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Systemic Disease Flashcards

1
Q

LVH causes pressure overload due to a concentric thickening of the LV.
T or F ?

A

T

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2
Q

What is the Major cause of cardiovascular morbidity and mortality & #1 risk factor for death throughout the world?

A

Systemic arterial hypertension

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3
Q

Systemic HTN Eventually causes Systemic and Diastolic dysfunction and leads to ________

A

CHF

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4
Q

Peripartum cardiomyopathy is identical to findings of dilated cardiomyopathy and never resolves. Peripartum cardiomyopathy is identical to findings of dilated cardiomyopathy and never resolves.

T or F ?

A

F

It may resolve after pregnancy

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5
Q

During Pregnancy, the metabolic demands by both the maternal and fetal circulation results in an _____________________

A

increase in CO and SV

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6
Q

During pregnancy, the increase in _________ levels results in vascular vasodilation and decrease in systemic and pulmonary vascular resistance resulting in an increase in blood flow.

A

hormonal

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7
Q

During the pregnancy, mother increase in blood volume by ____% by the 3rd trimester

A

50

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8
Q

Normal echo features that may be seen during pregnancy:

A
  1. Mild increase in chamber sizes
  2. Small pericardial effusion may be seen
  3. In late pregnancy, the large uterine size may compress thoracic structures and cause pseudo-wall motion abnormalities
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9
Q

Cardiac pathology relating to pregnancy

A

peripartum CM

aortic & coronary artery dissection (more common)

Preeclampsia is a complication of pregnancy. With preeclampsia, you might have high blood pressure, high levels of protein in urine that indicate kidney damage (proteinuria), or other signs of organ damage

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10
Q

Cocaine users have a higher incidence of myocardial ischemia and infarction, aortic dissection, arrhythmias, and sudden death.

T or F ?

A

T

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11
Q

For cocaine users, the consequential __________ of the coronary microcirculation limits the myocardial oxygen supply resulting in the imbalance in myocardial oxygen demand.

A

vasoconstriction

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12
Q

During pregnancy, there is an increase in blood volume by 50% by the ___________ trimester.

A

3rd

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13
Q

_______ usage is a leading cause of cardiovascular disease in young adults in the United States.

A

Cocaine

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14
Q

Long-term cocaine use can lead to prolonged transmitral deceleration time and ___________. Ultimately, cocaine abusers may develop a _________ with or without heart failure

A

concentric left ventricular hypertrophy

dilated cardiomyopathy

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15
Q

____________ is a major predictor of outcomes in chemo therapy and is the most common method used to evaluate cardiac function of baseline and during treatment

A

LVEF

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16
Q

A noninvasive estimation of ____________ has become the most widely used method for monitoring cardiac function during and after cancer therapy.

A

LVEF

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17
Q

Cardiac toxicity by ____________ drugs was recognized early on as a form of heart failure.

A

chemotherapeutic

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18
Q

Cardiac toxicity by chemotherapeutic drugs was recognized early on in the form of ______

A

heart failure

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19
Q

What is CTRCD?

A

cancer therapy related cardiac dysfunction

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20
Q

CTRCD (cancer therapy related cardiac dysfunction) – best exemplified (be a typical example of) with _____ used in the treatment of breast cancer

A

anthracyclines

Anthracyclines are widely used chemotherapy drugs derived from certain types of Streptomyces bacteria. Anthracycline drugs are used to treat many types of cancer, including leukemias, lymphomas, and cancers of the breast, stomach, uterus, ovary, and lung, among others.

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21
Q

The myocyte damage: _______ later causes a drop in LVEF related to the negative ventricular remolding

A

apoptosis - the death of cells which occurs as a normal and controlled part of an organism’s growth or development

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22
Q

__________ has been linked to a poor prognosis, with a 2-year mortality rates up to 60%

A

Anthracycline cardiomyopathy

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23
Q

Myocyte _________ occurs as a normal and controlled part of an organism’s growth or development.

