Other Heart Diseases

Question 1

Transposition of Great Vessels

Answer 1

Most common Cyanotic heart defect identified in First Week of Life.

Severity depends on amount of mixing between Pulmonary and Systemic circulation via another defect.

Poor Feeding, Cyanosis, Clubbing, Dyspnea

Murmur may present depending on presence of a secondary defect.

Surgical correction is necessary.

PDA is required for life until surgically repaired.

Question 2

Rhematic Heart disease

Answer 2

Post-streptococcal infection of any of the heart valves.

Develops in ~3% of Untreated Strep infections.

Diagnosis is made in combo with other manifestations of Rheumatic Fever, e.g. Arthritis (joints), Erythema Marginatum (skin), Sydenham’s Chorea (brain).

Elevated ASO titers.

Elevated ESR (sed rate).

Echocardiogram may be useful in characterizing the Valvular disease.

Question 3

Endocarditis

Answer 3

Inflammation of the lining of the heart chambers, including the valves.
–Usually caused by infection.

Fever (hallmark), Splinter hemorrhages under Fingernails,
Malaise,
Roth’s Spots (infected thrombus causing oval, white hemorrhages in back of eye over retina),
Osler’s Nodes (deposition of complement complexes, causing pain, erythema, on pads of fingers and toes, may be hyper-pigmented),
Janeway Lesions (not painful/ nontender, erythmatous, palms and soles)

Risk Factors: Congenital Heart Disease,
Prior Rheumatic Disease,
Cardiac Valve Anomalies,
Prosthetic Valves
Hematogenous spread of infection.
#1 cause is IV Drug Use.
Recent Dental surgery, other invasive procedures

Question 4

Pericarditis

Answer 4

Inflammation of lining of heart.
Most commonly caused by viruses.

Chest pain (hallmark) (usually relieved with sitting).
--Leaning forward/ laying down (moving heart around) can exacerbate chest pain.

Friction Rub (key physical finding in 90% patients) @ Left Sternal Border
(Friction Rubs usually indicate either pericarditis or pleuritis)

If an Effusion is present, may lead to Cardiac Tamponade – Pulsus Paradoxus.

EKG shows diffuse ST segment elevation.

Autoimmune Disorders, Malignancies, HIV, Thyroid Disease

Question 5

Myocarditis

Answer 5

Inflammation of Heart muscle itself.

Symptoms may mimic an MI.

Tachycardia, Murmurs, Gallop rhythms, other Arrhythmias, Pulsus Alternans