Cardio Flashcards by Nayla Mansoor

What part of the heart is most involved in an MI

LAD, causing anterior wall infarct

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What are other involved areas of the heart s/p MI

RCA causes RV and posterior LV wall infarct

LCA causes lateral wall of LV infarct

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What is the main reason for sudden cardiac death

Major cardiac arrhythmia (VFib)

-Later on, complete heart block/pump failure

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What are the two types of MI

Transmural MI: involves all 3 layers of of the heart (LV/IVS)
Intramural/subendocardial: involved endocardium and 1/2 of myocardium- some contraction possible, but weaker

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What kind of MI has a worse prognosis

Transmural, because it involves all 3 layers of the heart

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What are 3 complications of an MI

Ventricular rupture, aneurysm, and clot

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What can MI complications listed lead to

HF, cariogenic shock, organ failure, and cerebral ischemia

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What are the general features of myocarditis

virus can’t survive outside the cell, so it goes into actual muscle cells. IL and TNS go into muscle cell to kill virus, but end up damaging out heart as well

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What are characteristic signs of myocarditis

Tiger effect: pale, congested areas with hypertrophy and biventricular dilation
Flabby, dilated heart
Patchy, diffuse interstitial infiltrate made of T cells and macrophages

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What is the prognosis of myocarditis

Patients usually recover, if acute.

If patients die, it is due to co-morbid conditions (CHF, arrhythmia)

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What is the cause of myocarditis

Coxsackie B virus

can be a primary dz, or secondary due to RF or other AI dz

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Can myocarditis be caused by bacteria?

Rarely- if it is, then its due to diphtheria, strep, or Staph

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How do you diagnose myocarditis

Endomyocardial biopsy (punch biopsy from LV or R heart)

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How do you treat myocarditis

Supportive Tx!

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What are the causes of pericarditis

Bacteria, Viruses, Fungi, RHD, Uremia (chronic renal failure)

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What are the types of pericarditis and their specific causes

Serous pericarditis: Viral

Purulent exudate: bacteria, Staph and Strep

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What is the cause of fibrinous pericarditis

Rheumatic fever or early bacterial infections

-Lupus is good example of serofibrinous effusion

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What is another name for fibrinous pericarditis

Bread and Butter (friable fibrin strands between parietal and visceral layers of pericardium)

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What is a cardiac myxoma

Primary cardiac tumor in ADULTS- found in LA- can cause mitral valve dysfunction- can lead to death by emboli to the brain

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What is a Rhabdomyoma

Primary cardiac tumor in KIDS- In LV/RV, also atria

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What is the difference physically between cardiac myxoma and rhabdomyoma

Cardiac myxoma is gelatinous with a stalk

Rhabdomyoma is a pale grey mass projecting into cardiac chamber

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Where does the heart accept metastasis from

Lung, breast, and GI tract mainly

All lead to restrictive CM

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What are the RF for atherosclerosis

A Small Happy Lamb Hopped Over Dads Cop Shoes;

–Age, Sex, Heredity, Lipid metabolism, Hypertension, Obesity, Diabetes, Cigarette smoking, Stress

What are the 2 most common underlying conditions that start atherogenesis

Hypertension and Diabetes

What are the common complications of atherosclerosis of the aorta

Aorta becomes a rigid tube with jagged internal surface covered in thrombi Calcified aorta can't adjust to changing pressure, Hypertension, aneurysm, rupture (rupture is deadly, death by exsanguination)

What cells are involved in atherogenesis

Platelets (release growth factors that stimulate smooth muscle proliferation) Macrophages (eat lipids and become foam cells-- also release TNF and cytokines, causing collagen production)

What does collagen build up in an arterial lesion lead to

stenosis (calcification)

What is acute endocarditis

highly destructive infection of previously normal valve causing necrotic valvular lesions Death within days, even with abx

What are symptoms of acute endocarditis

fever, murmur, QUICK onset, chills, weakness

What is subacute endocarditis

slower, less virulent infection of previously abnormal valve. Patients recover well w/ abx

What are symptoms of subacute endocarditis

low grade fever, murmur, flu Sx

What are the specific causes of each type of endocarditis

Acute: Staph Aureus Subacute: Strep. Viridans

What are RF for endocarditis

``` Artificial valves Bicuspid aorta Valvular stenosis MVP Congenital defects ```

What organism is most commonly involved with prosthetic valve endocarditis

Staph Epidermidis | also enterococci, gram - bacteria

Where are vegetations found in RHD

along the closure of the valves, they are sterile lesions

What is the most common complication of RHD

secondary bacterial endocarditis

Which valve is most involved in IVDU, and which organism

``` Tricuspid valve (R heart) Staph Aureus (then strep, and candida) ```

What is the end result of valvular INSUFFICIENCY

Mitral: atria dilate d/t blood reflux in systole Aortic: LVH/dilation d/t backflow in diastole

What are the end results of valvular STENOSIS

Mitral: clot in LA goes into pulmonary circulation causing RVH/RHF Aortic: eventually RHF

What is responsible for most deaths after the acute phase of RHD

Endocarditis

What is CAFE P (jones criteria for RF)

``` CRP elevated Arthralgia Fever ESR elevated/EKG Previous RF ```

What is CANCER (jones criteria for RF)

``` Carditis Arthritis Nodules Chorea Erythema marginatum (rheumatic fever) ```

What is pancarditis

inflammation of all three layers of the heart d/t RHD

What is Sydenhams chorea

involuntary, continuous jerky movements of limbs, trunk, and face d/t RHD

What is fish mouth stenosis

in endocarditis, the chordae tendinae of mitral valve are thick short and fused causing fish mouth structure

What are Aschoff bodies

clumps of lymphocytes and macrophages around central necrosis in Myocarditis Eventually they form a scar

What is an ASO titer

serum testing presence of antibodies to Strep antigen O, which develops in all RF patients

What is erythema marginatum

in RF, maculopapular erythematous rash over trunk and proximal limbs but NOT face No scarring

What lab findings are associated with RHD

ESR and CRP (though nonspecific) ASO titer indicates recent Strep Progenies (concrete evidence) Throat culture will be negative (bacteria present 2-3 weeks ago)

How is native tissue destroyed in RF

ASO abs develop against strep antigens, but they cross react with similar antigens in the heat leading to valve destruction

What is the most common cardiomyopathy

Dilated CM: progressive chamber dilation and systolic dysfunction= reduced EF

What is popcorn for hypertrophic CM

Banana septum! extensive LVH=LV obstructs flow | AKA IHSS

What are characteristics of restrictive CM

decrease in ventricular compliance causing abn diastole | Patty interstitial fibrosis

What can restrictive CM be due to

abnormal infiltrate (amyloid, sarcoidosis, tumor)

What CM yields the largest heart

Hypertrophic; can reach 1200g

What are causes of dilated CM

``` #1: alcohol induced! #2: anti-cancer drugs (Adriamycin) cocaine, cobalt exposure, viral myocarditis, pregnancy, pheochromocytoma ```

What are causes of restrictive CM

idiopathic | amyloid, sarcoidosis, metastatic tumor