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Block 3 - Cardio > Clin Med: Cardio III > Flashcards

Clin Med: Cardio III Flashcards

1
Q

List causes of pericarditis.

A
  • Infectious
  • Systemic dz
  • Radiation
  • Drug toxicity
  • other than viral most are idiopathic
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2
Q

What is the pericardium

A

a fibrous covering of the heart & great vessels (like aorta)

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3
Q

Describe infectious pericarditis.

A
  • most common is viral
  • TB rare in developing countries
  • bacterial rare, usually from extension of pulm infx
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4
Q

What are the common viruses that cause pericarditis?(8)

A
  • Coxsackie
  • Echovirus
  • Influenza
  • Epstein-Barr
  • Varicella
  • Hepatitis
  • Mumps
  • HIV
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5
Q

What is pulmonary bacteria that causes pericarditis?

A

strep pneumo

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6
Q

Describe systemic dz causing pericarditis.

A

autoimmune syndromes, neoplasms

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7
Q

Pericarditis account for how many hospital admissions?

A

0.2%

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8
Q

Pericarditis account for about what number of pts w/ non-ischemic chest pain in the ED?

A

5%

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9
Q

Pericarditis: Pathophys

A

inflammation of pericardium causes chest pain–> movement of heart w/n inflamed pericardium may produce friction

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10
Q

What is pericardial friction rub?

A

the friction b/t 2 inflamed pericardial layers

(scratchy or squeaky sound; walking on snow)
heard best at Left lower sternal border, louder w/ inspiration, have patient lean forward

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11
Q

Pericarditis: Hx

A
  • pleuritic chest pain
  • may report prodrome
  • abrupt onset of severe, sharp, inspiratory chest pain on the left side or substernal (pleuritic chest pain)
  • chest pain happen days after resp or GI infx
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12
Q

Pericarditis pain may (location):

A

–> radiate to neck, L. shoulder, & arm
–>radiate to trapezius muscle ridge
be reduced w/ sitting & leaning fwd
–>be aggravated by lying supine or w/ inspiration

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13
Q

Pericarditis: Physical

A
  • assess for signs of cardiac tamponade**
  • tachycardia, tachypnea
  • Fever
  • Pericardial friction rub
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14
Q

Pericarditis: Dx

A
  • usually SL
  • leukocytosis
  • EKG
  • CXR
  • Echo
  • ESR/CRP elevated
  • Look for underlying causes
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15
Q

Pericarditis: Describe EKG

A

Generalized ST-T wave changes, diffuse ST elevations, followed by return to baseline, then T wave inversions

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16
Q

Pericarditis: Describe CXR

A

Cardiac enlargement if pericardial effusion

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17
Q

Pericarditis: Describe Echo

A

can demonstrate pericardial effusion, tamponade

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18
Q

Acute pericarditis: Tx

A

Aspirin OR Ibuprofen + Colchicine

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19
Q

Recurrent pericarditis: Tx

A

Aspirin OR Ibuprofen

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20
Q

Describe pericardial Effusion

A
  • Buildup of extra fluid in the space around the heart
  • Can occur w/ any form of pericarditis
  • Can lead to cardiac tamponade
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21
Q

Describe cardiac tamponade

A

heart isn’t pumping good bc of fluid accumulation in the pericardial sac

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22
Q

Causes of cardiac tamponade…

A
  • idiopathic pericarditis
  • Pericarditis 2ndary to neoplastic dz
  • Aortic dissection
  • Trauma
  • Anticoagulation
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23
Q

3 classic features of cardiac tamponade (Beck’s Triad):

A
  • Hypotension
  • Soft or absent heart sounds
  • JVD
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24
Q

Other S/S of cardiac tamponade

A
  • Tachypnea
  • Chest discomfort
  • Lower extremity edema
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25
Q

Cardiac tamponade: Dx (& what will it show)

A
  • CXR: enlarged “globular” heart
  • EKG: low voltage (amplitude)
  • Echo
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26
Q

Cardiac tamponade: Tx

A
  • treat underlying cause
  • Pericardiocentesis
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27
Q

Myocarditis leads to…

A

decr ability for heart to pump

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28
Q

Myocarditis can be…

A

infectious or non-infectious

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29
Q

Myocarditis: S/S

A
  • May present several days - weeks after acute febrile illness
  • May present w/ S/S of HF
  • Tachypnea, chest pain, arrhythmias
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30
Q

Most common cause of myocarditis?

