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clin med > cardio day 2 pp3 > Flashcards

cardio day 2 pp3 Flashcards

1
Q

myocarditis?

A

Heart is inflamed and has dec cardiac function

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2
Q

2 phases of myocardial cell damage

in myocarditis and MCC

A

Myocardial cells are damaged from viral infection
Myocardial cells are damaged from hosts immune response
Lymphocytic myocarditis- MC

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3
Q

Ongoing inflammation in myocarditis causes_________

A

myocardial inflammation, dilated CMP, restrictive CMP, acute LV failure

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4
Q

Can be “focal”- in just one part of the heart so we like to get 4-6 biopsies

A

myocarditis

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5
Q

myocarditis cause

A

MCC coxsackievirus and echovirus
Hypersensitivity of eosinophils and leukocytes
GAS Rheumatic carditis
Lyme carditis from borrelia burgdorferi

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6
Q

myocarditis sx

A

Chest pain, joint pain, myalgia, fatigue, palpitations, CHF, syncope, SCD, fluid retention/edema

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7
Q

myocarditis pe

A

fever over 100.4, pericardial friction rub, diminished CO

If serious, tachycardia, weak pulses, cool extremities, muffled heart tones, S3, JVD, edema

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8
Q

myocarditis dx

A

ECG- T wave inversion, ST elevation, Q waves, BBB, prolonged QT, high grade AV block, AFib, ventricular arrhythmias
CXR- cardiomegaly, pleural effusion
Labs: CBC, blood cultures, cardiac enzymes, LDH, ESR, CRP, IgM serologies, anticardio IgG and IgM
Leukocytosis, high troponin and CKMB, high inflammatory markers, eosinophilia
Echo- LV EF, wall motion abnormalities, in filling pressures, left pleural effusion
MRI- inflammation, delayed enhancement of gadolinium

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9
Q

myocarditis trmt

A

Endocardial biopsy for if you have acute deterioration of cardiac function, unknown cause, and unresponsive to therapy
If due to Rheumatic carditis, give PCN
If from hypersensitivity of eosinophils and leukocytes, remove agent and give corticosteroids
If from lyme carditis, give corticosteroids and tetracycline

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10
Q

Dilated CMP?

A

Heart is weak and enlarged

Walls are thin and cant contract well

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11
Q

causes Dilated CMP

A

Nonischemic- toxic, metabolic, infectious, autoimmune, ETOH, adriamycin, herceptin, PVC, pregnancy peripartum
Ischemic- MI, CAD
Idiopathic- genetic
MC in men 20-60 yo

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12
Q

sx Dilated CMP

A 
CHF (orthopnea, PND, edema, weight gain, low output state)
SCD (sudden cardiac death)
Atrial Arrhythmias 
Syncope
Chest pain
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13
Q

exam Dilated CMP

A

JVD, rales, S3, hepatomegaly, pitting edema, displaced PMI, murmur

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14
Q

dx Dilated CMP

A

X ray, echo, cath, cardiac MRI, genetic testing

ECG- LBBB, atrial or ventricular arrhythmias

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15
Q

trmt Dilated CMP

A 
ICD
Beta blockers
Afterload reduction- ACE, ARB, Entresto
Aldactone
Anticoag- LV thrombus
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16
Q

Hypertrophic CMP

pathyphys

A

Pathophys:
R or L ventricular hypertrophy
LVOT obstruction
Diastolic dysfunction
Myocardial ischemia
Mitral regurg
Arrhythmias
LVOT gradient- increased with dec preload or afterload or inc contractility
Venturi effect- dec in pressure when blood flows through a stenosis at high venosity
Dec in pressure causes anterior leaflet of mitral valve to go in that direction
Chordal SAM- anterior mitral valve leaflet and chordae get sucked into outflow tract causing a “jet MR” in mid-late systole

17
Q

HOCM causes

A

Genetic, autosomal dominant
Leading cause of SCD in athletes less than 35 yo
MC Asymmetric hypertrophy of septum and anterior wall

18
Q

mcc hypertrophic CMP

A

HOCM

19
Q

sx hypertrophic CMP

A

SOB, CP, palpitations, LH, fatigue, syncope, SCD

LVOT obstruction can cause acute hemodynamic collapse

20
Q

PE hypertrophic CMP

A

Prominent Q wave, rapid upstroke carotid pulse, lateral PMI, s4, systolic ejection murmur, mitral regurg murmur, sinus tach

21
Q

dx hypertrophic CMP

A

ECG- no changes pathognomonic; LVH and repolarization changes
Echo- asymmetric septal hypertrophy, systolic anterior motion of MV, thick LV wall and small LV cavity, diastolic dysfunction
Obstructive vs nonobstructive
Obstructive- resting LVOT gradient over 30 mmHg
Nonobstructive- resting LVOT gradient less than 30 mmHg
Cardiac cath- ischemia
Brochenbrough response- after PVC you have inc LV SBP, dec aortic SBP, inc gradient between LV and AoV

22
Q

trmt hypertrophic CMP

A

Reassurance
Screen if genetic via echo
No competitive athletics
Exercise testing
48 hr holter- looks for silent arrhythmias
Antiarrhythmic
Beta blocker- slows HR to inc diastolic filling
CCB (Verapamil)
Surgery- transplant or remove septal muscle
NSRT (nonsurgical septal reduction therapy)- occlude septal artery with catheter and ETOH
Antigoag- bc they have inc risk for AFib and thromboembolism

23
Q

Restrictive CMP?

A 
Systemic disease involving myocardium
Classification:
Non Infiltrative- idiopathic, familial, scleroderma
Infiltrative- amyloidosis, sarcoidosis
Storage disease- hemochromatosis
Endocardial fibrosis
Carcinoid
Malignant infiltration
24
Q

exam

Restrictive CMP

A

S3

25
Q

dx

Restrictive CMP

A

CXR- no Ca
Echo- both atria dilated, normal or small LV, diastolic dysfunction
ECG- BBB, AV block
CT/MRI- normal pericardium
Biopsy- fibrosis, hypertrophy, infiltration
Hemodynamics- unequal diastolic pressures

26
Q

Constrictive CMP exam

A

Pericardial knock

27
Q

Constrictive CMP dx

A 
CXR- pericardial calcification
Echo- normal atria and ventricles; effusion
ECG- abnormal repolarization
CT/MRI- pericardial thickening; effusion
Biopsy- normal 
Hemodynamics- normal diastolic pressures
28
Q

Constrictive CMP?

A

Acute pericarditis, cardiac surgery, radiation, chest trauma, systemic disease inv. pericardium

29
Q

amyloidosis?

A

Interstitial amyloid protein deposits on organs usually the heart
Causes restrictive CMP

30
Q

dx amyloidosis

A

Echo- granular/sparkling myocardium in a patchy distribution
Impaired LV relaxation
Serum and protein electrophoresis is diagnostic
Fat pad biopsy or RV endomyocardial biopsy

31
Q

trmt amyloidosis

A

No cure- limit production of amyloid proteins

Steroids, immunosuppressives, hemodialysis, SCT, chemo, support

clin med (35 decks)

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