myocardial infections

Question 1

what is a common cause of myocarditis in south and central america and what are the associated problems?

Answer 1

oftan caused by trypanosoma cruzi, which causes chagas disease. it may be associated with achalasia

Question 2

what are the infections that cause myocarditis?

Answer 2

coxsackie, parvovirus B19, HHV6, adenovirus, EBV/CMV, flu. sometimes bacteria, rickettsiae, fungi, parasites
may also be caused by drugs (doxorubicin, penicillins, suflonamides, cocaine, radiation) or toxins/endocrine reasons

Question 3

what labs are seen in acute rhemuatic fever?

Answer 3

increased ESR, CRP, WBC count; 90% have antistreptococcal antibodies. may have incr PR interval on EKG

Question 4

Jones criteria

Answer 4

used to diagnose rhematic heart disease:
major criteria:
JONES: joints, heart, nodules (subcutaneous), erythema marginatum, syndeham chorea. need 2 major or 1 major and 2 minor
minor criteria: prior rheumatic fever, EKG with PR prolongation, arthalgias, CRP/ESR elevation, fever

Question 5

which patients are most at risk for endocarditis?

Answer 5

IV drug users, pts with congenital heart defects, prosthetic valves. pts with SLE may present with noninfective endocarditis

Question 6

duke criteria

Answer 6

used to diagnose infective endocarditis:
requires:
-histologic evidence of endocarditis
or
-positive gram stain/culture from surgical debridement of cardiac abscess
or
2 major criteria: serial blood cultures positive for organisms associated with endocarditis, presence of vegetations on echo, new valvular regurg, culture positive for coxiella burnetii
or 1 major and 3 minor or all 5 minor
minor: heart condition/IV drug use, fever, vascular phenomenon (like emboli, septic pulm infarcts, mycotic aneurysm, intracranial hemorrhage, conjuctival hemorrhage, janeway lesions), immune phenomenon (glomerulonephritis, osler nodes (nodues on fingers and toes), roth spots (retinal hemorrhages, positive rheumatoid factor), positive cultures not meeting major critera

Question 7

how is bacterial endocarditis treated?

Answer 7

4-6 wks iv abx. usually use a beta lactam + aminoglycoside. may need valve replacement

Question 8

What are the most common causes of secondary HTN?

Answer 8

renal

Question 9

what are common causes of secondary HTN

Answer 9

renal disease, renal artery stenosis, OCPs, pheos, primary hyperaldosteronism or excess glucocorticoids, coarctation of the aorta, hyperparathyroidism

Question 10

renal artery stenosis: how diagnosed? how treated?

Answer 10

dx: arteriography, MRA, CT, renal artery duplex scan
tx: angioplasty, stent placement, ACE-I if one sided, surgery

Question 11

diagnosis of pheo

Answer 11

present with episodic HTN, diaphoresis, HA. sx occur suddenly
they have incr 24 hr urinary catecholamines or vanillylmandelic acid. use CT, MRI

Question 12

how is primary hyperaldosteronism diagnosed and treated?

Answer 12

dx: suspect in pts with HA, hypokalemia, metabolic alkalosis. high ratio of plasma aldosterone to plasma renin. tx is surgical or with aldo antagonists

Question 13

how does hyperparathyroidism present?

Answer 13

confusion, kidney stones, constipation

incr. serum calcium and PTH, decr. serum phosphates

Question 14

how fast can you reduce BP in hypertensive emergency?

Answer 14

initial decr over the first 2 hours in diastolic BP should not exceed 25% to prevent ischemia