A

viral
–> parvovirus B19 (5ths dz (erythema Infectiosum))

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31
Q

Myocarditis: Dx & what it will show

A
  • Usually- WBC, ESR, CRP, troponin, BNP elevated
  • CXR- may show cardiomegaly, pulmonary edema
  • Echo- may show HF
    (peripheral edema, dyspnea)

**MRI may show areas of myocardial inflammation

**Myocardial biopsy can make a definitive diagnosis

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32
Q

What is the common workup for myocarditis?

A
  • BNP (HF)
  • CBC
  • CMP
  • CXR
  • EKG
  • Lipase
  • Troponin
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33
Q

Myocarditis: Tx

A

Antimicrobials/immunosuppressives
- Limit exercise

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34
Q

What is bacterial endocarditis?

A

infx of the endocardial surface of the heart, most often the heart valves, particularly prosthetic heart valves

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35
Q

They majority of cases of bacterial endocarditis are caused by…

A

staph or strep (80%)

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36
Q

What is the mortality prediction of bacterial endocarditis in IV drug users

A

33%

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37
Q

Community Acquired Native valve endocarditis bacteria

A
  1. Strep & 2. Staph
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38
Q

Health Acquired: Native valve endocarditis bacteria

A
  1. Staph
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39
Q

Prosthetic valve endocarditis bacteria

A

Staph

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40
Q

IVDA Right-sided bacteria

A

Staph

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41
Q

IVDA Left-sided bacteria

A

Enterococci

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42
Q

Bacterial endocarditis: RFs

A
  • prosthetic valves, cardiac devices, & a hx of endocarditis
  • IV drug use
  • Prolonged bacteremia
  • Congenital heart disease
  • Poor dental hygiene
  • HIV
  • Long term hemodialysis
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43
Q

Bacterial Endocarditis risk requires:

A
  • structural heart abnormality to causes turbulent blood flow this forms fibrin deposits

+

Introduction of microbes into bloodstream that get stuck on fibrin

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44
Q

Vegetation is

A

fibrin + bacteria

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45
Q

What is the HACEK group?

A

members of fastidious gram (-) bacteria associated w/ infective endocarditis in associated w/ dental procedures (oropharynx/mouth)

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46
Q

List eh HACEK bacteria

A
  • Haemophilus
  • Aggregatibacter
  • Cardiobacterium
  • Eikenella
  • Kingella
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47
Q

Infective Endocarditis: Hx

A
  • fever, anorexia, malaise, weight loss
  • ask about dental procedures, heart dz, fake valve, pacemaker, rheumatic heart dz, HIV/ RFs, IVDA
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48
Q

Describe the Modified Duke Criteria for dx infective endocarditis

A
  • pathologic criteria
  • 2 major + 1 minor OR
  • 1 major + 3 minor OR
  • 5 minor criteria
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49
Q

Describe pathologic criteria for infective endocarditis

A

Microorganisms in a vegetation or implant

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50
Q

Describe major criteria for infective endocarditis

A
  • (+) blood culture of typical organism (2 cultures), or (+) PCR
  • Evidence of endocardial involvement
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51
Q

Describe minor criteria for infective endocarditis

A
  • Predisposing heart condition or IV drug use
  • Fever
  • Vascular phenomenon
  • Immunologic phenomenon
  • Microbiologic (1 (+) blood culture)
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52
Q

Infective endocarditis: PE

A

Fever
- New or worsening heart murmur
- Splenomegaly
- Roth Spots
- Splinter hemorrhages
- Janeway lesions
- Osler nodes

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53
Q

What are Roth spots?

