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Medicine > Cardiology 2 > Flashcards

Cardiology 2 Flashcards

1
Q

Diseases that involve myocardium directly and not result of conditions such as HTN, congenital, valvular, arterial or pericardial abn

2 forms

A

Cardiomyopathy

Primary - unknown cause
Secondary - known assoc with organ dysfunction

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2
Q

Genetic alteration in cardiomyopathy

A

Dystrophin complex

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3
Q

Basic structural and fxn unit of muscle

A

Sarcomere protein

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4
Q

Ryanodine receptors of SR

Disease

A

L type calcium ch

Malignant hyperthermia

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5
Q

Extrinsic protein on RBC membrane and myocyte

A

Spectrin

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6
Q

Most common cause of myocarditis

A

Coxsackie B

Viral replication in myocyte -> myocyte lysis -> delayed apoptosis

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7
Q

Glycogen storage disease with cardiac involvement

A

Pompe Disease

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8
Q

Bacteria notorious for causing myocarditis

Metachromatic granules

A

Diptheria

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9
Q

Most common cause of heart transplant

Diminished myocardial contractility, systolic pump function resulting in impaired ventricles leading to cardiac enlargement

A

Dilated cardiomyopathy

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10
Q

Most common cause of dilated cardiomyopathy

A

Idiopathic

  • peripartum
  • postmyocarditis

Alcoholic 2nd

Doxorubicin, cocaine
Infiltrative: amyloid

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11
Q

Most common assoc toxin with chronic dilated cardiomyopathy

Tx abstinence

A

Alcohol

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12
Q

This amount of consumption may develop DCM resembling idiopathic or familial DCM

A

> 90g/d

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13
Q

Alcohol consumption regularly during weekend or holiday

Acute cardiac rhythm or conduction disturbance mc Supraventricular Tachyarhythmia assoc with heavy ethanol without other clinical evidence of heart disease

Appears after binge drinking

Considered in px without structural heart disease and with new onset artrial fibrillation

A

Holiday heart syndrome

Abstinence resolution

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14
Q

Most frequently seen arrhythmia in holiday heart syndrome

A

Atrial fibrillation

Atrial flutter

Ventricular premature dep PVCs

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15
Q

A fib causes

A 
Ethanol
Valvular heart disease
Ischemia
Cardiomyopathy
Cocaine
Thyroid
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16
Q

Pathophysiology of holiday heart syndrome

A

1 inc secretion of epi and norepi
2 inc sympathetic output
3 rise in level of plasma free fatty acid
4 indirect effect through acetaldehyde (primary metabolite) or fatty acid ethyl ester
5 dec sodium current and affect intracellular pH

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17
Q

Most common symptom of holiday heart syndrome

A

palpitation

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18
Q

Only PE abnormality in Holiday Heart Syndrome

A

Irregular or thready pulse

Rapid heart rate

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19
Q

Cardiac dilation and CHF developing during last trimester of pregnancy within 6 mos after delivery

A

Peripartum cardiomyopathy

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20
Q

Peripartum cardiomyopathy rf

A 
Multiparous, over 30
Twin pregnancy
Malnutrition
Tocolytic use (terbutaline, ritodrine) 
Premature labor
Preeclampsia (vasospasm)
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21
Q

Most common drug that causes cardiotoxicity

Rf
>70

Tx

A

Doxorubicin
Danorubicib

Dexrazoxane

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22
Q

Myocardial hypertrophy
Abnormal diastolic filling
Intermittent ventricular outflow obstruction

A

Idiopathic hypertrophic subaortic stenosis

Hypertrophic obstructive cardiomyopathy (HOCM)

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23
Q

Cause of sudden cardiac death in young athletes

Thick walled heavy hypercontracting heart

A

Hypertrophic cardiomyopathy

Differential: Brugada syndrome

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24
Q

Hypertrophic cardiomyopathy pathophysiologic abnormality

A

Diastolic dysfunction

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25
Q

Most common mutation in hypertrophic cardiomyopathy

Half with HCM have family history

A

Cardiac b myosin heavy chain gene on ch 14

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26
Q

HOCM hallmark

A

systolic murmur at left sternal border as well as at apex

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27
Q

Most common complaint in HOCM

A

dyspnea

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28
Q

Inherited metabolic cardiomyo with LVH

A

Cardiac danon disease
Glycogen storage cardiomyo
Fabry disease
Friedrich ataxia -Frataxin gene

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29
Q

Abnormal diastolic function
Dec ventricular compliance/restriction of cardiac filling
Ventricular walls are excessively rigid and impede ventricular force
Caused by fibrosis, infiltration and hypertrophy