A

apoptosis

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24
Q

_________________ is a major cause of morbidity and death in Latin America.

A

Chagas Cardiomyopathy (CC)

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25
Chagas CM is caused by \_\_\_\_\_\_\_
**Trypanosoma cruzi** (a _parasitic_ protozoan that is the causative agent of Chagas disease
26
Symptoms of Chagas CM includes: ______ & ______ and can progress to \_\_\_\_\_
tachycardia small P.E CHF
27
***\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ caused by a B-globin gene mutation, is characterized by systemic complications due to vaso-occlusive episodes and hemolysis affecting approximately 1 in 500 African Americans and 1 in 1200 Hispanic Americans.***
SCD (sickle cell disease)
28
SCD: echo findings:
elevated TR velocity above **2.5m/s** DD
29
For SCD patients, ________ is a major cause of death
**Pulmonary hypertension**
30
**TR velocities at or above _____ are associated with a 9-16 fold risk ration for early death in SCD adults**
**2.5 m/sec**
31
What is amyloid?
Amyloid is **an abnormal protein that is produced in your bone marrow and can be deposited in any tissue or organ**. Amyloidosis frequently affects the heart, kidneys, liver, spleen, nervous system and digestive tract. It is often overlooked because it may cause no symptoms at first.
32
***\_\_\_\_\_\_\_\_\_\_\_\_ is characterized by the deposition of extracellular proteins in various organs which results in tissue damage and organ malfunction.***
amyloidosis
33
What is **primary** type of amyloidosis? common presentation?
**immunoglobulin amyloidosis** **hepatomegaly, splenomegaly, peripheral neuropathy**
34
What is secondary/reactive amyloidosis?
**acute phase reactants produced in response to systemic inflammation** such as _TB, RA, inflammatory bowel syndrome,_ _chronic lung disease_
35
What is the less common form of amyloidosis?
**familial (primary):** caused by autosomal dominant mutation
36
Primary carcinoid tumors?
**GI tract (most prevalent)** bronchus ovaries pancreas biliary tract
37
What is carcinoid syndrome?
Carcinoid syndrome **occurs when a rare cancerous tumor called a carcinoid tumor secretes certain chemicals into your bloodstream, causing a variety of signs and symptoms**. A carcinoid tumor, which is a type of neuroendocrine tumor, occurs most often in the gastrointestinal tract or the lungs.
38
What are the symptoms of carcinoid syndrome?
1. Cutaneous flushing 2. Intestinal hypermobility (liver metastases) 3. Bronchial constriction (pulmonary carcinoid) 4. Heart failure 5. Cardiac Lesions 6. Death
39
What are the heart related clinical presentations of carcinoid syndrome?
* flushing * hypotension * diarrhea * wheezing * bronchospasm * endocardial plaque formation * RHF (late)
40
***Carcinoid syndrome has a clinical presentation of flushing, hypotension, diarrhea, wheezing bronchospasm, and endocardial plaque formation with \_\_\_\_\_\_heart failure developing late in the process.***
RIght
41
***Systemic Hypertension is the #1 risk factor for death throughout the world.*** T or F ?
T
42
***Systemic and Diastolic dysfunction and never leads to CHF.*** T or F ?
F
43
**Left-sided involvement seen with: ________ (3)**
**Intracardiac shun**t (right-to-left); Bronchial tumor lung metastases
44
cardiac carcinoid relating testing (3):
**Serotonin levels**; Urinary 5- HIAA; Tissue biopsy
45
Cardia Carcinoid Echo features
* ***Tricuspid valve leaflets thickened, retracted, fixed in semi-open position** (usually severe TR with mild TS)* * *Pulmonary valve leaflets thickened, retracted and rigid (varying degrees of PR and PS- usually more PS than PR)* * Evidence of right heart volume overload* * Liver metastasis*
46
What is **Hypereosinophilic Syndrome?**
an abnormal formation and accumulation of extremely large number of eosinophils in blood without identifiable etiology Results in organ infiltration Some varieties of hypereosinophilic syndrome tend to run in families. Other types have been associated with certain types of cancers, infections or other health problems. occurs more often in men, usually between 20 and 50
47
***\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is a rare form of endocardial fibrosis that is associated with chronic elevation in circulating eosinophils.***
**Loffler’s endocarditis** \*note: Loeffler endocarditis is **a rare restrictive cardiomyopathy caused by abnormal endomyocardial infiltration of eosinophils, with subsequent tissue damage from degranulation, eventually leading to fibrosis**. Although an uncommon entity, it is still a disease with significant morbidity and mortality.
48
