Systemic disease and heart

Question 1

acromegaly

Answer 1

bp↑; lvh; hypertrophic cardiomyopathy; high output cardiac failure; coronary artery disease.

Question 2

amyloidosis

Answer 2

Restrictive cardiomyopathy. Bright myocardium on echo.

Question 3

ankylosing spondylitis

Answer 3

Conduction defects; av block; ar.

Question 4

Behcet’s disease

Answer 4

Aortic regurgitation; arterial ± venous thrombi.

Question 5

cushing’s syndrome

Answer 5

Hypertension

Question 6

Down’s syndrome

Answer 6

asd; vsd; mitral regurgitation

Question 7

Ehlers-Danlos syndrome

Answer 7

Mitral valve prolapse + hyperelastic skin ± aneurysms and gi bleeds. Joints are loose and hypermobile; mutations exist, eg in genes for procollagen (COL3A1); there are 6 types

Question 8

Friedrich’s ataxia

Answer 8

Hypertrophic cardiomyopathy, dilatation over time.

Question 9

Haemochromatosis

Answer 9

af; cardiomyopathy

Question 10

Holt-Oram syndrome

Answer 10

asd or vsd with upper limb defects

Question 11

HIV

Answer 11

Myocarditis; dilated cardiomyopathy; effusion; ventricular arrhythmias; sbe/ie; non-infective thrombotic (marantic) endocarditis; rvf (pulmonary hypertension); metastatic Kaposi’s sarcoma.

Question 12

Hypothyroidism

Answer 12

Sinus bradycardia; low pulse pressure; pericardial effusion; coronary artery disease; low voltage ecg.

Question 13

Kawasaki disease

Answer 13

Coronary arteritis similar to pan; commoner than rheumatic fever ([link]) as a cause of acquired heart disease.

Question 14

Klinefelter’s syndrome

Answer 14

asd. Psychopathy; learning difficulties; libido↓; gynaecomastia; sparse facial hair and small firm testes. xxy

Question 15

Marfan’s syndrome

Answer 15

Mitral valve prolapse; ar; aortic dissection. Look for long fingers and a high-arched palate.

Question 16

Noonan’s syndrome

Answer 16

asd; pulmonary stenosis ± low-set ears.

Question 17

PAN

Answer 17

Small and medium vessel vasculitis + angina; mi; arrhythmias; ccf; pericarditis and conduction defects.

Question 18

Rheumatoid arthritis

Answer 18

Conduction defects; pericarditis; lv dysfunction; aortic regurgitation; coronary arteritis. Look for arthritis signs,

Question 19

Sarcoidosis

Answer 19

Infiltrating granulomas may cause complete av block; ventricular or supraventricular tachycardia; myocarditis; ccf; restrictive cardiomyopathy. ecg may show q waves.

Question 20

Syphilis

Answer 20

Myocarditis; ascending aortic aneurysm.

Question 21

SLE

Answer 21

Pericarditis/effusion; myocarditis; Libman–Sacks endocarditis; mitral valve prolapse; coronary arteritis

Question 22

Systemic sclerosis

Answer 22

Pericarditis; pericardial effusion; myocardial fibrosis; myocardial ischaemia; conduction defects; cardiomyopathy.

Question 23

THyrotoxicosis

Answer 23

Pulse↑; af ± emboli; wide pulse pressure; hyperdynamic apex; loud heart sounds; ejection systolic murmur; pleuropericardial rub; angina; high-output cardiac failure.

Question 24

Turner’s syndrome

Answer 24

Coarctation of aorta. Look for webbed neck. xo.

Question 25

Williams syndrome

Answer 25

Supravalvular aortic stenosis (visuospatial iq↓).