Cardiology 1 Flashcards
Mayo Clinic Internal Medicine
What Systemic Diseases Commonly cause heart disease too?
Hyper/hypothyroidism AIDS
Diabetes Mellitus Marfan Syndrome
Amyloidosis Friedreich Ataxia
Hemochromatosis Osteogenesis Imperfecta
Carcinoid Lyme Disease
Hypereosinophilic Syndrome
Scleroderma
SLE
RA
Cardiac Effects of Hyperthyroidism
tachycardia, increased cardiac output, decreased PVR with a widened pulse pressure. Atrial Fib, Angina, palpitations, presyncope, DOE
Common Presentation of Hyperthyroidism
older woman, weight loss, weakness, tachycardia with or without angina or a fib. Tremor of fingers/tongue +/- goiter
Description of the PE findings of Hyperthyroid associated heart disease.
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.
Cardiac Effects of Hypothyroidism
cardiac enlargement, decreased function, bradycardia, decreased myocardial contractility and stroke volume and increased PVR. 30% with pericardial effusion. Possibly increased cholesterol
Common presentation of hypothyroidism
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
Description of the PE findings of Hypothyroid associated heart disease
Cardiac enlargement due to myocardial disease or to pericardial effusion. Decreased pulse volume, sometimes heart failure. Accelerated atherosclerosis.
Cardiac Effects of Diabetes Mellitus
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.
Treatment of cardiovascular disease associated with Diabetes Mellitus
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
Cardiac Effects of Amyloidosis
Extracellular deposition of insoluble proteins in organs. Caused by monoclonal immunoglubulin free light chains.
Genetics of Amyloidosis
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
Cardiac findings of primary Amyloidosis
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.
Organs involved in Amyloidosis
heart, liver, kidney, GI tract and nervous tissue.
Causes of Secondary Amyloidosis
RA, TB, chronic infection, neoplasia (multiple myeloma) and chronic renal failure. Cardiac involvement may occure, but not common.
Clinical Presentaion of Amyloidosis
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.
Diagnostic indicators of Amyloidosis
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)
Treatment of Amyloidosis
Correcting the underlying problem does not usually help the cardiac problems. Try experimental protocols.
Cardiac effects of Hemochromatosis
congestive heart failure
Tetrad of Hemochromatosis
diabetes, liver disease, brown skin pigmentation, congestive heart failure
Treatment of cardiomyopathy from hemochromatosis
prognosis is poor once symptoms appear. Treat with phlebotomy and iron chelation.
Clinical Presentation of hemochromatosis
middle aged with heart failure. Well tanned with diabetes or increased blood glucose, arthralgias and loss of libido.
diagnosis of hemochromatosis
Transferrin saturation and serum ferritin
Cardiac Effects of Carcinoid Tumor
derotonin like substances are toxic to valves, usually on the right because the toxins are metabolized in the lungs.
Classic Syndrome of carcinoid tumor
cutaneous flushing, wheezing and diarrhea
What is a carcinoid lesion?
fibrous plaques that form on valvular endocardium. Valve leaflets becdome thickened, immobile and retracted causing regurgitaion with stenosis in the tricuspid and pulmonary valves.
Clinical presentation of Carcinoid
50-70yo patient with weight loss, fatigue, watery diarrhea, dyspnea on exertion and audible wheezes. Red complexion and gets hot flashes.
Cardiac and other exam findings in carcinoid
prominent V wave in increased jugular venous pressure profile, pulsatile liver that may be enlarged, ascites and peripheral edema.
Diagnosing Cardiac carcinoid
EKG with RVH and RBBB. Echo with thickened tricuspid valve and pulmonary valve and liver mets. Get 24hr urine for 5-hydroxyindoleacetic acid.
Treatment of Carcinoid Cardiac problems
Treat the tumor. If heart intervetion is necessary because of right heart failure, tricuspid valve replacement and pulmonary valve resection may be needed.
Causes of Eosinophilic Syndrome
idiopathic hypereosinophilia, Loffler endocarditis, reactive or allergic eosinophilia, leukemic or neoplastic eosinophilia or Churg-Strauss syndrome
Clinical Features of Eosinophilic syndrome
young male patient with weight loss, fatigue,,dyspnea, syncompe and systemic embolization. Cardiac manifestations: arrythmia, myocarditis, conduction abnormalities, thrombosis
Cardiac manifestations of Eosinophilic syndrome
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
Cardiac effects of SLE: syndromes
antiphospholipid syndromme, Libman-Sacks endocarditis, congential heart block in the offstrping of mothers with lupus.
Cardiac effects of SLE: findings
pericarditis, myocarditis, valvulopathy, coronary arteritis, and Libman-Sacks endocarditis.
Libman-Sacks endocarditis
noninfective vegetation. It does not embolize or interfere with valvular function
Cardiac Effects of Scleroderma
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.
Common presentation of Scleroderma
sclerotic changes, dysphagia, Raynaud phenonmenon, pericardial effusion, conduction defects, pulmonary hypertension and cor pulmonale.
Cardiac Effects of Rhematoid Arthritis
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
Ankylosing Spondylitis and Cardiac effects
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.
Cardiac effects of Marfan Syndrome
.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
Marfan Syndrome features in general
AD condition associated with degenerative elastic tissues, arachnodactyly, tall stature, pectus excavatum, kyphoscoliosis and lenticular dislocation
Cardiac effects of Friedrich ataxia
Autosomal Resessive with the heart involved in 90% of cases. Usually symmetrical hypertrophy but sometimes as a dilated cardiomyopathy.
Cardiac effects of Osteogenesis Imperfecta
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.
Cardiac effects of Lyme Disease
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
Cardiac effects in AIDS
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.
Cardiac Trama
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