A

exudative, edematous lesions of the retina

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54
Q

What are Splinter hemorrhages?

A

non-blanching, linear, reddish-brown lesions under nails

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55
Q

What are Janeway lesions?

A

macular, blanching, painless, purple lesions on palms and soles

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56
Q

What are Osler nodes?

A

painful, purple nodules in pulp of fingers and toes

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57
Q

List and describe complications of infective endocarditis

A
  • cardiac complications (50%)
  • Neurologic complications (40%)
  • Septic emboli (25%)
  • Metastatic infection
  • Systemic immune reactions
58
Q

Infective Endocarditis: Cardiac complications

A

Valve regurgitation, heart failure, and conduction abnormalities.

59
Q

Infective Endocarditis: neurologic complications

A

Embolic stroke, intracerebral hemorrhage, brain abscess

60
Q

Infective Endocarditis: septic emboli

A

Infarction of kidneys, spleen, and other organs.

61
Q

Infective Endocarditis: Metastatic infx

A

vertebral osteomyelitis, septic arthritis, splenic or psoas abscess

62
Q

Infective Endocarditis: Systemic immune rxns

A

glomerulonephritis

63
Q

Infective endocarditis: Dx

A
  • Modified Duke Criteria
  • Blood cultures
  • ESR (elevated)
  • CBC (elevated WBC)
  • EKG (may show AV block that can progress from 1st degree to 3rd degree)
  • Echo (TTE vs TEE)
  • Brain CT if neuro deficits
64
Q

Infective endocarditis: Tx

A
  • Guided by blood cultures
  • Consult infectious disease
  • Pts w/ acute symptoms should be treated empirically w/ Vancomycin
    –> 6wks of IV abx (can go home w/ pick line)

Long term tx required

65
Q

Infective Endocarditis: prophylaxis required for pts with?

A
    • A prior history of IE
  • Prosthetic heart valves
  • Cardiac valve repair
  • Unrepaired cyanotic congenital heart dz
66
Q

Procedures that can cause infective endocarditis

A
  • Dental work
  • Invasive resp procedures
  • Skin/soft tissue infx over infxd skin
  • Cardiac surgery w/ prosthetic material
    +/- GI/GU procedures (depends on organization)
67
Q

Prophylactic abx to prevent infective endocarditis

A

MOST PATIENTS WILL GET PCN

Oral Amoxicillin

if not oral–> Ampicillin OR Cefazolin or ceftriaxone

allergic to PCN–> Cephalexin OR Clindamycin OR Azithro or clarithro

allergic to PCN & unable to take oral med–> Cefazoline or ceftriaxone OR Clindamycin OR Vanc

68
Q

Describe acute infective endocarditis?

A

develops suddenly & may become life threatening within days.

69
Q

Describe subacute infective endocarditis?

A

develops gradually & subtly over a period of wks - several months but also can be life threatening.

70
Q

Describe noninfective Endocarditis

A

Blood clots that do not contain microorganisms form on heart valves & adjacent endocardium.

Noninfective endocarditis can lead to infx endocarditis bc microorganisms can attach to & grow w/n the fibrous blood clots.

71
Q

What is rheumatic fever?

A

A systemic immune process that is secondary of a B-hemolytic streptococcal infx of the pharynx (strep throat)

72
Q

Rheumatic fever can affect the…

A

heart, joints, skin, & brain

73
Q

Rheumatic fever: prevalence

A
  • rare before 4yo or after 40yo
74
Q

Rheumatic heart dz: prevalence

A
  • Ages: 25 - 40
75
Q

Rheumatic Heart Dz: Pathophys

A
  • Immune response against M PRO from strep bacteria
  • Those antibodies are thought to cross-react w/ PROs on our own cells.
  • Once bound to cardiac tissue, the antibodies activate more immune cells, which causes acytokine-mediated inflammatory response & tissue destruction.
76
Q

When does rheumatic fever occur?

