Diseases Flashcards
This valvular disease is caused by a narrowing of the mitral orifice.
Sx include….
Dyspnea
Orthopnea
PND
Fatigue
MItral Valve Stenosis
What is the most common cause of mitral valve stenosis?
What are additional causes?
Rheumatic Fever
Lupus
RA
What procedure is done to correct mitral valve stenosis?
Valvotomy (replace valve)
This valvular disease causes a back-flow of blood into the left atrium from the left ventricle.
Sx include…..
Fatigue
Dyspnea
Orthopnea
DOE
MItral Regurgitatin
T/F: Rheumatic fever is a common cause of mitral valve regurgitation?
True
In a patient with mitral regurgitation, you should agreesively manage _______ _______ symptoms and consider surgical repair or replacement of the mitral valve.
Heart failure
This valvular disease is commonly associated with connective tissue disorders and can be largely asymptomatic.
Sx could include…
Pre-syncope
Chest pain
Mitral valve prolapse
Prophylaxis is used in mitral valve prolapse patient to protect against _________.
Endocarditis
Surgical repair is indicated in mitral valve prolapse patient is severe mitral ___________ develops.
Regurgitation
This valvular disease is a narrowing of the aortic valve commonly due to degenerative calcification.
Sx include….
Angina
Syncope
Dyspnea
Aortic valve stenosis
Is aortic valve stenosis more common in men or women?
Men
What is a common (85%) EKG finding in patients with aortic stenosis?
LVH
T/F: Aortic stenosis is primarily managed medically and surgery is only indicated in severe symptomatic cases.
True
This valvular disease is results in a back-flow of blood from the aorta into the left ventricle due to an incompetent closure of the aortic valve.
Sx include…..
DOE
PND
Orthopnea
Aortic Valve regurgitation
Would you see expect to see LVH or LAD on an EKG in a patient with Aortic valve regurgitation?
A _______ pattern with one of the above would be concerning.
Yes
Strain pattern
T/F: Surgery is always indicated in patient with aortic regurgitation
False
Only in severe symptomatic cases, EX:declining EF
This is a valvular disease in which there is a narrowing of the pulmonic valve and is commonly congenital in nature.
Sx include….
Asymptomatic
DOE
Fatigue
Pulmonic stenosis
This valvular disease results from an incompetent pulmonic valve that allows blood to flow back into the right ventricle from the pulmonary artery.
Sx include
RHF
Emboli
Pulmonary HTN
Pulmonic Valve Regurgitation
What are THREE common causes of pulmonic regurgitation?
Pulmonary HTN
Pulmonary Artery Dilation
Infectious Endocarditis
What may be a common EKG finding in a patient with pulmonic valve regurgitation?
RVH
This valvular disease results in an obstruction between the right atrium and ventricle and is almost always caused by rheumatic infection.
Sx include….
Fatigue
Edema
Mild PND
Tricuspid Valve Stenosis
How is tricuspid valve stenosis medically managed?
Diuretics prior to valvotomy
This valvular disease is commonly caused by right ventricular dilation and results in a back-flow of blood from the right ventricle into the right atrium
Sx include
WORSENING RHF
Tricuspid Valve Regurgitation
What concerning complication should you mpnitor patients with tricuspid valve regurgitation for?
Pulmonary HTN
What are the two most common bacteria that cause infectious endocarditis?
Staph
Strep
When working up a patient for suspected CAD, what is the appropriate stress test in a patient who is low probability?
Intermediate?
Low: Do nothing
Intermediate: Exercise Stress vs Radionuclide
T/F: An echocardiogram should be down in conjunction with a stress test in the evaluation of CAD
True
Is an exercise stress test the appropriate choice for an 85 y.o. who ambulates with a walker?
No, a radionuclide study would be more appropriate
Should you hold a patients CCBs or Beta-blockers if an exercise or dobutamine stress is being preformed?
Why?
Yes, because the patient will not be able to raise their HR enough.
Other than inability to ambulate, what other criteria prevent a patient from preforming an exercise stress test?.
- Abnormal EKG findings
- LBBB
- Baseline ST depression
- WPW
What medications used in a stress test should be avoided in patients with severe asthma/COPD?
Persantine/Adenosine
Which of the cardiac enzymes is the most non-specific however goes up the earliest in an AMI?
Myoglobin
What cardiac enzyme is the most sensitive in an AMI however takes up to 6 hours to reach sensitive levels?
CKMB
This cardiac biomarker can be detected as soon as 2-3 hours in patients with an AMI.
Troponin
What is the appropriate minimal amount of time to rule out an AMI through trending/repeating cardiac enzymes?
12-16 hours
What additional processes/diseases may elevate Troponin levels other then an AMI?
- Shock
- Myocarditis/Pericarditis
- CHF
- Sepsis
- PE
- CKD/ESRD
- Trauma
- BUrns
- CVA
- Rhabdomyolysis
- Extreme Exertion
- Inflammatory State
A patient who presents with the complaint of chest pain without ST changes on EKG however does have elevated cardiac biomarkers would rule in for a _______.
