Qbank 1st block Flashcards
What are common etiologies of acute pericarditis?
Common etiologies include idiopathic causes, viral infections, autoimmune diseases (e.g., SLE, drug-induced lupus, RA), cardiac surgery or radiation, post-myocardial infarction, and uremia.
What are the clinical features of acute pericarditis?
Clinical features include pleuritic chest pain relieved by sitting up and leaning forward, and a triphasic friction rub.
What does the ECG show in acute pericarditis?
The ECG shows diffuse ST-segment elevations and PR-segment depressions.
What is the treatment for acute pericarditis?
Treatment includes NSAIDs +/- colchicine, glucocorticoids, and dialysis.
What is fibrinous pericarditis?
Fibrinous pericarditis is the most common subtype of acute pericarditis, characterized by fibrin-containing exudate within the pericardial sac.
What is the relationship between acute pericarditis and systemic lupus erythematosus?
This patient’s fibrinous pericarditis is likely due to untreated systemic lupus erythematosus.
What is the nature of chest pain in acute pericarditis?
The chest pain is sharp, may radiate to the shoulders or scapulae, worsens with inspiration or movement, and is alleviated by sitting up and leaning forward.
What is a triphasic friction rub?
A triphasic friction rub is a sound heard during cardiac auscultation throughout atrial systole, ventricular systole, and early ventricular diastole, resulting from fibrinous exudate.
What is acute myocarditis?
Inflammation of the myocardium often caused by infection, drugs, or autoimmune disease.
Common causes include coxsackie B virus, cocaine, and systemic lupus erythematosus (SLE).
What are some potential outcomes of myocarditis?
Arrhythmias, dilated cardiomyopathy, heart failure, sudden cardiac death.
Symptoms may vary from asymptomatic to severe.
What type of chest pain is associated with myocarditis?
Not pleuritic.
Echocardiography typically shows global cardiac enlargement.
What are common manifestations of arrhythmias?
Chest pain, palpitations, dyspnea, syncope.
Presentation can range from mild and asymptomatic to severe and life-threatening.
Is acute onset chest pain a typical manifestation of congestive heart failure?
No.
Patients more commonly present with chronic symptoms such as progressive dyspnea.
What does endocarditis refer to?
Inflammation of the cardiac valves, most often due to bacterial infection.
Risk factors include congenital heart defects, prosthetic heart valves, IV drug use.
What are typical presentations of endocarditis?
High fever, new murmur, vascular manifestations, immunologic phenomena.
Examples include petechiae, splinter hemorrhages, glomerulonephritis, Osler nodes.
What characterizes myocardial infarction?
Sudden-onset, severe substernal chest pain, often radiating to the shoulder or jaw.
Associated symptoms include nausea, pallor, and diaphoresis.
What is the typical presentation of pulmonary embolism?
Sudden-onset shortness of breath and pleuritic chest pain.
A triphasic pericardial friction rub suggests acute pericarditis.
What is the most common cardiovascular manifestation of SLE?
Acute fibrinous pericarditis.
It typically causes sharp pleuritic chest pain relieved by sitting up and leaning forward.
What is pathognomonic for acute fibrinous pericarditis?
Presence of a triphasic friction rub on cardiac auscultation.
This finding is highly indicative of acute fibrinous pericarditis.
What symptoms indicate a heart failure exacerbation?
Increased shortness of breath with minimal exertion, pleuritic chest pain, and peripheral edema.
What happens during an acute heart failure exacerbation?
The heart can no longer compensate and produce adequate forward flow, causing fluid backup into the pulmonary and venous circuits.
What physical exam findings suggest heart failure exacerbation?
Increased jugular venous distention, positive hepatojugular reflex, and pitting edema to the level of the knee bilaterally.
What does an R wave greater than 12 mm in lead aVL indicate?
It indicates left ventricular hypertrophy according to the Sokolow-Lyon Criteria.
What is the mechanism of action of milrinone?
Milrinone selectively inhibits phosphodiesterase-3, increasing levels of cAMP and cGMP.
What effects does increased cAMP have in the myocardium?
It results in increased protein kinase A activity and calcium availability in the sarcoplasmic reticulum, enhancing contractility.
What are the positive effects of milrinone?
Positive inotropic and chronotropic effects, increasing contractility.
What side effects may result from increased calcium due to milrinone?
Muscle cramps and potential chest pain.
What is the vasodilatory effect of milrinone?
Increased GMP concentrations result in vasodilation, which may cause headaches and dizziness.
In what clinical settings is milrinone beneficial?
In acute heart failure or pulmonary hypertension, especially in hospitalized patients.
What is cilostazol and its primary action?
Cilostazol is a phosphodiesterase-3 inhibitor that preferentially acts on vascular smooth muscle and platelets. It increases protein kinase A levels within blood vessels to prevent platelet activation.
How does cilostazol compare to milrinone?
Cilostazol has less effect on cardiac tissues compared to milrinone, which is more effective in increasing cardiac output.
What is the primary use of dipyridamole?
Dipyridamole is a non-selective phosphodiesterase and adenosine deaminase inhibitor, often prescribed with warfarin as an antiplatelet agent to prevent thromboembolic disease after mechanical valve replacement.
What are the vasodilatory properties of dipyridamole?
Due to its prostacyclin-dependent vasodilatory properties, dipyridamole may be used intravenously as a pharmacologic stress test agent.
What is dobutamine used for?
Dobutamine is a B1-adrenergic receptor agonist used in cardiogenic shock to increase contractility and cardiac output.
What is the indication for dobutamine?
Dobutamine is indicated for short-term use in patients in intensive-care settings.
What is midodrine and its primary action?
Midodrine is an a1-adrenergic receptor agonist prescribed for orthostatic hypotension, increasing peripheral vascular resistance.
