Cardio Path 2 Flashcards by Jeff Rossow

What can cause the most common type of cardiomyopathy?

Dilated cardiomyopathy is caused by ABCCCD. Alcohol abuse, Beriberi, Coxsackie B, Cocaine, Chagas disease, Doxorubinicin, and hemochormatosis and peripartum cardiomyopathy

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How do you treat dilated cardiomyopathy? What kind of dysfunction ensues if untreated?

Transplant is the only way (pathoma says so). It is systolic dysfunction b/c dilated so much.

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What is the cause of hypertrophic cardiomyopathy?

Autosomal dominance is 60-70%. Young athletes can have it and SUDDEND EATH from ahhrythmia

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How do you treat a young athlete with an S4 and possibly systolic murmur?

It is hypertrophic cardiomyopathy. Stop high intensity athletics and use Beta blocker or verapamil.

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Because we care so much about pictures, note that hypertrophic cardiomyabothy has a unique histology:

Myofibrillar disarray (fibers go every which way)

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What is obstructive HCM?

Hypertrophied septum interferes with mitral leaflet and outflow is obstructed and dyspnea, or syncope can happen

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When do you see low voltage ECG?

Restrictive/infiltrative cardiomyopathy b/c there is non-cardiac tissue in the heart that doesn’t conduct electricity well, despite thick appearing myocardium

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What causes restrictive/infiltrative cardiomyopathy?

sarcoid, amyloidosis, postradiation fibrosis and endocardial fibroelastosis and LOFFLER SYNDROME: (endomyocardial fibrosis with EOSINOPHILIC INFILTRATE) and hemochromatosis

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What cardiomyopathy can hemochromatosis cause?

There are 2 things! Dilated and restrictive

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What decreases mortality in CHF? (what is more for symptomatic relief and no evidence in mortality)?

ACEi, beta blockers, Angiotensin II receptor blockers, sprionolactone, diuretics are more for symptomatic relief

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What are hemosiderin-laden macrophage?

Heart failure cells in lungs

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What is arguably most important drug in CHF and why?

ACEi b/c low cardiac output causes more renin/angiotensin-aldosterone pathway so more volume which exacerbates problem from after load and preload affecting the heart

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What does orthopnea happen?

CHF. Laying means more venous b/c redistribution of blood and more pulmonary vascular congestion

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Acute vs subacute endocarditis organism

Acute: S aureus (BAD symptoms and IV users usually)
Subacute: S viridans is most common overall cause (low virulence) on valves that had already been damaged (s bovid if colon cancer or epidermis if prosthetic)

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Does endocarditis destroy heart valves?

Staph A does, otherwise no (remember IV drug users are hit on tricuspid, which makes sense)

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What organisms cause endocarditis with negative blood cultures?

HACEK. Haemophilus, Actinobacillus, Cardiobacterium (easy to remember that one), Eikenella, Kingella

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Which valves are affected by rheumatic heart?

Mitral>aortic»tricuspid (high pressure hit most)

Rheumatically affected valve does what?

Early it is regurg, then mitral stenosis

2 Histology markers of rheumatic carditis?

Aschoff bodies (granuloma with GIANT CELLS!) and Anitschkow cells (enlarged macrophage with wavy rod like nucleus) Pics on page 292 in FA 2014.

Jones criteria?

Evidence of previous Group A infection. Minor criteria is fever and ESR
Major criteria: J<3 Pancarditis (all layers and can cause acute death)
Nodules of skin
Erythema marginatum (more red on border)
Sydenham chorea (dancing)

What causes three types of pericaditis?

Fibrinous: Dressler syndrome, ureamia and radiaiton
Serous: Viral pericarditis (spontaneous resolution) or noninfectious inflame like rheumatoid arthritis and SLE
Supportive/purulent: caused by bacterial infections like Pneumococcus andstreptococcus(now rare with antibiotics)

Pulses paradoxus?

lower in amplitude of systolec BP by more than 10 mmHg during inspiration. Happens with tamponade, asthma, obstructive sleep apnea, pericarditis and croup

What is syphilitic heart disease?

tertiary syphilis disrupts vasa vesorum (vessels of the vessel) of aorta so atrophy of vessel an looks like “tree bark” appearance of aorta. Can result in aneurysm of ascending aorta and aortic insufficiency b/c of it

Most common cardiac tumor for adults? how about children?

