Heart pathology Flashcards
Acute rheumatic fever
Affects children 2-3 weeks post-strep throat due to molecular mimicry involving bacterial M protein
JONES criteria: Joints, heart, subcutaneous Nodules, Erythema marginatum, Sydenham chorea
Heart complications:
- endocarditis (small vegetations along lines of closure of MV, leading to regurgitation)
- myocarditis (Aschoff bodies with Anitschkow cells)
- pericarditis
Chronic rheumatic heart disease
Always involves mitral valve - thickening of chord tendinae and cusps, leading to mitral stenosis
Sometimes involves aortic valve - fusion of commissures, leading to aortic stenosis
Aortic stenosis
Usually due to “wear and tear”; sometimes due to chronic rheumatic heart disease; can lead to syncope, angina, and dyspnea on exertion
Systolic ejection click followed by crescendo-decrescendo murmur; “pulsus parvus et tarsus”
- Murmur louder with maneuvers that increase preload (squatting) and softer with maneuvers that decrease venous return (standing, valsalva) or increase SVR (handgrip)
Results in concentric LV hypertrophy (w/ decreased EDV)
Aortic regurgitation
Usually due to isolated root dilation; may be caused by syphilitic aneurysm, aortic dissection, infectious endocarditis
Early blowing diastolic murmur with increased pulse pressure (head bobbing, bounding pulse)
- Louder with maneuvers that increase SVR (handgrip)
- Louder when patient sits up and leans forward (valve closer to chest wall)
- Louder with expiration
- Softer with vasodilators (decrease SVR)
Results in eccentric LV hypertrophy (w/ increased LV EDV)
Mitral valve prolapse
Due to myxoid degeneration of the MV; may be seen in Marfan Syndrome or Ehlers-Danlos syndrome
Mid-systolic click followed by regurgitation murmur
- Click/murmur occur earlier with maneuvers that decrease venous return (e.g. standing or Valsalva)
- Murmur louder with maneuvers that increase TPR (e.g. squatting or hand grip)
Mitral regurgitation
Usually arises as a complication of mitral valve prolapse; may also be caused by LV dilatation, infective endocarditis, acute rheumatic heart disease, and papillary muscle rupture post-MI
Holosystolic blowing murmur
- Louder with maneuvers that increase TPR (squatting, hand grip) and increase LA return (expiration)
- results in volume overload and left-sided HF
Mitral stenosis
Usually due to chronic rheumatic heart disease
Opening snap followed by diastolic rumble. Decreased interval between S2 and OS correlated with increased severity.
- Louder with maneuvers that increase LA return (expiration)
Volume overload leads to dilatation of the LA, which results in pulmonary congestion, pulmonary HTN (right-sided HF), and A-fib with risk for mural thrombi
Hypertrophic cardiomyopathy
Commonly familial (AD) due to beta-myosin heavy-chain mutation; rarely associated with Friedreich ataxia; characterized by myofibrillar disarray and fibrosis; characterized by S4 (diastolic dysfunction) and systolic murmur (systolic dysfunction)
Systolic murmur louder with maneuvers that decrease venous return (e.g. squatting or Valsalva)
Systolic murmur softer with maneuvers that increase SVR (hand grip) or increase venous return (squatting)
Tx: beta-blockers or non-dihydropyridine Ca blockers
Tricuspid regurgitation
Commonly caused by RV dilation
Holosystolic blowing murmur
- Louder with maneuvers that increase RA return (inspiration)
VSD
Holosystolic, harsh-sounding murmur. Loudest at tricuspid area.
- Louder with maneuvers that increase SVR (hand grip)
PDA
Continuous machine-like murmur. Loudest at S2. Often due to congenital rubella or prematurity
Causes of dilated cardiomyopathy
“ABCCCD”
- Alcohol abuse
- wet Beriberi (thiamine deficiency)
- Coxsackie B virus myocarditis
- Cocaine abuse
- Chagas disease
- Doxorubicin toxicity
Also hemochromatosis, peripartum cardiomyopathy, and idiopathic
Results in systolic dysfunction and eccentric hypertrophy
Symptoms of bacterial endocarditis
“FROM JANE”:
- Fever
- Roth spots (white spots on retina)
- Osler nodes (tender lesions on fingers/toes)
- Murmur
- Janeway lesions (painless lesions on palms/soles)
- Anemia
- Nail bed hemorrhage
- Emboli
Pulsus paradoxus
Drop in SBP by greater than 10mmHg during inspiration; normal drop in SBP (< 10mmHg) during inspiration caused by decreased return from pulmonary veins
Causes include: cardiac tamponade, asthma, OSA, pericarditis, and croup.
Kussmaul’s sign
Paradoxical increase in JVP during inspiration
- normally JVP drops during inspiration due to negative intrathoracic pressure and increased return to R heart
Causes include: constrictive pericarditis, restrictive cardiomyopathies, cardiac tamponade, R heart tumors
