Cardiology 1

Question 1

What Systemic Diseases Commonly cause heart disease too?

Answer 1

Hyper/hypothyroidism AIDS
Diabetes Mellitus Marfan Syndrome
Amyloidosis Friedreich Ataxia
Hemochromatosis Osteogenesis Imperfecta
Carcinoid Lyme Disease
Hypereosinophilic Syndrome
Scleroderma
SLE
RA

Question 2

Cardiac Effects of Hyperthyroidism

Answer 2

tachycardia, increased cardiac output, decreased PVR with a widened pulse pressure. Atrial Fib, Angina, palpitations, presyncope, DOE

Question 3

Common Presentation of Hyperthyroidism

Answer 3

older woman, weight loss, weakness, tachycardia with or without angina or a fib. Tremor of fingers/tongue +/- goiter

Question 4

Description of the PE findings of Hyperthyroid associated heart disease.

Answer 4

tachycardia, bounding pulse with a wide pulse pressure.

Forceful apical impulse and a systolic ejection murmur. A fib in 10-20%. (always check thyroid function in a fib.

Question 5

Cardiac Effects of Hypothyroidism

Answer 5

cardiac enlargement, decreased function, bradycardia, decreased myocardial contractility and stroke volume and increased PVR. 30% with pericardial effusion. Possibly increased cholesterol

Question 6

Common presentation of hypothyroidism

Answer 6

elderly patient with depression, lethargy and slowed mentaion. Hair loss, macroglossia, sinus bradycardia, EKG with low voltage QRS with prolonged QRS, PR and/or QT. Increased cardiac size

Question 7

Description of the PE findings of Hypothyroid associated heart disease

Answer 7

Cardiac enlargement due to myocardial disease or to pericardial effusion. Decreased pulse volume, sometimes heart failure. Accelerated atherosclerosis.

Question 8

Cardiac Effects of Diabetes Mellitus

Answer 8

Premature atherosclerosis, increased hypertension and hyperlipidemia, angina and myocardial infaction may be atypical or silent. Congestive heart failure common first sign of CAD. Other cardiomyopathy without atherosclerosis from microvascular disease may exist.

Question 9

Treatment of cardiovascular disease associated with Diabetes Mellitus

Answer 9

BARI trial showed CABG better than STENT if multivessel disease. (no clopidogrel in that trial)
Risk factors include glycemic control and urinary protein excretion. AGRESSIVE BP lowering reduces mortality, glycemic control does not reduce incidence of cardiac problems in the short term.. Statins and fibrates, aspirin, ACE inhibitors

Question 10

Cardiac Effects of Amyloidosis

Answer 10

Extracellular deposition of insoluble proteins in organs. Caused by monoclonal immunoglubulin free light chains.

Question 11

Genetics of Amyloidosis

Answer 11

familial type is autosomal dominant and due to mutant transthyretin
“wild-type” or “senile type” is due to noraml transthyretin deposisiton
Secondary type is related to amyloid A protein, often from multiple myeloma

Question 12

Cardiac findings of primary Amyloidosis

Answer 12

Usually AL type.(90% with heart manifestations) enlarged heart with thickened myocardium, conduction abnormalities, valvular clogging by depositied proteins. arrhythmias, heart failure with left ventricular diastolic dysfuntion and sudden cardiac death.

Question 13

Organs involved in Amyloidosis

Answer 13

heart, liver, kidney, GI tract and nervous tissue.

Question 14

Causes of Secondary Amyloidosis

Answer 14

RA, TB, chronic infection, neoplasia (multiple myeloma) and chronic renal failure. Cardiac involvement may occure, but not common.

Question 15

Clinical Presentaion of Amyloidosis

Answer 15

CHF, arrhythmia, sudden death, angina, pericardial effusion, murmurs.
Patient 40-70 years old presents with dyspnea and progressive edema. May also have hoarsness, carpal tunnerl or peripheral neuropathy. LOW-V
OLTAGE QRS with or without other conduction abnormalities coupled with echocardiographic findings of thick wall and preserved ventricular function.

Question 16

Diagnostic indicators of Amyloidosis

Answer 16

EKG, Echo (increase in LV wall thickness in spite of EKG with low or normal voltage. Atria may be dilated, valves thickened with mild regurg. pericardial effusion. Abnormal Diastolic function (restrictive filling)

Question 17

Treatment of Amyloidosis

Answer 17

Correcting the underlying problem does not usually help the cardiac problems. Try experimental protocols.

Question 18

Cardiac effects of Hemochromatosis

Answer 18

congestive heart failure

Question 19

Tetrad of Hemochromatosis

Answer 19

diabetes, liver disease, brown skin pigmentation, congestive heart failure

Question 20

Treatment of cardiomyopathy from hemochromatosis

Answer 20

prognosis is poor once symptoms appear. Treat with phlebotomy and iron chelation.

Question 21

Clinical Presentation of hemochromatosis

Answer 21

middle aged with heart failure. Well tanned with diabetes or increased blood glucose, arthralgias and loss of libido.

Question 22

diagnosis of hemochromatosis

Answer 22

Transferrin saturation and serum ferritin

Question 23

Cardiac Effects of Carcinoid Tumor

Answer 23

derotonin like substances are toxic to valves, usually on the right because the toxins are metabolized in the lungs.

Question 24

Classic Syndrome of carcinoid tumor

Answer 24

cutaneous flushing, wheezing and diarrhea

Question 25

What is a carcinoid lesion?

