Cardiology - Diseases Flashcards
Ortner’s Syndrome
Hoarseness associated with mitral valve stenosis
Increased pressures in the left atrium cause left atrial hypertrophy, which can compress the left recurrent laryngeal nerve as it hooks around the aorta near the ligamentum arteriosum
Rheumatic Heart Disease
Consequence of pharyngeal infection with Group A b-hemolytic streptococci; antibody production against M protein cross-reacts with self-antigen on heart valves (mostly mitral > aortic»_space;> tricuspid)
Causes early mitral regurgitation followed by late mitral stenosis; may lead to heart failure under conditions of increased cardiovascular strain (i.e. pregnancy)
Dilated cardiomyopathy
Most common cardiomyopathy (90%); most cases are congenital or idiopathic, also caused by chronic alcohol/cocaine abuse, wet Beriberi, Coxsackie B virus myocarditis, Chagas disease, hemochromatosis, peripartum
Findings: Systolic heart failure, S3, dilated heart on ECHO
Treatment: Na restriction, ACEIs/B-blockers, diuretics, Digoxin, ICD, heart transplant
Hypertrophic Cardiomyopathy
60-70% of cases are familial, usually autosomal dominant mutation of myosin heavy chain
Cause of sudden death in young athletes due to ventricular arrhythmia; sub-type with prominent septal hypertrophy causes outflow obstruction with dyspnea ad syncope
Findings: S4, systolic murmur, marked ventricular hypertrophy +/- septal thickening on ECHO
Treatment: Cessation of high-intensity athletics, B-blockers, non-DHP CCBs (Verapamil), ICD
Cardiac Tamponade
Compression of the heart by fluid (blood, effusion) within the pericardial space, leading to decreased cardiac output
Findings: Beck triad, Kussmaul sign, pulsus paradoxus, ECG shows low voltage QRS
Ebstein Abnormality
Congenital cardiac malformation associated with maternal Lithium use during first trimester
Characterized by downward displacement of the tricuspid valve leaflets with adherence to the RV wall; causes functional division of the RV into a proximal ‘atrialized’ (thinned) compartment and a smaller pumping compartment
If pump function is compromised, can lead to hypoxia and heart failure
Temporal (Giant Cell) Arteritis
Focal, granulomatous inflammation most commonly affecting branches of the carotid artery
Presents most commonly in elderly females with headache and jaw claudication; may cause irreversible blindness secondary to involvement of the opthalmic artery
Dx: Temporal artery biopsy
Treated with high dose corticosteroids
Takayasu Arteritis
Granulomatous inflammation of the aortic arch and proximal great vessels leading to thickening and narrowing of the vessel lumen
Most commonly presents in Asian females <40 years old with weak pulses of the upper extremities, fever, night sweats, myalgias, arthritis
Treated with corticosteroids
Polyarteritis Nodosa
Vasculitis of medium-sized vessels; immune-complex mediated inflammation of renal and visceral vessels
Most commonly presents in young adults with fever, malaise, weight loss, headaches, hypertension, abdominal pain, and melena; associated with HBV (30%)
Findings: Transmural inflammation of the vessel wall with fibrinoid necrosis and innumerable microaneurysms; vessels are spastic on arteriogram
Treated with corticosteroids
Kawasaki Disease
Medium-vessel vasculitis most commonly seen in Asian children < 4 years old with fever, cervical lymphadenopathy, conjunctival injection, “strawberry tongue,” erythema of hands and feet, desquamating rash
Increased risk of coronary artery aneurysm or thrombosis
Treated with Aspirin (for anti-inflammatory and anti-platelet effect) + IVIG
Buerger Disease
Medium vessel vasculitis most commonly seen in male smokers < 40 years old
Presents with intermittent claudication; may lead to gangrene, auto-amputation of digits; Raynaud phenomenon often present
Findings: Segmental, thrombosing vasculitis
Treated with smoking cessation
Granulomatosis with polyangiitis (Wegener’s Vasculitis)
Small vessel focal necrotizing vasculitis of the vasculature of the lungs and kidneys
Presents with chronic sinusitis, otitis media, hemoptysis, cough, dyspnea, hematuria, RBC casts
Pathological triad = focal necrotizing vasculitis + necrotizing granulomas of the lungs and upper airway + necrotizing glomerulonephritis
Treated with corticosteroids / cyclophosphamide
Microscopic Polyangiitis
Small vessel necrotizing vasculitis of the lungs, kidneys, and skin; characterized by pauci-immune glomerulonephritis and palpable purpura
Presentation is similar to GPA without nasopharyngeal involvement - hemoptysis, cough, dyspnea, hematuria, RBC casts
Treated with corticosteroids and cyclophosphamide
Churg-Strauss Syndrome
Small vessel granulomatous, necrotizing vasculitis with eosinophilia
Presents with asthma, sinusitis, palpable purpura, and peripheral neuropathy (wrist/foot drop); may also affect GI, heart, kidneys
Henloch-Schonlein Purpura
Small vessel vasculitis secondary to IgA complex deposition; associated with IgA Nephropathy, most common vasculitis of chilhood
Most commonly presents after URI with triad of: palpable purpura + arthralgias + GI symptoms (abdominal pain, melena)
