other cardiac pathology

Question 1

consequence of untreated group A strep (strep pyogenes) pharyngitis
body fights of initial infection →
type 2 HSR: couple weeks later: autoantibodies attack heart + other organs

Answer 1

rheumatic heart disease

Question 2

4 complications of group A strep infection

Answer 2

scarlet fever
post-streptococcal glomerulonephritis
acute rheumatic fever
streptococcal toxic shock syndrome

Question 3

occurs while have group A strep pharyngitis

TOXIN-MEDIATED widespread SANDPAPER rash over entire body

Answer 3

scarlet fever

Question 4

occurs 1-6 wks following strep A strep pharyngitis
type 3 HSR: immune-complex mediated
hematuria, proteinuria, renal insufficiency

Answer 4

post-streptococcal glomerulonephritis

Question 5

occurs 2-4 weeks following strep A pharyngitis in KIDS

type 2 HSR: auto-antibodies attack heart

Answer 5

acute rheumatic fever

Question 6

more commonly follows group A strep skin or vaginal infection (but can follow pharyngitis)

Answer 6

streptococcal toxic shock syndrome

Question 7

diagnostic criteria (Jones criteria) for acute rheumatic fever

Answer 7

evidence of group A strep infection (↑ antistreptolysin O titer) + 2 major +  1 minor = high probability of rheumatic fever
Major Criteria (J♥NES):
Joints (MIGRATORY polyarthritis)
♥ PANcarditis (endo + myo+ peri)
Nodules (PAINLESS subq)
Erythema marginatum (serpiginous= irregular "ring-like" rash, creeping outward/starts small, come-go over few hours)
Sydenham chorea = St. Vitus dance (chorea of face, tongue, upper limb)
Minor Criteria:
arthralgia
fever
↑ ESR or CRP
prolonged PR interval on EKG

Question 8

complications of acute rheumatic fever

Answer 8

early sequelae: myocarditis → can be fatal
late sequelae: rheumatic heart disease: autoimmune damage to valves, MITRAL > aortic, may begin as mitral regurgiation → mitral stenosis, ↑ antistreptolysin O (ASO) titers, aschoff bodies, Anitschkow cells

Question 9

aschoff bodies: inflammatory nodules in myocardium = granuloma: fibrinoid necrosis, lymphocytes, mutlinucleated giant cells

Answer 9

rheumatic heart disease

Question 10

Anitschkow cells: activated histiocytes with “owl-eye” appearance

Answer 10

rheumatic heart disease

Question 11

causes of fibrinous pericarditis

Answer 11

uremia: chest pain + friction rub + ↑Cr
RA
Dressler syndrome: pericarditis that occurs several weeks post-MI

Question 12

causes of serous pericarditis

Answer 12

non-infectious inflammatory diseases:
lupus: + ANA
rheumatic fever (pancarditis)

Question 13

sharp chest pain
pleuritic chest pain: worse with inspiration, RELIEVED by sitting FORWARD
distant heart sounds
friction rub
DIFFUSE ST elevations in all 12 leads (no pattern: 2,3, AVF =inferior MI; 1, AVL = lateral MI)
DIFFUSE PR depression
can resolve without scars or lead to chronic constrictive pericarditis

Answer 13

acute pericarditis

Question 14

infection of pericardium + pus in pericardial space

Answer 14

suppurative (pus) pericarditis

Question 15

causes of hemorrhagic pericarditis

Answer 15

TB

melanoma (common cancer that causes cardiac mets)

Question 16

common cause of constrictive pericarditis

Answer 16

lupus

Question 17

signs/symptoms of acute pericarditis
AND
Kussmaul sign: JVD distention with inspiration (right sided heart problem - RIGHT ventricle doesn’t fill well →↑ JVD)

Answer 17

chronic constrictive pericarditis

Question 18

inspiration →↓ intrathoracic pressure →↑ RV filling (less blood in JVD = flat JVD)

Answer 18

normal JVD response to inspiration is flat

Question 19

fluid between myocardium + pericardium → compresses heart → ↓ filling during diastole →↓ CO + equilibration of diastolic in all 4 chambers → 
hypotension
↑ venous pressure = JVD
distant heart sounds
↑ HR
pulsus paradoxus
\+/-EKG: electrical alternans

Answer 19

cardiac tamponade

Question 20

exaggerated ↓ in amplitude of systolic bp (>10 mmHg) during inspiration (LEFT ventricle doesn’t fill well)

Answer 20

pulsus paradoxus

Question 21

inspiration: ↓ intrathoracic pressure → RV filling → pushes IV septum to left = LV smaller during inspiration →↓ volume out of LV → systolic bp slightly lower during inspiration (normal)

Answer 21

normal systolic bp response to inspiration

Question 22

causes of pulsus paradoxus: diseases with exaggerated inspiration (hyperinflated lungs) →exaggerated filling of RV→ exaggerated ↓ filling of left heart

Answer 22

cardiac tamponade
asthma
croup
obstructive sleep apnea
COPD
pericarditis (rare - more commonly Kussmaul sign)

Question 23

electrical alternans: alternating amplitude of QRS complex beat-to-beat

Answer 23

cardiac tamponade (specific, not sensitive)

Question 24

3° syphilis primarily affects:
vaso vasorum (blood vessels supplying AORTA) →
dilation of aorta and aortic valve ring→
aortic regurgitation
or aortic stenosis
THORACIC aortic aneurysms
calcification of aorta “tree bark” appearance of inside of aorta

Answer 24

syphilitic heart disease

Question 25

types of cardiac tumors

Answer 25

metastatic tumor: most common type overall

myxoma: most common 1° tumor in adults
rhabdomyoma: most common 1° tumor in children

Question 26

types of metastasis to heart

Answer 26

melanoma

lymphoma

Question 27

tumor in left atrium

Answer 27

“left atrial myxoma”

Question 28

echo: “ball valve” obstruction in LA → obstruct mitral valve → no blood flow into LV → systole: no blood out → syncope

tumor can flop over into LV during diastole → early diastolic sound “tumor plop”

Answer 28

myxoma

Question 29

tumors associated with tuberous sclerosis:

Answer 29

rhabdomyoma
astroctyoma
angiomyolipoma: renal tumor