**Hypereosinophilic Syndrome:** **Echo Features**
* Normal or decreased LV and RV size with normal systolic function * Atrial enlargement * Left and/or right ventricular **apical thrombus** with cavity obliteration * Posterior AV valves and subvalvular apparatus (**most often PLMV**) may become thickened and tethered with associated MR and/or TR * Thick **infero-basal LV wall** * Restrictive physiology due to decreased LV compliance
49
What is sarcoidosis?
Sarcoidosis is **granulomas (**small area of inflammation; benign; seem to be a defensive mechanism that triggers the body to "wall off" foreign invaders such as bacteria or fungi to keep them from spreading) **to develop in the organs of the body (**frequently occue n lungs) **\*typically present before 40** **Multisystem granulomatous disease of unknown cause** Lungs, skin, eyes, heart and other organs involved
50
**Sarcoidosis:** **Cardiac Manifestations:**
* sudden death * Arrhythmias * Conduction abnormalities * LV dysfunction * CHF * Restrictive mitral inflow pattern (rare) * Cor pulmonale when pulmonary sarcoid is present **Sarcoidosis** is a disease characterized by the growth of tiny collections of inflammatory cells (granulomas) in any part of your body — most commonly the lungs and lymph nodes. But it can also affect the eyes, skin, heart and other organs.
51
**!!!Sarcoidosis:** **Echo Features**
enlarged LV regional WMA posterolateral wall thinning DD right heart enlargement PHTN
52
Iron is deposited within cells in organ tissue, interfering with organ function
Hemochromatosis
53
_hemochromatosis_ **primary/hereditary** etiology
abnormal _increased absorption_ of iron from GI tarct
54
_hemochromatosis_ **secondary/acquired** etiology
transfusion iron therapy long-term renal dialysis certain forms of anemia
55
_hemochromatosis_ peaks in fifth decade & rare in children T or F ?
T
56
_hemochromatosis_ echo features
dilated CM global systolic dysfunction progressive diastolic dysfunction mild valvular regurgitation arrhythmia **Degree of cardiac dysfunction reflects degree of iron overload**
57
_hemochromatosis_ * clinical presentation * associate medical conditions * prevalence
male prevalence onset after 40 **DM, hyperpigmentation, liver disease, HF**
58
_hemochromatosis_ common treatment
therapeutic phlebotomy iron chelation dietary modification manage organ dysfunction
59
Characterized by asthma and/or allergic rhinitis, peripheral and tissue eosinophilia, extravascular granuloma formation, and vasculitis of multiple organ systems.
Churg-Strauss Syndrome
60
**Churg-Strauss Syndrome**: echo findings
* pericardial effusion * dilated CM * endomyocardial fibrosis \*note: Churg-Strauss syndrome is **a disorder marked by blood vessel inflammation**. This inflammation can restrict blood flow to organs and tissues, sometimes permanently damaging them. This condition is also known as **eosinophilic granulomatosis with polyangiitis (EGPA)**
61
Vasculitis of unknown origin, pathology defined by the **triad of small vessel vasculitis, granulomatous inflammation, and necrosis**
Wegener's Granulomatosis
62
_Wegener's Granulomatosis_ echo features
pericardial effusion LV RWMA global LV hypokinesis valvular regurgitation \*note: Granulomatosis with polyangiitis is an uncommon disorder that causes inflammation of the **blood vessels in your nose, sinuses, throat, lungs and kidneys**. Formerly called **Wegener's granulomatosis,** this condition is one of a group of blood vessel disorders called vasculitis. It slows blood flow to some of your organs. Cardiac involvement 6-25% (affect small to medium vessels) * pericarditis * myocarditis * aortitis
63
***\*\*\*List 4 echo features of Giant Cell arteritis:***
* **aortic aneurysm** * **aortic dissection** * **thickened AoV** * systolic dysfunction * pericardial effusion \*note: Giant cell arteritis is an inflammation of the lining of your arteries. Most often, it affects the arteries in your head, especially those in your temples. For this reason, giant cell arteritis is sometimes called **temporal arteritis**
64
***List 3 features of Takayasu arteritis:***
\*AKA: Pulseless disease **Granulomatous panarteritis of large vessels (**thickening and fibrosis of vessel wall narrows lumen) **(\*note:** **panarteritis: inflammation involving all coats of an artery)** * **aortic dilatation** * **AR** * *stenotic/occlusion of large vessels**