Answer 25

fibrous plaques that form on valvular endocardium. Valve leaflets becdome thickened, immobile and retracted causing regurgitaion with stenosis in the tricuspid and pulmonary valves.

Question 26

Clinical presentation of Carcinoid

Answer 26

50-70yo patient with weight loss, fatigue, watery diarrhea, dyspnea on exertion and audible wheezes. Red complexion and gets hot flashes.

Question 27

Cardiac and other exam findings in carcinoid

Answer 27

prominent V wave in increased jugular venous pressure profile, pulsatile liver that may be enlarged, ascites and peripheral edema.

Question 28

Diagnosing Cardiac carcinoid

Answer 28

EKG with RVH and RBBB. Echo with thickened tricuspid valve and pulmonary valve and liver mets. Get 24hr urine for 5-hydroxyindoleacetic acid.

Question 29

Treatment of Carcinoid Cardiac problems

Answer 29

Treat the tumor. If heart intervetion is necessary because of right heart failure, tricuspid valve replacement and pulmonary valve resection may be needed.

Question 30

Causes of Eosinophilic Syndrome

Answer 30

idiopathic hypereosinophilia, Loffler endocarditis, reactive or allergic eosinophilia, leukemic or neoplastic eosinophilia or Churg-Strauss syndrome

Question 31

Clinical Features of Eosinophilic syndrome

Answer 31

young male patient with weight loss, fatigue,,dyspnea, syncompe and systemic embolization. Cardiac manifestations: arrythmia, myocarditis, conduction abnormalities, thrombosis

Question 32

Cardiac manifestations of Eosinophilic syndrome

Answer 32

arrythmia, myocarditis, conduction abnormalities, thrombosis. Eosinophilic deposition, clot formation at the apices of the ventricles and in the inflow portions under mitral and tricuspid valves leading to regurgitation. Clot scars leading to endomyocardial fibrosis and restrictive cardiomyopathy. GET A CBC WITH DIFFERENTIAL

Question 33

Cardiac effects of SLE: syndromes

Answer 33

antiphospholipid syndromme, Libman-Sacks endocarditis, congential heart block in the offstrping of mothers with lupus.

Question 34

Cardiac effects of SLE: findings

Answer 34

pericarditis, myocarditis, valvulopathy, coronary arteritis, and Libman-Sacks endocarditis.

Question 35

Libman-Sacks endocarditis

Answer 35

noninfective vegetation. It does not embolize or interfere with valvular function

Question 36

Cardiac Effects of Scleroderma

Answer 36

intramural coronary and immune-mediated endothelial injury. Third most common cause of mortality. conduction defects in 20%, pericarrdial effusion in 1/3 but usually asymptomatic.

Question 37

Common presentation of Scleroderma

Answer 37

sclerotic changes, dysphagia, Raynaud phenonmenon, pericardial effusion, conduction defects, pulmonary hypertension and cor pulmonale.

Question 38

Cardiac Effects of Rhematoid Arthritis

Answer 38

pericardium, myocardium, valves, coronary arteries, and aorta. Granulomatous and non granulomatous inflammation of valve leaflets. Pericarditis of RA is associated with a low glucose level and complement depletion in the pericardial fluid. RA nodules may lead to heart block if they are deposited in the conduction system. Aortitis and pulmonary hypertension due to pulmonary vasculitis are rare

Question 39

Ankylosing Spondylitis and Cardiac effects

Answer 39

Aortic dilation and regurgitation may be in 10% of patients. Aortic valve cusps becdome distorted and retracted leading to aortic regurg. Conduction system may be involved as a result of fibrosis and inflammation.

Question 40

Cardiac effects of Marfan Syndrome

Answer 40

.mitral valve prolapse, aortic regurg due to aortic dilation and increased risk of aortic dissection. (use long term Beta blockade to slow this) Dissection occurs rarely inh aorta less than 5.5cm. If it occurs it tends to start in the ascending and etend along the entire aorta

Question 41

Marfan Syndrome features in general

Answer 41

AD condition associated with degenerative elastic tissues, arachnodactyly, tall stature, pectus excavatum, kyphoscoliosis and lenticular dislocation

Question 42

Cardiac effects of Friedrich ataxia

Answer 42

Autosomal Resessive with the heart involved in 90% of cases. Usually symmetrical hypertrophy but sometimes as a dilated cardiomyopathy.

Question 43

Cardiac effects of Osteogenesis Imperfecta

Answer 43

Brittle bones, blue sclera and deafness. Lack of collagen supporting matrix– leads to aortic root dilation, aortic regurgitation, annular dilation and chordal stretch causing atrioventricular regurg.

Question 44

Cardiac effects of Lyme Disease

Answer 44

spirochete infection by Borrelia burgdorderi. 10% have clinical cardiac involvement. AV block and Lyme carditis. Typically biopsy of the right ventrical or gallium scanning for diagnosis

Question 45

Cardiac effects in AIDS

Answer 45

clinically evident in about 10%. Myocarditis in about 50% at autopsy. May be ventricular arrhythmias, dilated cardiomyopathy, pericarditis or infection or malignant invasion of the cardiac structures.

Question 46

Cardiac Trama

Answer 46

arrhythmia, increased cardiac enzymes, transiet regional wall motion abnormalities and pericardial effusion or tamponade. Commotio cordis is sudded cardiac death due to mild trauma. (baseball,softball)
impact must occur 15-30 msec before or after the T-wave