Cardio Flashcards
Dilated cardiomyopathy
Etiology/RF
Idiopathic: 50 %: thought to be viral (myocarditis)
Alcohol
Cocain
Positiv family history
Dilated cardiomyopathy
Ssx
May present as
CHF, systemic or pulmonic emboli
Arrhythmia
Sudden death
Dilated cardiomyopathy
Diagnosis
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
Management
Dilated cardiomyopathy
Treat underlying cause Treat CHF Anticoagulantion Treat arrhythmia Immunise against influenza and s.pneumonia
Hypertrophic cardiomyopathy
Def and general
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
Ssx
Hypertrophic cardiomyopathy
ASYMPTOMATIC
SOB
angina, syncope, CHF, arrhythmia. SCD
Hypertrophic cardiomyopathy
Diagnosis
ECG:LVH, p wave abnormality, prominent q wave (I, aVL, V5, V6)
TTE+ echo: asymmetric septal hypertrophy
Hypertrophic cardiomyopathy
Treatment
B blocker verapamil, phenylephrine
AVOID: acei, nitrates, diuretics= may worsen symptoms
If drug refractory: surgical myomectomy, ICD placement, septal ethanol ablation, dual chamber pacing
Restricted cardiomyopathy
Def
Impaired ventricular filling with preserves systolic function in a non-dilated, non-hypertrophied ventricle secondary to factors that decrease myocardial compliance = fibrosis or infiltration
Causes
Restricted cardiomyopathy
Infiltrative: sarcoidosis and amyloidosis
Non-infiltrated: scleroderma idiopathic fibrosis
Storage disease: hemochtomatosis, fabrys, gaucher, glycogen storage disease
Restricted cardiomyopathy
Clinical
CHF: usually with preserved LV systolic function, arrythmias, elevated JVP, kussmauls sign, S3, MR,TR
Restricted cardiomyopathy
Diagnosis
Ecg Echo CXR Cardiac catheterisation: Biopsy
Restricted cardiomyopathy
Treatment
Exclude constrictive pericarditis
Treat underlying disease
Supportive care and tx for CHF, arrhythmia, anticoagulants if A. Fib, heart transplant
Dilated cardiomyopathy
Definition
Unexplained dilatation and impaired systolic function of one or both ventricles
Myocarditis
Ssx
Constitutional symptoms Acute CHF Chest pain Arrhythmia Systemic or pulmonic emboli Sudden cardiac death
Myocarditis
Diagnosis
Ecg Blood: troponins ckmb LDH, AST BLOOD cultures CXR ECHO: dilated hypokinietic segmental wall motion abnormalities Biopsy
Tx myocarditis
Supportive care + rest
Treat CHF arrythmias and anticoagulation
Treat underlying cause
Left ventricular failure: ethiopatho
any acute cause or decompensation of chronic heart failure, characterized by acute dyspnea, due to pulm edema, +- peripheral edema and hypoperfusion.
Clinical: Left ventricular failure
dyspne, orthopnea, paroxymal nocturnal orthopnea, cough ( frothy pink sputum), fatigue, poor exercise tolerance, weight loss wheezing, cold peripheries
Dx Left ventricular failure
ECG, CXR (kerley B lines, plum effusion, cardiomegaly, inc pulm vasc markings), echo, BNP, cardiac enzymes,
DDX Left ventricular failure
PE, asthma, pneumonia.
Tx Left ventricular failure
o2, diuretics, sodium restriction, nitro, dobutamine.
Aortic dissection
clinical picture
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
Aortic dissection
dx and ddx
Dx: CT = gold standars, CXR (widened mediastinum, pleural cap), ECG, TEE, blood:amylase, troponin, lactate to rule out other causes.
Aortic dissection
Tx
Pharmacologic: B blocker + ACEI if insufficient BP and HR control. Target is sBP 110 mmhg and HR
Cardiac tamponade Def:
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.
Cardiac tamponade
symptoms
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.
