Week 9 Cardiovascular and Pulmonary Implications

Question 1

ALS cardiac involvement

Answer 1

Sympathetic nervous system involvement – sudden cardiac death or arrhythmia
Decreased myocardial mass
Decreased EF
Myocardial fibrosis in 25%

Question 2

ALS respirator involvement

Answer 2

Both paresis of respiratory muscles  respiratory failure and pneumonia can increase speed at which mortality occurs

Question 3

What is the most common cause of mortality in ALS

Answer 3

Pulmonary complications

Question 4

Bulbar ALS can result in

Answer 4

difficulty with secretion management, but also difficulty with PFT’s due to weakness/spasticity

Question 5

A ALS model including increasing age, longer time to diagnose, bulbar disease, lower FVC, more functional limitations, and the presence of respiratory symptoms was

Answer 5

strongly predictive of respiratory insufficiency at 6 months

Question 6

MS cardiac involvement

Answer 6

Increased risk of CAD/CVD
Increased risk of ACS, MI, a fib
Lesions in ANS affecting areas involved in cardiac function
Cardiotoxicity of certain medications

Question 7

MS pulmonary involvement

Answer 7

rare

Question 8

Contributions to cardiovascular dysfunction in patients with MS include

Answer 8

Lack of mobility
Changes to myocyte structure
Changes to endothelial function
increased risk of CVD
ANS involvement
Inflammation

Question 9

Parkinson’s disease cardiac involvement

Answer 9

Cardiac dysautonomia – HTN, orthostatic hypotension
Medication toxicity
Structural dysfunction – L ventricular hypertrophy, diastolic dysfunction, heart failure, arrhythmias

Question 10

Parkinson’s disease pulmonary involvement

Answer 10

Common cause of mortality
Respiratory dyskinesia
Restrictive dysfunction
Chest wall rigidity
Aspiration

Question 11

PD peripheral

Answer 11

respiratory muscles, posture, airways

Question 12

PD central

Answer 12

brain centers for respiratory control

Question 13

Myasthenia gravis

Answer 13

Autoimmune disorder in which antibodies attack neuromuscular junction and result in muscle weakness

Question 14

Myasthenia gravis commonly affects

Answer 14

ocular and bulbar musculature, but may affect pulmonary organs/functions

Question 15

Muscular Dystrophy

Answer 15

Series of genetic mutations resulting in progressive muscle weakness/atrophy
Respiratory muscle weakness -> poor cough, hypercapnia
Restrictive pulmonary dysfunction
Sleep-disordered breathing
Aspiration -> hypoxia, hypercapnia
Dilated cardiomyopathy
Arrhythmias and electrical abnormalities

Question 16

Guillain-Barre Syndrome

Answer 16

Acute inflammatory demyelinating polyneuropathy

Question 17

Guillain-Barre syndrome has 20-30% of cases require ventilatory surgery

Answer 17

Bulbar involvement most associated with need for mechanical ventilation
Higher mortality rate (41%) with MV compared to non-MV (7%) in one study

Question 18

_____% of patients with Guillain-bare syndrome develop respiratory complications

Answer 18

50

Question 19

Guillain-Bare Syndrome risk of complications

Answer 19

Sepsis, PE, Pulmonary infections like pneumonia

Question 20

Guillain-Bare Syndrome symptoms

Answer 20

Dyspnea, poor/weak cough, dysphagia, weakness of inspiratory and expiratory muscles, aspiration, atelectasis

has decreased vital capacity

Question 21

Post-polio syndrome

Answer 21

bulbar or muscle dysfunction resulting in restrictive pulmonary presentation

Question 22

Myotonic dystrophy

Answer 22

arrhythmias, sudden cardiac death

Question 23

Amyloidosis

Answer 23

build up of the protein in on organs/tissues

Question 24

Amyloidosis associated dx

Answer 24

Lung infiltrates and plaques
Diaphragm weakness
Respiratory failure
Cardiomyopathy
Diastolic dysfunction
MI
Arrhythmia

Question 25

Sarcoidosis

Answer 25

presence of granulomas in body tissue/organs due to immune dysfunction

Question 26

Sarcoidosis associated dx

Answer 26

Granulomas can develop in lung tissue
Narrowing of bronchi
Cardiomyopathy
CHF
Arrhythmias

Question 27

Ankylosing spondylitis

Answer 27

2-10% CV problems; endocardial/valvular dysfunction, EKG changes and vascular dysfunction, aortic dysfunction

Question 28

Polymyositis

Answer 28

myocarditis, pericarditis, cardiomyopathy, arrhythmia

Question 29

Dermatomyositis

Answer 29

myocarditis, pericarditis, cardiomyopathy, arrhythmia

Question 30

Marfan syndrome

Answer 30

valve and coronary artery disease; risk of aortic dissection/aneurysm

Question 31

Osteogenesis imperfecta

Answer 31

endocardial/valvular disease; aortic and mitral valve prolapse

Question 32

Scleroderma

Answer 32

pulmonary complications associated with fibrosis of skin/tissues/organs; HTN, myocardial fibrosis, myocarditis/pericarditis, dypsnea

Question 33

Rheumatoid Arthritis

Answer 33

2x risk of CVD
2x risk of developing HF - HFpEF
2-3x risk of VTE
HTN

Question 34

Lupus

Answer 34

Risk of premature atherosclerosis
Valve dysfunction
Myocarditis, pericarditis**
Multi-system organ involvement
Development of HF
Risk of MI
HTN

Question 35

Anemia

Answer 35

infrequent angina, decreased activity tolerance, DOE

Question 36

Sickle Cells disease

Answer 36

cardiomegaly, poor activity tolerance, pulm HTN, L ventricular diastolic dysfunction

Question 37

HIV

Answer 37

risk of VTE, opportunistic infections, non-Hodgkin lymphoma (NHL)

Kaposi sarcoma – may develop near aorta, pulmonary artery, other coronary arteries

Question 38

Peripartum Cardiomyopathy

Answer 38

heart failure that develops in the last month of pregnancy or up to 5 months postpartum without known cause

Question 39

Peripartum cardiomyopathy risk factors

Answer 39

genetics, race, HTN, advanced maternal age, preeclampsia, multiparity

Question 40

Peripartum Cardiomyopathy diagnostic criteria

Answer 40

reduced EF, L ventricle systolic dysfunction

Question 41

Peripartum cardiomyopathy assessed via

Answer 41

cardiac cath, echocardiogram

Question 42

Peripartum cardiomyopathy medical management

Answer 42

ACE inhibitors, diuretics, beta-blockers, anticoagulation

Question 43

Peripartum cardiomyopathy mortality rate

Answer 43

up to 10%

higher risk with subsequent pregnancies