A

2-3 weeks after untreated strep infx

77
Q

Rheumatic Fever: Hx-S/S

A
  • fever
  • carditis
  • arthritis
  • chorea (involty movements)
  • subcutaneous nodules
  • erythema marginatum
78
Q

Rheumatic Heart Dz: Hx-S/S

A

10 -20 years after rheumatic fever
- palpitations
- Fatigue
- Dyspnea
- Chest pain
- Syncope
- Edema

79
Q

What is needed to make a dx of rheumatic fever?

A

2 major criteria

OR

1 major & 2 minor criteria

80
Q

Rheumatic fever: Major Dx Criteria

A
  • Joints (arthritis)
  • O (carditis)
  • N (nodules)
  • E (erythema migrans)
  • S (Sydenham chorea)
81
Q

Rheumatic fever: Minor Dx Criteria

A
  • Fever
  • Polyarthralgia
  • Prolonged PR interval
  • Elevated ESR or CRP
  • (+) throat culture, rapid strep test, or elevated (& rising) strep antibody titer
82
Q

Rheumatic Fever: PE

A
  • Arthritis
  • Carditis
  • Subcutaneous Nodules
  • Erythema migrans
  • Sydenham chorea
83
Q

Describe rheumatic fever: arthritis

A

swelling & inflammation of the joints, migratory polyarthritis affecting large joints including knees, elbows, ankles, & wrists

84
Q

Describe rheumatic fever: carditis

A

endocarditis

85
Q

Describe rheumatic fever: subcutaneous nodules

A

on joints including knees, elbows, or wrists.
Small, firm, & painless

86
Q

Describe rheumatic fever: erythema migrans

A

nonpruritic, pink, ring-link rash on trunk & proximal extremities,

usually excluding face
rash may be induced by heat & blanches w/ pressure

individual lesions may appear, disappear, & reappear w/n hrs

87
Q

Describe rheumatic fever: Sydenham chorea

A

uncontrolled jerky movement

88
Q

Rheumatic heart dz: PE

A
  • MV most commonly affected
    –> mitral regurg
    –> mitral stenosis
  • Aortic valve 2nd most common
    –> aortic regurg
89
Q

Rheumatic Heart Dz: Dx

A

Echo

90
Q

Rheumatic Fever: Tx

A

symptomatic relief of arthritis, carditis w/ NSAIDs for 1-2 weeks (or until joint symptoms go away)

  • Eradication of GABHS–>PCN
  • Prophy against future GAS infx–> PCN
91
Q

Rheumatic Heart Dz: Tx

A
  • prophy to prevent recurrent acute rheumatic fever episodes
  • treat valvular conditions
92
Q

Valvular disorder: pathophys

A

each heart valve is dz–> abnormal valve movement & blood flow–> abnormal heart sounds/murmurs

93
Q

Which side of the heart is most effected by valve disorders and why?

A
  • left side of heart
  • due to incr pressure of systemic circulation
94
Q

Valvular dz to which valve is rare?

A

pulmonic valve

(usually related to congenital defects)

95
Q

What is stenosis?

A

narrowing of the valve

96
Q

What is regurgitation?

A
  • allows blood to flow the wrong way. Can occur w/ prolapse
  • AKA insufficiency
97
Q

Write out murmur cheat sheet

A

DONE

98
Q

Describe mitral stenosis?

A

Mid diastolic murmur w/ mitral valve opening snap, best heard over apex

99
Q

Mitral stenosis is presumed to be caused by…

A

rheumatic heart dz (rare in US)

100
Q

Mitral stenosis: S/S

A
  • worse w/ exertion
  • lead to HF
101
Q

Mitral stenosis: Dx

A

TTE

102
Q

Mitral stenosis: Tx

A

depends on severity (always tx HF)
- close monitoring
- balloon valvuloplasty
- MV replacement

103
Q

Describe mitral regurg

A

pan systolic murmur, radiates to axilla

104
Q

Mitral regurg is caused by…

A
  • MI
  • endocarditis
  • CT dz
105
Q

Mitral regurg affects what % of the US population.

