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Internal Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

MCC of myocarditis & presenting symptoms

A

MC= Viral infection – Enterovirus, Adenovirus, EBV
Autoimmune– SLE, RA, Kawasaki
Systemic- Uremia
Medications- Clozapine

Viral prodrome- fatigue, fever, dyspnea, chest discomfort, tachycardia

severe cases lead to heart failure symptoms

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2
Q

What is the Gold Standard for diagnosing Myocarditis?

A

endomyocardial biopsy

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3
Q

How do you treat Myocarditis

A

Supportive

  • BB
  • diuretics
  • IVIG
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4
Q

What are common causes of Pericarditis?

A 
Idiopathic
Viral (enterovirus) = MCC
Systemic = thyroid, lupus, RA
Neoplasms = lung & breast CA
Drug Toxicity
Myocardial Injury
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5
Q

What are the symptoms of Pericarditis?

A

Pleuritic chest pain WORSE with inspiration & laying flat BETTER when sitting up/leaning forward

+ Fever

Auscultation = pericardial friction rub

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6
Q

What do you see on EKG for pericarditis?

A

Diffuse ST segment elevations

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7
Q

How do you treat pericarditis?

A

1- NSAIDs for 7-14 days

  1. Steroids if symptoms >48 hours
  2. Pericardialcentesis (if necessary)
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8
Q

What is Dressler’s syndrome?

A

Pericarditis 2-5 days post MI

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9
Q

What is Homan’s sign & what is it used to diagnose?

A

Calf pain with dorsiflexion of the foot

DVT…unreliable test

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10
Q

What is Virchows triad?

A
  1. Venous stasis
  2. Endothelial damage
  3. Hypercoagulability
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11
Q

Signs of Peripheral Artery Disease

A
  • Weak/absent distal pulses
  • arterial bruits
  • loss of hair
  • shiny atrophic skin
  • pallor with dependent rubor
  • intermittent claudication
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12
Q

Acute Arterial Embolism S/S

A

6 P’s

  • pulseless
  • pale
  • painful
  • polikothermia
  • pallor
  • paresthesias
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13
Q

Diagnosis of Peripheral Artery Disease

A

ABI <0.9
Ultrasound
Arteriography = gold standard

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14
Q

PAD treatment

A

Cilostazol
Discontinue tobacco
Control BP, HLD, DM
Structured exercise for intermittent claudication

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15
Q

Chronic Venous Insufficiency MCC + a few others

A

Hx of DVT

  • smoking
  • prolonged standing
  • family history
  • advanced age
  • sedentary
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16
Q

Where are venous insufficiency ulcers most commonly located?

A

Medial Malleolus

17
Q

MCC of acute arterial occlusion

A

Afib

18
Q

Rheumatic Fever

A

Inflammatory reaction to strep throat infection (Group A Strep)

Formation of antistreptolysin antibodies which react with proteins on the synovium, heart muscle, and heart valves

Initial reaction occurs 2-4 weeks after strep infection

19
Q

a 30-year-old woman presents with 2 weeks of arthralgias, migrating from distal to proximal joints. It began with increased warmth and erythema in her right ankle and left knee. She has a low-grade fever and reports a history of sore throat and swollen glands about 1 month ago. On physical exam she has red skin lesions on the trunk and proximal extremities, and also small, non-tender lumps located over the joints. Antistreptolysin O titer is positive.

A

Rheumatic Fever

20
Q

What criteria do you use to diagnose Rheumatic Fever?

A

Jones Criteria

21
Q

Jones Criteria

A

rheumatic fever
+2 major criteria OR +1 major & 2 minor
+evidence of preceeding GAS infection

Major:
J- joints (polyarthritis)
O- heart (carditis)
N- Nodules (subcutaneous)
E- Erythema marginatum 
S- Sydenhams chorea (rapid involuntary movements)

Minor:

  • Arthralgias
  • elevated ESR or CRP
  • Fever
  • Prolonged PR
22
Q

Treatment of Rheumatic Fever

A
  1. NSAIDs- control fever, arthralgias, carditis sxs
  2. Prednisone
  3. Prophylaxis = Penicillin G IM q 3-4 weeks
    - children w/o carditis = x5 years or until 21
    - children w/ carditis w/o evidence of residual heart damage = 10 years
    - children w/ carditis & evidence of heart damage = >10 years…possibly forever
23
Q

Rheumatic heart disease is characterized by ______

A

Early stage = valve regurgitation – MC mitral valve

Late stage = valve stenosis

Sx:

  • palpitations
  • dyspnea
  • mitral regurgitation
  • mitral stenosis
  • aortic regurg
  • aortic stenosis
24
Q

When do symptoms of rheumatic heart disease typically start?

A

10-20 years after acute rheumatic fever

25
Q

How do you diagnose rheumatic heart disease?

A

Diagnosis: based on clinical presentation and confirmed with echocardiography

Echocardiography → valvular abnormalities, including regurgitation or stenosis

Labs: ↑ anti-streptolysin O (ASO) titers

Histology: Aschoff bodies (granulomas with giant cells) on heart valves

26
Q

How do you treat rheumatic heart disease?

A

Prophylaxis to prevent recurrence or worsening
-Penicillin G
evidence with valvular abnormalities = 10 years or until age 40

Surgical –> valve repair or replacement

Internal Medicine (3 decks)

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