NSTEMI
AS long as a patient diagnosed with a NSTEMI is pain free without EKG changes, is immediate PCI warranted?
No, the goal still remains to get the patient to the PCI lab within 24 hours however there is no benefit seen to immediate catheterization in NSTEMI patients like there is in STEMI patients.
What dose of ASA should NSTEMI patients be given in combination with O2, NTG, and Cardiac Monitoring?
What will the daily dose of ASA be in the next following days?
325 mg PO
Daily dose of 81 mg PO
Are Beta-Blockers withing 24 hours a core measure of treatment in patients with NSTEMI?
What if the EF is <40?
Yes
ACEi or ARB
If Beta-blockers are contraindicated and there is no sign of heart failure then what class of medications is the next appropriate in NSTEMI management?
Non-dihydropyridine CCB (diltiazem/verapamil)
T/F: Coumadin is the anticoagulant of choice in NSTEMI patient treatment while in the hospital
False (Heparin)
What is the primary difference in the treatment of NSTEMI vs STEMI?
Immediate PCI is indicated in STEMI patients whereas PCI is only required within the first 24 hours.
If a PCI lab is not within 90 minutes of your facility, what medications should be given to STEMI patients?
Thrombolytics
After thrombolytics are given should the patient still be transferred to a facility capable of preforming PCI?
YES!
What should always be considered when giving thrombo or fibrinolytics?
The patients bleeding risk
T/F: Cardiac Rehab is not an appropriate outpatient management step in STEMI / NSTEMI
False
It is
What complications can you see in patients who are post-MI?
- Cardiogenic Shock
- Acute MR
- Ventricular wall rupture
- LV Dysfunction
- Dressler’s Syndrome
- Restenosis / Thrombosis
- Renal Failure
- Bleeding
Following an AMI, a follow-up echo is preformed within the first 12 weeks to confirm LV revascularization to r/o ___ __________.
LV Dysfunction
This is the most common disorder of the pericardium and is common caused by viruses.
Sx include….
Pleuritic chest pain worse with lying flat and better when leaning forward
Pericarditis
What may you hear on auscultation of the heart in a patient with pericarditis?
Pericardial friction rub
What EKG findings may be seen in a patient with pericarditis?
Diffuse ST Elevation
PR depression >0.8 mm
Pericarditis following cardiac surgery is often referred to as _______ syndrome.
Dressler’s
Elevated troponin (or other cardiac biomarkers) or LV systolic dysfunction in the setting of acute pericarditis is indicative of __________.
Myopericarditis
What are the two “mainstays” of pericarditis and myopericarditis treatment?
If the duration is longer than 2 weeks, what medication class should be added?
NSAIDs
Colchicine
Steroids
If treatment of pericarditis continues to fail and the patient develops constrictive pericarditis, what may need to be preformed?
Pericardial stripping
Partial Pericardiectomy (Last resort)
This disease occurs when fluid collects between the pericardial layers typically either due to infectious, neoplastic, idiopathic, or renal etiologies.
Sx include…
Tachycardia
Dsypnea
Tachypnea
Friction Rub
Pericardial Effusion
The pericardium can stretch and hold up to ___ L of fluid.
1
Exudative fluid in the pericardium is likely indicative of an ________/_________ process.
Transudative?
Hemorrhagic?
Infectious/Inflammatory
CHF
Trauma/Surgical
This is a hallmark sign of a pericardial effusion which is described as a >10 mm Hg drop in systolic blood pressure with inspiration
Pulsus Paradoxus
T/F: A patient with a pericardial effusion may also have JVD
True
Would the EKG in a pericardial effusion patient be high or low voltage in the precordial leads?
Low
What THREE things compose Beck’s Triad?
What is this a sign of?
In a patient with the above, what shape may the heart be described as on CXR?
- Elevated JVP
- Muffled heart sounds
- Hypotension
Cardiac Tamponade
“Bottle-shaped” heart
T/F: Cardiac Tamponade is NOT a medical emergency
False
It is
Is cardiac tamponade more likely with rapid or slow collection of fluid?
Rapid
How is cardiac tamponade treated emergently?
Pericardiocentesis
Pericardial Window
In a patient with cardiac tamponade it is important to keep fluid pressure inside the heart _____ ____ fluid pressure outside the heart to maintain a normal BP.
Equal to
This disease is occurs due to bacterial or fungal growth inside the hear most commonly in the valves and patients frequently have underlying valvular disorders.
It is commonly seen following procedures and in IVD users.
Sx include….
fever
malaise
Murmur
Endocarditis
What specific lab test should be drawn if you suspect endocarditis?
What imaging study?
Blood Cx
Echocardiogram
T/F: In a patient with a history of valvular disease, are prophylactic ABx warranted prior to the patient undergoing procedures?
True
_____ criteria is often used in the treatment of Endocarditis
Duke
______ nodes are often seen in conjunction with Endocarditis and are typically found on the fingers and toes.
_______ lesions are also associated with endocarditis but can last longer and are more likely with an acute form of bacterial endocarditis.