65
***Rare adrenal tumor or tumor along the sympathetic chain (usually intra-abdominal)that produces excessive catecholamines.*** ***echo feature?***
pheochromocytoma arrhythmias CM aortic dissection due to HTN
66
_Pheochromocytoma_ echo features
increased HR LV systolic dysfunction LV hypertrophy hypertrophic CM \*note: **the tumor releases hormones that may cause high blood pressure, headache, sweating and symptoms of a panic attack. If a pheochromocytoma isn't treated, severe or life-threatening damage to other body systems can result.**
67
**Secretion of excessive growth hormone**, nearly always caused by a **pituitary adenoma**
Acromegaly * \*nearly always caused by a * Cardiac disease occurs in ⅓ of patients * Acromegaly is **a rare condition where the body produces too much growth hormone, causing body tissues and bones to grow more quickly**. Over time, this leads to abnormally large hands and feet, and a wide range of other symptoms. Acromegaly is usually diagnosed in adults aged 30 to 50, but it can affect people of any age. * The high levels of cardiovascular morbidity in patients with acromegaly are likely a cumulative effect of several concomitant and possibly independent disease processes, including **cardiac hypertrophy, congestive heart failure, hypertension, obstructive sleep apnea, and arrhythmias** that target the cardiovascular system.
68
**What HIV/AIDS stands for?**
**Human Immunodeficiency Virus** **Acquired Immunodeficiency Syndrome**
69
HIV/AIDS cardiac manifestation/echo features
* Dilated cardiomyopathy/CHF (**dilated LV and/or RV with systolic dysfunction**) * **Pericarditis** * **pericardial effusion** * **PHTN** * RV dysfunction and pulmonary hypertension * Endocarditis * **Cardiac neoplasm**
70
**restrictive** vs **constrictive** cardiomyopathy
In **restrictive** cardiomyopathy, reduced compliance is caused by abnormal elastic properties of the myocardium and/or intercellular matrix, whereas in **constrictive** pericarditis, reduced chamber compliance is imposed by the external pericardial constraint.
71
Most common cause of restricted cardiomyopathy?
amyloidosis
72
Endomyocardial biopsy - true for diagnosis
amyloidosis carcinoid sarcoidosis hemochromatosis
73
Endomyocardial biopsy - true for diagnosis
amyloidosis carcinoid sarcoidosis hemochromatosis
74
\_\_\_\_\_\_\_\_\_\_\_is **an inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse**. This fusing makes the spine less flexible and can result in a hunched posture. If ribs are affected, it can be difficult to breathe deeply.
Ankylosing spondylitis \*affects **male** more than female
75
Ankylosing spondylitis echo features:
**Aortic disease common** * **AoV and MV disease** * Conduction abnormalities • **Cardiomyopathy** * Pericarditis **Echo Features:** Dilatation of aortic annulus and sinus of Valsalva; AoV thickening and regurgitation; MVP; LV systolic dysfunction; Pericardial effusion (rare)
76
Connective tissue disease; General (common autoimmune disease characterized by production of autoantibodies; more prevalent and severe in females; **cardiac involvement \>40%**
**systemic lupus erythematosus**
77
systemic lupus erythematosus echo features:
* valvular regurgitation/stenosis * MVP * **Libman-Sacks endocarditis** - nonbacterial thrombotic valve mass * P.E
78
*Excess connective tissue accumulates in blood vessels, skin, joints, skeletal muscle, and/or heart. Clinical variants: Skin thickening.*
scleroderma ***More prevalent in females***
79
The diagnosis of is confirmed by tissue biopsy, which is typically fat pad or \_\_\_\_\_\_\_\_\_\_\_
endomyocardial biopsy
80
81
pericardial effusion
82
Eosinophil counts ____ for ≥ 6 months or younger than 6 months with evidence of organ damage
**\>1500/mm3**
83
cardiac amyloidosis
84
The earliest manifestation of LV systolic dysfunction in DM are generally decreases in ______ as well as in peak LV S' (with exercise and possibly at rest)
peak global longitudinal strain (GLS)
85
AL (amyloid light chain) amyloidosis
86
cardiac amyloidosis
87
88
cardiorenal syndrome
89
Lv diastolic dysfunction is a frequent finding in patients with \_\_\_. DD is associated with the development of _____ and increased mortality. ____ is one of the causes of the development of DD.
CKD CHF myocardial fibrosis
90
serotonin

Echo (35 decks)

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