A

6-8% over 65yo

106
Q

Mitral regurg: S/S

A

leads to HF

107
Q

Mitral regurg: Dx

A

TTE

108
Q

Mitral regurg: Tx

A

depends on severity (tx HF)
- monitoring
- valve repair
- valve replacement

109
Q

Describe aortic stenosis?

A

crescendo-decrescendo murmur head at right sternal border, 2nd ICS, radiates to carotids during systole

110
Q

Aortic Stenosis occurs due to…

A

calcification

111
Q

Aortic Stenosis affects what % of the US

A

1% usually older age

112
Q

Aortic Stenosis: S/S

A
  • angina
  • syncope
  • dyspnea
  • fatigue
113
Q

Aortic Stenosis: Dx

A

Echo

114
Q

Aortic Stenosis: Tx

A
  • Mild symptoms–> periodic monitoring
  • Mod/severe–> valve replacement
115
Q

Describe aortic regurg.

A

early diastolic decrescendo murmur

116
Q

Aortic regurg common cause…

A

HTN

117
Q

Aortic regurg affects what % of the population >65 yo

A

1%

118
Q

Aortic regurg: S/S

A

HF & dyspnea

119
Q

Aortic Regurg: Dx

A

echo

120
Q

Aortic regurg: Tx

A

valve replacement if very symptomatic

121
Q

Describe tricuspid stenosis

A

late diastolic murmur

122
Q

Prevalence of tricuspid stenosis

A

very rare

123
Q

Tricuspid Stenosis is caused by…

A
  • rheumatologic dz
  • endocarditis/IV drug uses
124
Q

Tricuspid stenosis: S/S

A
  • right sided HF w/ hepatomegaly
  • ascites
  • dependent edema
125
Q

Tricuspid stenosis: Dx

A

Echo

126
Q

Tricuspid stenosis: Tx

A
  • valve replacement if symptomatic
  • for mild- diuretics, for moderate/severe- repair or replacement
127
Q

Describe tricuspid regurg

A

pansystolic murmur

128
Q

Describe prevalence of tricuspid regurg?

A
  • mild is common
  • severe is rare
129
Q

Tricuspid regurg is caused by…

A
  • infective endocarditis
  • trauma
130
Q

Tricuspid regurg: S/S

A
  • right sided HF w/ hepatomegaly
  • ascites
  • dependent edema
131
Q

Tricuspid regurg: Dx

A

Echo

132
Q

Tricuspid regurg: Tx

A
  • mild–> diuretics
  • mod/severe–> repair or replacement
133
Q

Name the two types of prosthetic valves

A
  • Bioprosthetic
  • Mechanical
134
Q

Advantages for bioprosthetic valve

A
  • no lifelong anticoag needed
  • lower risk of bleeding
  • can be used in pts who can’t tolerate anticoag (pregnancy)
  • good for older pts, cancer pts, & pts in renal failure on dialysis
135
Q

Disadvantages for bioprosthetic valve

A
  • less durable & higher re-operation rates
136
Q

Advantages for mechanical valve

A
  • more durable & less re-operation rate
  • good hemodynamic properties
  • good for younger pts
  • good in pts w/ other mechanical valves
137
Q

Disadvantages for mechanical valve

A
  • incr risk of thrombosis
  • lifelong need for anticoag
  • incr risk of bleeding
138
Q

Anticoag: mechanical vavles

A
  • lifelong anticoag w/ Coumadin
  • target INR 2.5 - 3.0
139
Q

Anticoag: bioprosthetic valves

A
  • anticoag 3 months
  • Coumadin or DOAC
140
Q

All patients will a valvular disorder must take…

A

lifelong ASA (aspirin) as an antiplatelet therapy

Block 3 - Cardio (13 decks)

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