A

Restrictive cardiomyopathy

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30
Q

Most frequent cause of hemochromatosis

A

B thalassemia

Multiple transfusion and hemoglobinopathy

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31
Q

Marked subendocardial fibrosis

encroachment of lumen, dec ventricular filling and cardiac failure

A

Obliterative cardiomyopathy

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32
Q

Apical ballooning syndrome
Severe chest discomfort preceded by very stressful emotional or physical event
Women >50
ST segment elevation and T wave inversion in chest leads
Reversible within 3-7d
No long term cardiac dysfunction

A

Takotsubo stress cardiomyopathy

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33
Q 
Firm rubbery waxy non compliant heart
Diastolic dysfxn
Systolic dsyfxn
Arrhythmias 
OH
A

Amyloid cardiomyopathy

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34
Q

Parasite migrates to myocaridium and larvae causes necrosis

A

Heterophyes

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35
Q

Immune mediated myocarditis from post strep infection (rf) strep pyogenes bec of

A

M protein

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36
Q

Major causes of myocarditis

A

Coxsackie B
Diptheria
T cruzi

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37
Q

Myocarditis sx

Dx

Best dx

A 
Dyspnea 
Fatigue
Arrhythmia
Chest pain 
Murmur

Degree of heartblock on ECG
Elevation of cardiac enzyme

Endomyocardial biopsy

38
Q

Normal amount of pericardial fluid

Thin clear straw colored fluid in pericardial sac ie ultrafiltrate of the plasma

A

15- 50ml

39
Q

Restricts anatomic position of heart
Minimizes friction between surrounding structures
Prevents displacement of heart and kinking of great vessel

A

Pericardium

40
Q

Most common form of pericardial effusion

A

serous

ex CHF, hypoproteinemia

41
Q

Pericardial effusion of blunt chest trauma

A

Serosanguinous

ex CPR

42
Q

Pericarditis infectious agent

Pericarditis immunologically mediated

A

Virus
TB
Fungi
Parasite

Scleroderma
Postcardiotomy
PostMI Dressler syndrome
Drug hypersensitivity

43
Q

Post myocardial infarction pericarditis

A

Dressler syndrome

44
Q

Drug induced SLE can produce pericarditis

A

Procainamide (anti arrhythmic)
Hydralazine
Isoniazid
Methyldopac

45
Q

Drug causes constrictive pericarditis

A

Methysergide

46
Q

Miscellaneous causes of pericarditis

A 
MI
Uremia 
Ff cardiac surgery
Neoplasia
Trauma
Radiation
47
Q

Cancer that metastizes to the pericardium

A

Lung ca

48
Q

Most often cause of myocarditis

A

Virus

49
Q

Inflammatory reaction in epicardial and pericardial surface with scant numbers of PMN lympho and macrophage

A

Serous pericarditis

RF, SLE, scleroderma, tumor, uremia

50
Q

Most frequent type of pericarditis

Serous fluid mixed with fibrinous exudate

Cause: MI, Dressler, uremia, chest radia, RF, SLE and trauma

Clinical presentation:

A

Fibrous/serofibrinous pericarditis

Pericardial friction rub

51
Q

Fibrinous pericarditis is also known as

A

fibrinous pericarditis

52
Q

Denotes invasion of pericardial space by infective organism

Route:
direct extension from neighboring inflamm

Thin to creamt pus 400-500 ml

Serosal surface reddened granular and coated with exudate

Acute inflamm reaction

A

Purulent or suppurative

53
Q

Blood mixed with fibrinous or suppurative effusion

Most commonly causes by

Others: bacterial, diasthesis, TB(caseous) and cardiac surgery

A

Hemorrhagic

Malignancy

54
Q

Healing of acute lesion resolution or pericardial fibrosis ranging from thick pearly nonadherent epicardial plaque to thin delicate adhesions to massive adhesions

A

soldier’s plaque

55
Q

Pericardial sac obliterated and parietal layer tethered to mediastinal tissue

A

Adhesive mediastinopericarditis

Chronic or healed

56
Q

Perocarditis symptoms

A

Chest pain in acute infectious type related to hypersensitivity
Pericardial friction rub
Reduction in voltage with large effusion on ECG
Elevation of ST in ECG returning to normal within hours

Pericardial effusion leads to cardiac tamponade
Water bottle appearance of cardiac silhouette on radio

57
Q

Most common cause of tamponade

A

Neoplastic disease
Idiopathic pericarditis
Uremia

58
Q

3 principal features of tamponade

A

Elevation of intracardiac pressure
Limitation of ventricular filling
Reduction in cardiac output

59
Q

Cardiac involvemeny manifesting valvular abnormality from recurrent rheumatic fever

A

Rheumatic heart disease

60
Q

Immune mediated disease triggered by antecedent infection assoc with

A

RHD

Most antecedent event: Group A Streptococcus Pyogenes
Group A Beta Hemolytic Streptococci GABHS

61
Q

MC Cause of acquired heart disease in children/young adults

Peaks

A

Rheumatic fever

5-15 years old

rare in >30?

