Cardiology Flashcards
MCC of myocarditis & presenting symptoms
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
What is the Gold Standard for diagnosing Myocarditis?
endomyocardial biopsy
How do you treat Myocarditis
Supportive
- BB
- diuretics
- IVIG
What are common causes of Pericarditis?
Idiopathic Viral (enterovirus) = MCC Systemic = thyroid, lupus, RA Neoplasms = lung & breast CA Drug Toxicity Myocardial Injury
What are the symptoms of Pericarditis?
Pleuritic chest pain WORSE with inspiration & laying flat BETTER when sitting up/leaning forward
+ Fever
Auscultation = pericardial friction rub
What do you see on EKG for pericarditis?
Diffuse ST segment elevations
How do you treat pericarditis?
1- NSAIDs for 7-14 days
- Steroids if symptoms >48 hours
- Pericardialcentesis (if necessary)
What is Dressler’s syndrome?
Pericarditis 2-5 days post MI
What is Homan’s sign & what is it used to diagnose?
Calf pain with dorsiflexion of the foot
DVT…unreliable test
What is Virchows triad?
- Venous stasis
- Endothelial damage
- Hypercoagulability
Signs of Peripheral Artery Disease
- Weak/absent distal pulses
- arterial bruits
- loss of hair
- shiny atrophic skin
- pallor with dependent rubor
- intermittent claudication
Acute Arterial Embolism S/S
6 P’s
- pulseless
- pale
- painful
- polikothermia
- pallor
- paresthesias
Diagnosis of Peripheral Artery Disease
ABI <0.9
Ultrasound
Arteriography = gold standard
PAD treatment
Cilostazol
Discontinue tobacco
Control BP, HLD, DM
Structured exercise for intermittent claudication
Chronic Venous Insufficiency MCC + a few others
Hx of DVT
- smoking
- prolonged standing
- family history
- advanced age
- sedentary
Where are venous insufficiency ulcers most commonly located?
Medial Malleolus
MCC of acute arterial occlusion
Afib
Rheumatic Fever
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
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.
Rheumatic Fever
What criteria do you use to diagnose Rheumatic Fever?
Jones Criteria
Jones Criteria
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
Treatment of Rheumatic Fever
- NSAIDs- control fever, arthralgias, carditis sxs
- Prednisone
- 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
Rheumatic heart disease is characterized by ______
Early stage = valve regurgitation – MC mitral valve
Late stage = valve stenosis
Sx:
- palpitations
- dyspnea
- mitral regurgitation
- mitral stenosis
- aortic regurg
- aortic stenosis
When do symptoms of rheumatic heart disease typically start?
10-20 years after acute rheumatic fever
How do you diagnose rheumatic heart disease?
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
How do you treat rheumatic heart disease?
Prophylaxis to prevent recurrence or worsening
-Penicillin G
evidence with valvular abnormalities = 10 years or until age 40
Surgical –> valve repair or replacement