Overall most common is metastasis from melanoma or lymphoma
Adults most common cardiac tumor is myxoma which has BALL VALVE that can cause syncope
Children most common cardiac tumor is rhabdomyoma

What is rhabdomyoma associated with?

tuberous sclerosis HIGH YIELD. Benign hamartomas (resembling tissue it came from, so makes sense that rhabdomyoma is a hamartoma) throughout body with this genetic mutation in tumor suppressor TSC1 and TSC2 (names for tuberosclerosis, TSC).

Kussmaul sign?

High JVP with inspiration instead of lower like normally. HAPPENS when heart can't pass on negative inthrathoracic pressure. So if there is restriction of the heart from restrictive cardiomyapothy, constrictive pericarditis or right atrial/ventricular tumors

Skipping vascular tumors on page 295 of FA 14

What are the large vessel types of vasculitis and what is the difference between the two?

Temoral Giant Cell Arteritis (elderly females) and Takayasu arteritis (asian females less than 40 with aortic arch involvement)

How do you treat every vasculitis except Kawasaki?

Corticosteroids! some other things have more stuff, but hey, its a good start

What do you see on biopsy with Temporal arteritis?

Giant cells, duh! but might miss it because the disease is segmental, so negative biopsy does not mean it is a negative test

Danger of temporal arteritis?

Blindness b/c branches of carotid is affected and can have occlusion of ophthalmic artery

35 year old asian presents with ear upper extremity pules, fever, night sweats, arthritis, myalgia, skin nodule and ocular disturbances

Takayasu arteritis. Corticosteroids. Granulomatous thickening and narrowing of aortic arch

25 year old, weight loss, mailaise, headache, abdominal pain, melena (blood in stool), HTN, neurologic dysfunction, cutaneous eruptions and renal damage? What is it? What would you see on exam and tests?and how do you treat it?

Polyerteritis NODOSA (nodes in many arteries) b/c immune complex mediated, makes sense that they are scattered everywhere. Transmural inflammation of arterial wall with fibrinoid necrosis that looks pink on histology. The fibrinoid is bumpy and feels like nodes and microaneuysms and spasm on arteriogram also look like nodes! SO NAME MAKES SENSE AND I LOVE IT. 30% have Hep B Treat with Corticosteroids (duh) and Cyclophosphamide

Asian 3 year old has a fever with fever, cervical lymphadenitis, conjunctival injection, strawberry tongue, hand-foot erythema and desquamating rash? disease and complications and tx?

Kawasaki: has vague symptoms. Imagine a kid riding a motor cycle with hand and foot erythema from holding bike so tight and heart racing from adrenaline. Complications: Coronary artery aneurysm so MI/rupture Treatment: IV immunoglobulin and aspirin (note this is the ONLY time you give aspirin to a little kid)

What is causing a person to have chronic sinusitis with nose bleeds and hemoptysis and dyspnea and hameutria and red cell casts?

Granulomatosis with polyangiitis (wagerers!) C disease. C Shape of body symptoms (nose, lung kidney) and cyclophosphamide and corticosteroids and C-ANCA. (antiNEUTROPHIL c-ANCA (anti-proteinase 3). Granulomas are a key finding here (p-ANCA doesn't have it) Granulomas are necrotizing in lung and upper airways with focal necrotizing vasculitis. CXR will have nodular densities

Microscopic polyangiitis is different than granulomatosis how?

it is MPO-ANCA/pANCA meaning against myeloeroxidase and is perinuclear. No nasopharyngeal involvement. No granulomas. Still treat with cyclophoashmaide and corticosteroids. Relapse is common

When do you have asthma, sinusitis with palpable purport and peripheral neuropathy (wrist/foot drop)? Also can involve heart, GI, kidneys. What antibodies will you find?

Churg-Strauss syndrome. Note palpable purpura. It is granulomatous necrotizing vasculitis with EOSINOPHILIA. MPO-ANCA/p-ANCA (that is like microscopic polyangiitis) with high IgE

What is most common systemic vasculitis in children? What antibodies are present (High YIELD)

Henoch-Shonlein purpura. Palpable purpura on butt and legs, arthralgia, abdominal pain, melena and many lesions starting at same time. IgA complex exposition and is associated with IgA nephropathy

How do you treat primary HTN?

Diuretic, ACE inibhitors, ARBs, calcium channel blockers

How do you treat HTN with CHF?

ACEi/ARBs, Diuretics, Aldosterone antagonists. Beta blockers MUST BE CAUTIOUSLY USED in decompensated CHF and are contraindicated in cardiogenic shock (sympathetics are important to keep you alive, sometimes, ya know)

How do you treat HTN in diabetes?

ACEi/ARBs are protective against diabetic nephropathy! others are kind of duh: Beta blockers, alpha blockers calcium channel blocker and diuretics