RF & VHD Flashcards
RF: ARF
duration, pathology (2) + d/t (2), prevention
affects what, when morbid, throat sx (3.1)
age, recurrence
- lasts 2 weeks
- multisystemic, autoimmune
- group A beta hemolytic streptococci (GABHS) & supprative pharyngitis (strep pyogenes/sore throat)
- can’t be eradicated since unknown course
- back of throat = hyperemic & beefy red, sides have separation/nana
- affects joints
- morbid consequences: after 15-20y
- age: 5-14y
- can recur
RF: AHF
RHD - if, age, sex
- RHD if heart damage
- epi: 25-40y, F
RF: ARF
major & minor criteria, risk x temp
- major: joints, o/myocarditis, nodules, erythema marginatum, syndenham chorea
- minor: CRP inc, arthralgia, fever, ESR, prolonged PR, anamnesis of rheumatism, leukocytosis (inc WBC)
- high risk for warmer countries
major criteria
- carditis: clinical
- arthritis: poly | monoarthritis, polyarthalgia
minor criteria
- carditis: prolonged PR interval (ECG)
- arthralgia: polyarthalgia| mono
- erythrocyte sedimentation rate: >30 | >60
- c-reactive protein: >3
RF: ARF
carditis - responsible for (3), main manifestation describe (3) + which valve & why + leads to what
- responsible for major sequelae of RF; acute & subacute myocardial and acute pericardial dysfunciton
signs/sx
- valvulitis: inflammation, vegetation, growth
- mitral > aortic since higher polysaccharides (looks like epitopes)
- leads to regurgitation
RF: ARF
dx criteria
molecular mimicry - significance, what which mimics what (2) and therefore
dx
- 2 major or 1 major 2 minor
- throat culture ESR or elevated anti-strep (ASO)
molecular mimicry
- why there’s autoimmune sx
- epitopes on bacterial surface mimic cardiac myosin & antigens = can’t be removed
RF: ARF
polyarthritis - most what (2), may be what, where (2) + severe (1), onset, duration (2), sx (3), tx, recovery, jaccoud
- most frequent & earliest RF sx, may be the only sx
- where: major joints of arms & legs; severe on knees
- onset: 2-3w after RF start
- sx: tender painful joints, leukocytosis
- tx: no inflam just pain meds
- only permanent effect is heart
duration
- inflam: 1-2w
- arthritis: < 1m
- jaccoud arthropathy: finger deform
RF: ARF
chorea - sx (2), disappear when, onset, duration, recovery (3) + recurrence
- involuntary irregular fibrillatory on tongue, spooning & ER on hands
- gone when sleep
- onset: delayed (1-7m p onset)
- duration: months to years
- no residual neuro, can have psychiatric decades later, common recurrence, complete recovery
RF: ARF
subcutaneous nodules - seen in (2), recovery, onset, duration, where (2), Dx, sx
erythema marginatum - d/t, duration, onset, where (2), Dx
SUBCUTANEOUS NODULES
- mod to severe carditis
- recovery: complete
- onset: weeks after RF
- duration: 1-2m
- where: major joints & bone
- non-specific Dx
- sx: asymptomatic
ERYTHEMA MARGINATUM
- any skin condition is d/t carditis
- duration: months to years
- onset: early
- where: trunk, proximal extremity
- non-specific Dx
RF: ARF
primary prevention (2), secondary (2), sx (3)
primary prevention
- anti-microbial therapy for GABHS & streptococcal infection
secondary prevention
- antibiotic (penicilin)
sx
- anti-inflammatory: streoids, salicylate, aspirin
VHD: Mitral Stenosis
normal mitral orifice, significant, severe
LA needed pressure
normal mitral orifice: 4-6
significant: < 2
severe: < 1
LA need 25mmHg for normal cardiac output
VHD: Mitral Regurgitation
fish mouth - what happens to valve (2) + d/t (2), orifice, chordinae (2), eye-balling what (2)
what = what = A-fib –> (1) –> (1)
explain shit
fish mouth valve
- valve leaflets: thickened d/t fibrous tissue or calcium deposits = immobilized
- orifice: narrowed
- chordae tendinae: shortened, fused
- eye-balling: severe; both mitral & aortic
steps
- dilation of LA = abnormal electrical signal = atrial fiibrillation
- inc risk of blood pooling & clot (thrombus) –> go out of heart = stroke (embolus)
- rupture valve = valve can’t block blood from going in = pool into LV = regurgitate to LA if full LV = dilated LA = thrombus = embolus
VHD: Mitral Regurgitation
acute - etiology (5), occur when (2)
MR
- sx when, sx (3), sx as onset, which side HF
- mx (2)
etiology
- posmed papillary muscle rupture
- blunt chest wall trauma
- infective endocarditis
- mitral valve prolapse
- congenital metabolic error
- during ischemia or angina pectoris
MR
signs/sx
- mild to mod = asymp = don’t tx
- severe = dyspnea on exertion, orthopnea, fatigue, pulmonary edema
- (R) HF
- palpitations as onset
mx
- mitral valve replacement, repair
VHD: Mitral Regurgitation
chronic - etiology (7), prognosis, pathology (1=1), cycle (1=1=2=1)
etiology
- myxomatous
- congenital (cleft, AV canal)
- endocarditis (healed)
- RF, DCM
- hypertrophic obstructive cardiomyopathy (HOCM), systolic anterior motion of mitral (SAM)
pathology
- progressive
- enlarged LA = pulls pos leaflet from orifice
- cycle: LV enlarge = more regurgitate = LV LA dilate - more regurgitate
VHD: Mitral Valve Prolapse
epidemiology - eti, malignancy, severity, age, sex, sequel
patho - leaflet what + d/t + which side more, chordae (2), annulus (1), inc what
etiology - (1.1.3.1)
sx - (1.4), chest pain where + duration + mimic
epidemiology
- usually familial
- usually benign, mild
- 15-30y, F
- rare as sequel
pathology
- excessive leaflet tissue d/t myxomatous degeneration (affected pos leaflet more)
- inc mucopolysaccharides
- chordae: elongate, rupture
- annulus: dilated
etiology
- unknown
- dec type III collagen
- CT disease: marfan, osteogenesis imperfecta, ehler-danlos syndrome
- thoracic (straight spine)
sx
- asymptomatic
- arrythmia, palpitations, light headed, syncope
- chest pain: substernal, prolonged, not like angina pectoris
VHD: Aortic Stenosis
associated, epidemiology (sex), prognosis (narrowing), death when (2)
pathology (2=3=1)
etiology (3)
sx when, (3)
- associated with chronic VHD
- epi: M
- prog: narrow 0.1cm/y, SCD or death at 7-8th decade
patho
- LVH & dilation = dec CO & SV inc MVO2max = ischemia
etiology
- degenerative calcification
- congenital (bicuspid AV)
- rheumatic inflammation
signs/sx (6-8th decade)
- exertional dyspnea, angina on dyspnea, syncope