62
Q

Usual presentation of RF

A

Pharyngitis (sore throat, odynophagia)

Strep skin infection

63
Q

Most common cause of mitral stenosis 2/3 worldwide

A

rheumatic fever

64
Q

Peaks at 25-40

Predominant at females

A

RHD

65
Q

Most common cause of heart disease in children in developing countries
95% of ARF cases and RHD occur in developing

A

RHD

66
Q

ARF is caused by infection of upper respiratory tract with group A strep pyogenes whose virulence factor is

Pathogenesis HLA

A

M protein

HLA DR7 HLA DR4(RA)

67
Q

Immune response targeted at strep antigens aka

of Group A streptococcal carbohydrate a process called recognizing human cell (myocyte)

A

M protein
N-acetylglucosamine

Molecular mimicry

68
Q

Demonstrates cross reactivity with M protein

Protein that is helical coiled

Antibodies to cardiac valve tissue cross react with leading to valvular damage

In IV users most common valve involved

A

Myosin

Laminin

N acetylglucosamine targetting mitral valve

Tricuspid valve

69
Q

Modified JONES criteria for RF
(MAJOR)

CASES

A 
Carditis
Arthritis
Sydenham chorea
Erythema marginatum
Subcutaneous nodule
70
Q

Modified JONES Minor Criteria:

A

PEACH FEVER

Prolonged PR 
Elevated ESR
Arthralgia
C-RP
Hx of preceding sore throat or recent strep infection
Fever
71
Q

RF Dx

A

Two major
One major and 2 minor
+
supporting evidence of preceding Group A Strep infection

72
Q

Most common feature

A 
Polyarthritis 60-75
Carditis 50-60
Chorea <2-30
Erythema marginatum and 
Subcutaneous nodules are rare <5
73
Q

Exception

Presence of this alone with history of recent streptococcal infection is enough to diagnose RF

A

chorea

74
Q

Inflammation of endocardium

valves, myocardium and pericardium (pancarditis)

A

Carditis

75
Q

Diastolic rumble and opening snap

A

Mitral stenosis

76
Q

Most common valves involved in rf

A

Mitral 2/3
Aortic 25%
Tricuspid infrequent
Pulmonic rare

77
Q

Most common joints affected in rf

Occur in 75%
Pain is debilitating
Highly responsive to NSAIDs and salicylate

A

Knees, ankles, hip, elbow

78
Q

Classic rash of ARF

Painless small mobile lumps seen overlying bony prominences

A

Erythema marginatum

Subcutaneous nodules

79
Q

Erythema chronicum migrans

A

Lyme disease

Bull’s eye / Target rash

80
Q

Histologic hallmark of subcutaneous nodules

Also a histologic marker of rheumatic activity

A

Aschoff bodies attached to tendon sheaths

Assoc with severe carditis

81
Q

T lymhpocytic plasma cell

A

Aschoff bodies

82
Q

Pathognomonic for RF
Caterpillar cells
Pancarditis
Histiocytes of cardiac myocyte

A

Anitschkow cell

83
Q

Irregular thickening induced by subendocardial lesions exacerbated by regurgitant jets usually in L atrium

A

MacCallum Plaque

84
Q

1-2mm small vegetation

Serve as nidus for infection

A

Verrucae

Infective endocarditis

85
Q

Chronic RHD thickening the commisural fusion and shortening thickening and fusion of the tendinous cords

Calcification and fibrous bridging across valvular commisures

A

Fishmouth

Buttonhole appearance

86
Q

Basal ganglia and caudate nucleus involvement

Present as single manifestation of RF

A

Sydenham’s chorea

St. Vitus dance

87
Q

Trinucleotide CAG repeat

Atrophy of caudate nucleus

A

Huntington’s disease

88
Q

Gradual onset
Involuntary uncoordinated purposely jerky movements aggravated under stress when patient is awake with emotional instability

Speech is indistinct halting and explosive
Milkmaids hand
Handwriting affected
Darting tongue

A

Sydenham’s chorea

89
Q

Drug of choice for rheumatic f and prophy

A

Benthanzine penicillin

Orally BID

Amox 50mg/kg max 1g daily

90
Q

drug of choice Used for treatment of arthritis, arthralgia and fever

A

Aspirin

May also take NSAID

91
Q

Mainstay of primary prevention for ARF

A

Primary prophylaxis timely and complete Group A strep sorethroat with antibiotics

92
Q

Mainstay of controlling ARF and RHD

Secondary prevention

A

Benzanthine pen G
1.2M units
600,000 u if <27 kg

Medicine (29 decks)

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