Heart Pathology Flashcards
What are the signs and symptoms of left heart fail?
On CXR?
Will see progressive dysnpea and orthopnea (cough when lying down)
CXR: Cardiomegaly, blunting of costophrenic angle (pleural effusion) and batwing in the peri-hilum area, Kerley B lines and increased vasdcular shadowing.
Caused by Left ventricle failure leading to increased left atrial pressure and increased ventricle filling pressure (or preload). This increased pressure transmists back to pulmonary capillaries==> fluid transudation into pulmonary interstial and alveolar spaces
When would you see the AV node take over to pace the heart? What would this look like on ECG?
If conduction between SA and AV node is impaired; may be d/t 3rd degree heart block
Changes will be bradycardia (SA has much higher firing rate, AV has slow firing rate at 45 bpm) and will see atria and ventricle depolarize ind of each other = AV dissocation
the QRS complexes will still be narrow bc ventricle depolarization is occuring normally.
Bacterial endocarditis FROM JANE
Bacteria FROM JANE ♥:
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions Anemia
Nail-bed hemorrhage Embol
What bacteria are implicated in Acute Bacterial Endocarditis?
Acute—S. aureus (high virulence).
Large vegetations on previously normal valves with rapid onset.
Pt comes to clinic with fever he’s had for the past several days. During your PE you notice he has conjuctival pallor and small erythematous lesions on his hands and soles. You ask if they hurt and he states mostly not, except for a raised one on the pad of his thumb. While gathering history on the patient, he admits he has a pretty dangerous drug habit.
What abnromatility would you expect to see in his heart?
BActerial endocarditis: signs of fever, anemia, Osler and Janeway lesions
IV drug use history: (Tricuspid valve implicated in IV drug use)
Think Acute and Staph Aureus; there will be large vegitaitons on previously normal valves
What type of bacterial endocarditis would you expect in a pts that has had recent dental procedures?
What would the vegitations in his heart look like?
Subacute—viridans streptococci
(low virulence). Smaller vegetations on congenitally abnormal or diseased valves. Sequela of dental procedures. Gradual onset.
Most commonly implicated bacteria in culture negative bacterial endocartditis?
What about if the patient also has colon cancer?
What about a pt with prosthetic valves?
Culture Negs: Coxiella burnetii, Bartonella spp., HACEK (Haemophilus,
Actinobacillus, Cardiobacterium, Eikenella, Kingella)
Colon cancer + endocarditis = S. Bovis
Prosthetic vavle + endocarditis = S. Epidermidis
Little girl shows up to the ER with her mother. This little girl has a fever of 102 and crys every time she tries to walk or lift her arms but she doesn’t keep still and keeps moving and shifting. The mom states she would like you to avoid putting anything with preservitives in her daughter, that she and her husband are trying to raise them ‘holistically’. What is the most immediate concern for this girl?
Child has Acute Rheumatic Fever = Group A B-hemolytic Strep.
: FEVERSSS
Fever, Erhythma marginatum, Vavlular damage, ESR, Red hot joints, SubQ nodules, Syndham chorea
Death from Myocarditis is most concerning.
What late sequale are seen in Rheumatic Fever?
What is the pathology for such complicated heart involvement seen in this diesase?
Late sequelae include rheumatic heart disease, which affects heart valves—mitral > aortic >> tricuspid (high-pressure valves affected most).
Early lesion is mitral valve regurgitation;l ate lesion is mitral stenosis.
Immune mediated (type II hypersensitivity); not a direct effect of bacteria. Antibodies to M protein cross-react with self antigens (molecular mimicry).
What are Antisckow cells and Aschoff bodies?
Associated with Aschoff bodies (granuloma with giant cells ), Anitschkow cells (enlarged macrophages with ovoid, wavy, rod-like nucleus), anti- streptolysin O (ASO) titers.
seen in Acute Rheumatic fever
Beck triad (hypotension, distended neck veins, distant heart sounds), Increased HR, pulsus paradoxus. ECG shows low-voltage QRS and electrical alternans
Cardiac Tamponade: Compression of heart by fluid (e.g., blood, effusions) in pericardial space–> Decreased CO.
Equilibration of diastolic pressures in all 4 chambers.
What is Pulsus Parvus and when do you see it?
DECREASE in amplitude of systolic BP by > 10 mmHg during inspiration.
Seen in cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup.
Commonly presents with sharp pain, aggravated by inspiration, and relieved by sitting up and leaning forward. Presents with friction rub. ECG changes include widespread ST-segment elevation and/or PR depression.
Acute pericarditis
Most common Primary Heart tumor in adult: Where is it locted and What does it look like?
What is the most common Primary cardiac tumor in children?
Myxoma: 90% in Left Atrium adn often called a “ball valve”–> see mult syncopal episodes
Rhabdomyomas: often assoicated with Tuberous Sclerosis
What effects does Nitroprusside have on the cardiac pressure loop when given to pt with heart fail?
Nitroprusside is a balanced venous and arterial vasodialator: Reduces preload and reduces afterlooad but compliance and contractibilty are left unchanged
