Penetrating trauma, iatrogenic (CVC, pacemaker insertion, pericardiocentesis) pericarditits, post MI free wall rupture.

29
Q

Treatment

Cardiac tamponade

A

pericardiocentesis, pericardiotomy, avoid diuretics and vasodilators, treat underlying cause.

30
Q

DX of Cardiac tamponade

A

echo, cxr (cardiomegaly without pulm vascular congestion) ECG (electrical alterans)

31
Q

Long QT syndrome

definition

A

QT: start of Q wave until the end of T wave. represents the time taken for ventricular depolarization, and reploarization. QT shortens as HT inc and prolonges as HR dec. Abnormally prolonged QT is associated with Inc risk of ventricular arrhythmia.

32
Q

Long QT syndrome

etiology

A

Hypokalemia, hypomg, hypoca, hypotermia, MI, congential long QT syndrome, inc ICP; post cardiac arrest, DRUGS: antipsychotic, antiarrhythmic, TCA, MACROLIDES (erythromycin)

33
Q

Long QT syndrome

clinical presentation

A

syncope, cardiac arrest and SCD

34
Q

clinical features of aortic aneurysm

A

75 % = ASYMPTOMATIC, syncope, pain (chest, abdomen, flank, back), hypotension, pulsatile abd mass, hoarsness, airway or esophageal obstruction, hoarsness, hemoptysis, hematemesis

35
Q

Classical trias of ruptured AAA

A

pain, hypotension, pulsatile abdominal mass.

36
Q

aortic aneurysm

etiology

A

Degeneration, traumatic, CT disorders, vasculitis, infection (syphilis, fungal), RF = smoking, HTN, age, FHx.

37
Q

Dx of anurysm

A

CBC, electrolytesm urea creatin, PTT, abdominal usg, CT MRI

38
Q

TX of aneurysm

A

5,5 cm or rapid rate of enlargement or symptoms + comorbidities = surgery.

39
Q

Peripheral vascular disease: symptoms

A

pain decreases with walking, better with hanging legs out of bed and worse when elevating foot. (reverse of symptoms of DVT)

40
Q

cardiac tamponade

etiology

A

major complication of rapidly accumulating pericadial effusion. Cany be due to any cause of pericarditis but esp: malignancy, uremia, trauma, proximal aortic dissection w rupture

41
Q

cardiac tamponade

SSX

A

tachycardia, hypotension, distenden neck veins (inc JVP), pulsus paradoxus: inspiratory fall in s BP >10 mmhg during quiet breathing.. Muffeled heart sounds.

42
Q

aortic dissection etiology

A

HTN; CT disease (marfan, elhers danlos) atherosclerosis, infections (syphilis) trauma

43
Q

Atheroslerosis definition

A

is a specific form of arteriosclerosis in whihch an artery-wall thickens as a result of invasion of and accumulating WBC (foam cells) and proliferation of intimal smooth muscle cell creating a fibrofatty plaque

44
Q

RF for Atheroslerosis

A

Non modifiable: age, male , FHx
Modifiable: hyperlipidemia, HTN, DM, smoking.
Metabolic syndrome, obesity, sedentary lifestyle, heavy alkohol intake.

45
Q

Etiopatopathgenes

A

RF cause endothelial injury – >monocyte recruitment and enhanced LDL permeability , monocytes enters into intimal space –> becomes macrophage take up oxidized LDL to become foam cell, cytokines and growth factors –> medial smooth muscle proliferation.

46
Q

Consequence of formation of an atherosclerotic plaque

A

thrombose, emboli, bleeding into plaque (obstruction) calcification, aneurysm

47
Q

Treatment of atherosclerois

A

Treatment of RF, lifestyle modification.

48
Q

Infective endocarditits etiopathogenesis, clinical picture, differential diagnosis

A

Fever + new murmur is IE until proven otherwise. Acute IE = s. aureus, usually on normal valves. RF for acute: Iv injection, dermatitis, renal failure, organ transplant, post op wounds, DM. Subacute (MC) usually have abnormal heart valves. Strep viridans. RF for subacute: Aortic and mitral valvular disorder. prothetic valves.
Can also be caused by HACEK, fungal, SLE

49
Q

Infective endocarditits clinical picture

A

fever, chills, malaise, weight loss, clubbing, cardiac murmus. osler node (painful in pulp, subacute), janeway lesion (acute, paimless: palmar and plantar). Emboli may cause abscess: brain kidney, spleen, gut

50
Q

DDx IE

A 
Antiphospholipid Syndrome
Atrial Myxoma
Infective Endocarditis
Lyme Disease
Systemic Lupus Erythematosus
Polymyalgia Rheumatica
Primary Cardiac Neoplasms
Reactive Arthritis
51
Q

Rheumatic fever

etiopathogenesis

A

peake age: 5-15. Due to GAS infection of phraynx, 2-4 weeks later. antibody cross react and may cause permanent damage to the heart valves.

52
Q

Clinical picture and dx rheumatic fever

A

Jones criteria: migratory artheritis (large joints), carditis (tachycardia, murmur, cardiomegaly, pericardial rub), subcutaneous nodules (painless, extensor surfaces), erythema marginatum: (thigh, trunk, arms). Sydenham´s chorea. Minor: inc temp and crp, arthralgia, prolonged PR time, previous RF.

53
Q

differential diagnosis rheumatic fever

A 
Gonococcal Arthritis
Juvenile Idiopathic Arthritis
Lyme Disease
Mixed Connective-Tissue Disease
 Systemic Lupus Erythematosus
Reactive Arthritis
Rheumatoid Arthritis
Septic Arthritis
54
Q

Rheumatic fever

treatment

A

Bedrest, Penicillin, analgesia for arthritis and carditis, haloperidol or diazepam for chorea

55
Q

Pericarditis: etiopathogenesis, clinical picture, diagnosis, treatment

A 
Iddiopathic: most common
viral: coxackie a, B (MC) echovirus
Bactrial: s pneumonia, s aureus 
TB
fungal: hisoplasmosis, blastomycosis
Post MI, post cardiac surgery or trauma, uremia (common), neoplasm (hodgkin, breast, lung, RCC, melanoma), SLE, RA, scleroderma, dissecting aneurysm, drugs (hydralazine), infiltrative disease
56
Q

clinical picture Pericarditis

A

pleuritic chest pain, pericardial friction rub, fever and malaise

57
Q

Diagnosis Pericarditis

A

ECG: initially diffuse elevated ST segments, can be depressed. CXR: normal heart size, pulm infiltrates. ECHO: assess for pericardial effusion

58
Q

Tx Pericarditis

A

Treat underlying disese, high dose NSAIDS, analgesi.

59
Q

DDx Pericarditis

A

Acute Gastritis

Angina Pectoris

Aortic Dissection

Aortic Stenosis

Coronary Artery Vasospasm

Esophageal Rupture

Esophageal Spasm

Esophagitis

Gastroesophageal Reflux Disease

Myocardial Infarction

Myocardial Ischemia

Peptic Ulcer Disease

Pulmonary Embolism

Internal medicine (9 decks)

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