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71 Cards in this Set

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  • Back
what percentage of people over 60 have atrial fibrillation?
2-5%
what is the most common symptom of AF?
rapid irregular palpitations
how does AF appear on an ECG?
absent P waves, finely undulating baseline (fibrillation waves), irregular QRS complexes with an average rate of 150-200 bpm
what are the two major complications of AF?
heart failure and embolism
what is the percentage risk of serious thromboembolism in patients with AF?
5% per year
what induces vasodilatation during pregnancy?
progesterone
which organ does not have increased blood flow during pregnancy?
brain
how much does plasma volume increase in pregnancy?
40%
which valve is most often affected in rheumatic fever?
mitral
which arrythmia is most commonly associated with rheumatic heart disease?
AF
what percentage of people with rheumatic heart disease have no history of rheumatic fever?
50%
which valves are most often affected in RHD?
mitral and aortic
which arrhythmia is commonly associated with RHD?
AF
what percentage of patients with acute rheumatic fever will develop chorea?
10-15%
what cross reacts with cardiac myosin in rheumatic fever?
streptococcal M-protein
what cross-reacts with myocardial sarcolemma?
streptococcal membrane proteins
what cross-reacts with heart valve glycoprotein?
capsule hyaluronate
what components of the immune system are deposited in the heart during acute carditis?
immunoglobulin and complement
what is the characteristic histological feature of rheumatic carditis?
mononuclear cell infiltrate (predominantly of T cells)
which HLA genes are associated with ARF?
HLA-DR2 and HLA-DR4
what is rheumatic fever?
nonsuppurative acute inflammatory complication of infection due to certain strains of beta-haemalytic Group A streptococcus pyogenes
what are the skin manifestations of rheumatic fever?
subcutaneous nodules
erythema marginatum
at what age does RF usually occur?
5-15 years
what is the incidence of RF?
0.1-3% of those with streptococcal infections
what is the latent period between streptococcal pharyngitis and the initial episode of acute RF?
1-5 weeks (average 19 days)
what characterises RF?
arthritis
chorea
carditis
skin manifestations
what is the average duration of RF?
3 months or longer
describe the valve involvement in rheumatic heart disease
acute interstitial valvulitis
what happens to untreated valves in rheumatic heart disease?
valve thickening, fusion, retraction of leaflets and cusps
t/f... antibiotics modify an acute RF attack
false
why is a regimen of antibiotics prescribed for acute RF?
to eradicate any remaining GAS
what is the treatment goal in treating acute RF?
suppress inflammation and avoid a rebound
what causes endocarditis?
directly - microbial colonisation of the endocardium
indirectly - RF
what microorganisms are causative in most cases of infective endocarditis?
streptococci
staphylococci
what are the initial symptoms of infective endocarditis?
low grade fever
anorexia
fatigue
anaemia
splenomegaly
t/f... anticoagulation with heparin is indicated for infective endocarditis
false
how does the body increase central venous pressure?
muscle pump
sympathetic innervation of veins
reduced blood flow to kidney
what is preload?
central venous pressure (filling pressure for heart)
what is afterload?
arterial BP (pressure into which the heart has to pump)
t/f... hypertension increases the work of the heart
true
what is involved in pancarditis?
fibrinous pericarditis
myocarditis
endocarditis
which antibodies to streptococcal enzymes are demonstrable in rising titre in RF?
anti-streptolysin O
anti-DNase B
anti-streptokinase
anti-hyaluronidase
what exacerbates tissue damage in acute RF?
auto-immunity may develop to antigens provided by damaged cardiac tissue
how does ARF affect the joints?
migratory polyarthritis with temporary pain and swelling
what percentage of children with RF develop carditis?
50-75%
what are the risk factors for ARF?
lower standards of living, especially crowding
socially and economically disadvantaged populations
what are the clinical features of ARF?
migratory polyarthritis
carditis
subcutaneous nodules
erythema marginatum
Sydenham chorea
what are the acute effects of RF on the heart?
myocarditis
arrythmias and cardiac failure (occasionally)
what is often described as a bread and butter pericarditis?
acute fibrinous pericarditis
what is the mechanism of acute fibrinous pericarditis?
exudation of fibrin into pericardial cavity stimulating fibrous adhesions between parietal and visceral pericardium
what is involved in rheumatic myocarditis?
immunological inflammation (granulomatous) leads to development of Aschoff nodules close to blood vessels
what is an Aschoff nodule?
possible central necrosis
foci of swollen eosinophilic collagen surrounded by lymphocytes (mainly T cells), occasional plasma cells and plump macrophages (Anitschkow cells, Aschoff multi-nucleated giant cells)
which cells are pathognomonic for RF?
Anitschkow cells (plump macrophages)
describe the vegetations that occur in acute rheumatic endocarditis
small, nodular, pale thrombi firmly attached to valve cusps
consist of fibrin and platelets but no micro-organisms
where do rheumatic vegetations occur?
lines of apposition of valves
what is the result of organisation of vegetations on valve cusps?
cusps become thicker and more rigid due to fibrosis
cusp vascularity increases
cusp calcification (adds to the rigidity)
what type of overload occurs with hypertension and aortic stenosis?
pressure overload
what type of overload occurs with mitral regurgitation?
volume overload
what happens to the lung in chronic left heart failure?
brown induration: brown foci of haemosiderin, lung parenchyma firm due to - blood vessel congestion, alveolar oedema, fibrosis
which ventricle will fail more rapidly and why?
right ventricle
thinner wall and thus a smaller functional reserve
what is the appearance the liver in chronic venous congestion?
nutmeg liver
what happens to the spleen in chronic venous congestion?
grossly enlarged
prominent pale fibrinous trabeculae
what are the manifestations of systemic venous congestion?
elevation of JVP
pitting oedema
ascites and effusions
what changes are exhibited in the failing heart?
severe dilatation of all chambers
hypertrophy of walls of all chambers but most evident in ventricles
t/f... stable atherosclerotic plaques are at a low risk of rupture
true
when should surgery be undertaken in aortic stenosis?
once the lesion reaches moderate severity
what type of overload is caused by aortic regurgitation?
volume overload
t/f... aortic regurgitation is better tolerated than aortic stenosis
true
what type of pulse occurs with aortic regurgitation?
bounding pulse
t/f... mitral stenosis is well tolerated
true
which valvular pathology has the poorest prognosis?
aortic stenosis