________ hemorrhages are narrow, reddish-brown lines beneath the nails and are associated with an infection of the heart valve
Osler’s Nodes
Janeway lesions
Splinter hemorrhages
In constrictive pericarditis, ________ ______ occurs since the amount of blood flow into one ventricle is dependent on the amount of blood flow into the other ventricle.
Ventricular Interdependence
Are hepatic congestion. ascites, and JVD commonly seen in patients with constirctive pericarditis.
Yes
What is the initial treatment of constrictive pericarditis?
What is the only definitive treatment?
Diuretics
Pericardiectomy
________ sign is seen in constrictive pericarditis, which is described as an elevation of JVP with inspiration.
Kussmal’s Sign
Stab wounds, MVA, CPR, or burns are all examples of ________ _______ ____.
Traumatic heart disease
T/F: EKG and Echocardiogram are good screening tools in athletes if there is concerning over cardiac disease
True
________ _______ is a connective tissue disease with an autosomal dominant inheritance pattern that can effect the cardiovascular system namely the aorta.
Sx include….
long limbs
Sciolosis
Marfan’s Syndrome
__________ are defined as a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction, which usually exhibit inappropriate ventricular hypertrophy or dilatation, and are due to a variety of etiologies that frequently are genetic. They are confined to the heart or are part of a generalized disorder, often leading to cardiovascular death or progressive heart failure-related disability
Cardiomyopathies
________ cardiomyopathies are solely or predominantly confined to the heart muscle
__________ cardiomyopathies have myocardial involvement as a prat of a generalized systemic disorder
Primary
Secondary
___________ cardiomyopathy is the most common cardiomyopathy and is the most common cause of sudden cardiac death in the young.
Hypertrophic cardiomyopathy
Is hypoertrophic cardiomyopathy an autosomal dominant or recessive trait?
Dominant
HCM is characterized by a hypertrophic ___-______ left ventricle in the absence of other causes.
non-dilated
T/F: Patients with HCM can be largely asymptomatic
True
What is the diagnostic test for HCM?
Echocardiogram
What composes the pathophysiology of HCM?
- Diastolic Dysfunction
- LV outflow tract obstruction
- Mitral Regurgitatin
- Myocardial Ischemia
- Arrhythmias
What causes the diastolic dysfunction in HCM?
“Stiffness” of the LV requiring higher than normal LA pressure
In a patient with HCM, would you typically expect to see the LVOT obstruction manifest at rest or with exercise?
Exercise
Why would myocardial ischemia occur in a patient with HCM?
Supply and demand mismatch
What is the most common murmur associated with HCM?
Mitral Regurgitation
T/F: Patients with HCM should refrain from competitive athletics however moderate levels of activity are okay
True
What two classes of medications are commonly used in HCM patients?
What procedure can be down to lower the LVOT gradient in HCM patients?
CCB
Beta-blackers
Alcohol Septal Ablation
Can dual chamber pacing be used in HCM patients to lower the LVOT gradient?
Yes
What procedure is reserved for HCM patients who continue to have symptoms despite medical therapy?
Septal Myomectomy
____________ cardiomyopathy is a common and IRREVERSIBLE disease of the heat muscle and 20-30% may have a familial component
Dilated
T/F: Dilated cardiomyopathy is the most frequent indication for heart transplant
True
Dilated cardiomyopathy is a diagnosis of _______.
Exclusion
What types of things should be ruled out when assessing for dilated cardiomyopathy?
What tests/procedures should be preformed?
- CAD
- Valvular Disease
- Echo
- Stress Test
- Cardiac Catheterization
- Endomyocardial Biopsy
(Routine blood work is also beneficial)
Dilated cardiomyopathy is characterized by dilation and impaired contraction of the ventricles with an EF of _____ ____ __%
Less than 40%
What are common presenting symptoms of dilated cardiomyopathy?
- CHF
- Arrhythmia
- Thromboembolic complications
- Sudden Death
If medical management of dilated cardiomyopathy fails, what is indicated?
Heart Transplantation
Dr. Oaks is a ________ surgeon
SUPER
________ involves inflammation of the cardiac myocytes with viral being the most common cause
Myocarditis
_____________ cardiomyopathy is most commonly seen in obese, multiparous, black women older than 30 y.o.
Presentation is typically HF symptoms in the first 6 months of pregnancy
Peripartum Cardiomyopathy
_________ cardiomyopathy is associated with heavy and sustained alcohol use.
Alcoholic
__________ cardiomyopathy (not a true cardiomyopathy) typically results from multiple MIs and CAD.
Ischemic cardiomyopathy
T/F: Chemotherapy is associated cardiomyopathy
True
__________ cardiomyopathy is characterized by restrictive ventricular filling, reduced ventricular, and near normal ventricular function.
Restrictive cardiomyopathy
Patients with restrictive cardiomyopathy will present with heart failure in the absence of _____________.
Cardiomegaly
What is the most common cause of restrictive cardiomyopathy?
amyloidosis
How is restrictive cardiomyopathy diagnosed?
Serum and urine electrophoresis
Endomyocardial biopsy
How is restrictive cardiomyopathy treated?
Treat underlying blood dyscrasia
T/F: Heart transplant is indicated in patients with restrictive cardiomyopathy
False
It is contraindicated