Cardiac tamponade
etiology
Penetrating trauma, iatrogenic (CVC, pacemaker insertion, pericardiocentesis) pericarditits, post MI free wall rupture.
Treatment
Cardiac tamponade
pericardiocentesis, pericardiotomy, avoid diuretics and vasodilators, treat underlying cause.
DX of Cardiac tamponade
echo, cxr (cardiomegaly without pulm vascular congestion) ECG (electrical alterans)
Long QT syndrome
definition
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.
Long QT syndrome
etiology
Hypokalemia, hypomg, hypoca, hypotermia, MI, congential long QT syndrome, inc ICP; post cardiac arrest, DRUGS: antipsychotic, antiarrhythmic, TCA, MACROLIDES (erythromycin)
Long QT syndrome
clinical presentation
syncope, cardiac arrest and SCD
clinical features of aortic aneurysm
75 % = ASYMPTOMATIC, syncope, pain (chest, abdomen, flank, back), hypotension, pulsatile abd mass, hoarsness, airway or esophageal obstruction, hoarsness, hemoptysis, hematemesis
Classical trias of ruptured AAA
pain, hypotension, pulsatile abdominal mass.
aortic aneurysm
etiology
Degeneration, traumatic, CT disorders, vasculitis, infection (syphilis, fungal), RF = smoking, HTN, age, FHx.
Dx of anurysm
CBC, electrolytesm urea creatin, PTT, abdominal usg, CT MRI
TX of aneurysm
5,5 cm or rapid rate of enlargement or symptoms + comorbidities = surgery.
Peripheral vascular disease: symptoms
pain decreases with walking, better with hanging legs out of bed and worse when elevating foot. (reverse of symptoms of DVT)
cardiac tamponade
etiology
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
cardiac tamponade
SSX
tachycardia, hypotension, distenden neck veins (inc JVP), pulsus paradoxus: inspiratory fall in s BP >10 mmhg during quiet breathing.. Muffeled heart sounds.
aortic dissection etiology
HTN; CT disease (marfan, elhers danlos) atherosclerosis, infections (syphilis) trauma
Atheroslerosis definition
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
RF for Atheroslerosis
Non modifiable: age, male , FHx
Modifiable: hyperlipidemia, HTN, DM, smoking.
Metabolic syndrome, obesity, sedentary lifestyle, heavy alkohol intake.
Etiopatopathgenes
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.
Consequence of formation of an atherosclerotic plaque
thrombose, emboli, bleeding into plaque (obstruction) calcification, aneurysm
Treatment of atherosclerois
Treatment of RF, lifestyle modification.
Infective endocarditits etiopathogenesis, clinical picture, differential diagnosis
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
Infective endocarditits clinical picture
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
DDx IE
Antiphospholipid Syndrome Atrial Myxoma Infective Endocarditis Lyme Disease Systemic Lupus Erythematosus Polymyalgia Rheumatica Primary Cardiac Neoplasms Reactive Arthritis
Rheumatic fever
etiopathogenesis
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.
Clinical picture and dx rheumatic fever
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.
differential diagnosis rheumatic fever
Gonococcal Arthritis Juvenile Idiopathic Arthritis Lyme Disease Mixed Connective-Tissue Disease Systemic Lupus Erythematosus Reactive Arthritis Rheumatoid Arthritis Septic Arthritis
Rheumatic fever
treatment
Bedrest, Penicillin, analgesia for arthritis and carditis, haloperidol or diazepam for chorea
Pericarditis: etiopathogenesis, clinical picture, diagnosis, treatment
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
clinical picture Pericarditis
pleuritic chest pain, pericardial friction rub, fever and malaise
Diagnosis Pericarditis
ECG: initially diffuse elevated ST segments, can be depressed. CXR: normal heart size, pulm infiltrates. ECHO: assess for pericardial effusion
Tx Pericarditis
Treat underlying disese, high dose NSAIDS, analgesi.
DDx Pericarditis
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
