Exam 8 Flashcards
Endocarditis: signs and symptoms
-acute / sub-acute
-new/changed murmur
-SOB
-tachycardic
-chest pain with inspiration
-Flu symptoms: fever, fatigue, chills, joint pain, night sweats
-Red Spots: on hands, fingers, eyelids
Endocarditis: On Echo
1) vegetations: irregularly shaped, small pedunculated masses adhered to the thickened valve
2) regurgitation: associated from leaflet destruction
3) leaflet destruction: perforation or from vegetation preventing closure
4) paravalvular abscess: echo lucent contour/ out pouching of the infected annulus
5) paravalvular aneurysm: EX: sinus of valsalva aneurysm
6) fistula
7) prosthetic valve dehiscence: ring tilting
Endocarditis: Candidates
1) pre-existing valvular heart disease
2) valve prosthesis / artificial devices / catheters / wires
3) congenital abnormalities
4) IV drug users
5) past history of endocarditis
6) recent surgical / dental / medical procedures
7) Lupus, AIDS, Antiphospholipid patients
Non-primary Tumors: Origins
1) lung, breast and blood (75%)
2) Lymph, stomach, skin melanoma, liver, colon
Non-primary Tumors: Presentations
1) Malignant Pericardial Effusion: examination of fluids to confirm
2) Pericardial Masses: hypolucent and incorporated into tissue
3) Invading Masses: from adjacent malagnancies
4) Extension Type Tumors: projections through the IVC or can come from Pulmonary Veins
5) Carcinoid Heart Disease: metastatic carcinoid tissue in liver produces serotonin leading to thickening, retraction, and ridigity of TV, PV, and regurgitation
Primary Tumors: Malignant
1) Angiosarcomas: cancerous endothelia cells (most common) bloody effusion with tamponade
2) Rhabdomyosarcomas: forms in soft tissue
3) Pericardial Mesotheliomas: mesothelium- lining that covers internal organs, forms in the pericardial lining due to asbestos exposure
4) Fibrosarcomas: forms in fibrous tissue of the heart
Primary Tumors: Benign
1) Mxyomas: large single undulating mass arising from fossa ovalis protruding into LA
2) Papillary Fibroelastoma: small mass attached to valvular tissue (MV/AV)
3) Hemagiomas: neoplasm that consists of blood vessels attached to walls
4) Mesothelioma on AV node: benign cyst on the AV nodal region of the IAS
5) Lipomatous Hypertrophy: superior and inferior IAS become enlarged with fat (dumbbell appearance)
6) Pericardial / Bronchogenic Cyst
7) Fibroma: refractile ovoid mass embedded in myocardium
8) Rhabdomyoma: most common in children; multiple and variable sized masses associated with tubular sclerosis
Predisposing Conditions of Thrombi:
1) LV thrombus: Regions of blood stasis or low flow such as an aneurysm, segmental kinesis, or diffuse hypokinesis
2) Left Atrial Thrombus: stasis of blood flow in LA; “spontaneous contrast” or swirl on TEE; MS, LAE, A-fib, low PW doppler velocities
3) Right Heart Thrombus: severe RVD, decreased RVSF, RV contusion, severe PHT, Peripheral Venous Disease (most common)
4) Extracardiac Thrombus: bleed into pericardial sac
Aortic Dissection: Definition
Life threatening intimal tear in the aortic wall which allows passage of blood into a “false” lumen between the intima and media
Aortic Dissection: At risk groups
1) Hypertension: chronic / uncontrolled
2) Atherosclerosis: significant plaque build up
3) Marfan ; Loeys-Dietz
4) Turners Syndrome: girls with only 1 X chromosome
5) Aortitis: inflammation of Aorta
6) Ehlers-Danlos Syndrome: MVP, ARD, familial connective tissue disorder
7) Bicuspid / Unicuspid AV: fivefold increased risk
8) Pre-existing Aneurysm
9) Pregnancy / Aging: vulnerable Aorta
Aortic Dissection: Symptoms
1) Severe “tearing” chest pain that radiates to the back / abdomen
2) SOB
3) Hypotensive
Complications of an Aortic Dissection
1) Aortic Regurgitation
2) Coronary Ostial Occlusion
3) Distal Vessel Obstruction
4) Pericardial Effusion / Tamponade
5) Acute Hemodynamic Collapse
How Aortic Dissections occur
1) AR: due to aortic dilation; dissection disrupting support structures
2) COO: flap prevents flow from entering artery
3) DVO: flap prevents flow from entering branch vessels
4) PE/T: rupture at the aortic annulus into the pericardial space
5) AHC: external rupture into mediastinum or pleural space
Mxyomatous Syndrome
recurrent mxyomas (freckles around eyes)
Differentiating Cardiac Masses
Tumor: area of normal contraction or flow; rarely attached to valve
Thrombus: near area of stagnant flow or akinesia
Vegetation: attached to proximal side of the valve
