Cardiac Manifestations Of Systemic Disease

Front 1

1. What is the nature of DM when related to CAD?

Back 1

a. Patients with DM have CAD

Front 2

2. What coronary vessels are affected in patients that have DM?

Back 2

a. Large and small

Front 3

3. What is the most common cause of death in adults with DM?

Back 3

a. CAD

Front 4

4. What % of ischemic events is silent? What does that mean?

Back 4

a. 90
b. Must have lower threshold for dx testing
c. More likely to be atypical ischemic symptoms

Front 5

5. What is the mechanism of restrictive cardiomyopathy due to DM? What is an associated symptom of this disease?

Back 5

a. Abnormal relaxation because myocardium is too stiff
b. HTN

Front 6

6. What are the signs of DM-induced interstitial fibrosis?

Back 6

a. Increased collagen, glycoprotein, TAGS, and cholesterol in the interstitium

Front 7

7. What is the classic presentation of heart failure?

Back 7

a. Fatigue
b. Shortness of breath

Front 8

8. What is the tx for DM with respect to heart disease?

Back 8

a. Aspirin
b. Control blood sugar
c. Control HTN
d. Control lipids

Front 9

9. Everyone with DM should be on….

Back 9

a. …. ACE/ARB and statins

Front 10

10. What is the HbA1c goal for a DM patient?

Back 10

a. < 7%

Front 11

11. What are the symptoms of metabolic syndrome?

Back 11

a. Truncal obesity
b. HTN
c. Low HDL
d. High TG
e. Glucose intolerance

Front 12

12. What happens to the heart in obese patients? What does that lead to?

Back 12

a. Eccentric cardiac hypertrophy with ventricular dilation
b. Increased circulating blood volume
c. Increased CO
d. Increased LV filling pressure

Front 13

13. What can weight reduction do to the heart if too rapid?

Back 13

a. Cause arrhythmias
b. Sudden death due to electrolyte abnormalities

Front 14

14. What do thyroid hormones do to the body?

Back 14

a. Increase total body metabolism
b. Increase oxygen consumption

Front 15

15. What do thyroid hormones do to the heart?

Back 15

a. Direct ionotropic and chronotropic effects
b. Increase N/K ATPase
c. Increase # of B receptors

Front 16

16. What are the cardiac symptoms of hyperthyroidism?

Back 16

a. Palpitations
b. Systolic/pulmonary HTN
c. Fatigue
d. Angina
e. Heart failure

Front 17

17. What are the signs of palpitations in hyperthyroidism?

Back 17

a. Forceful contraction
b. Sinus tachycardia
c. A fib

Front 18

18. If a patient presents with A-fib to the clinic, what should you always check?

Back 18

a. Thyroid

Front 19

19. What effect does hyperthyroidism have on the myocardium?

Back 19

a. Increased LV mass
b. LV hypertrophy

Front 20

20. What is the effect of hyperthyroidism on pulse pressure?

Back 20

a. Widened

Front 21

21. What does hyperthyroidism do to heart sounds?

Back 21

a. Increased first heart sound
b. 3rd heart sound present

Front 22

22. How do you tx cardiac symptoms of hyperthyroidism?

Back 22

a. B blockers-- atenolol 1x/day
b. Coumadin for a-fib
c. Diuretics and digitalis for heart failure
d. Radioactive iodine and anti-thyroid meds for thyroid

Front 23

23. What are the cardiac symptoms of hypothyroidism?

Back 23

a. Decreased cardiac output
b. HTN due to increased TPR
c. Fatigue
d. Dyspnea
e. Pericardial effusions
f. Lower extremity edema

Front 24

24. What substances increase in the blood in hypothyroidism?

Back 24

a. Hyperhomocysteinemia
b. Hypercholesterolemia

Front 25

25. How do you tx hypothyroidism?

Back 25

a. T4 replacement

Front 26

26. What is the classic presentation of pheochromocytoma?

Back 26

a. **Sweating**
b. **Tachycardia**
c. **Episodic headache**
d. Paroxysmal HTN
e. Orhtostatic hypotension
f. Dilated cardiomyopathy

Front 27

27. What causes dilated cardiomyopathy in pheochromocytoma?

Back 27

a. Catecholamines

Front 28

28. What are the symptoms of acromegaly?

Back 28

a. HTN
b. LV hypertrophy
c. Cardiomyopathy

Front 29

29. What is the #1 presenting arrhythmia?

Back 29

a. A-fib

Front 30

30. What causes diastolic dysfunction in cardiomyopathy due to acromegaly?

Back 30

a. Hypertrophy

Front 31

31. How do you tx acromegaly?

Back 31

a. Octreotide

Front 32

32. What risks are increased in RA?

Back 32

a. Risk of CAD 2x
b. Increased risk of heart failure

Front 33

33. What are the characteristics of pericarditis caused by RA?

Back 33

a. Usually clinically silent
b. Pericardial effusion

Front 34

34. How do you tx pericarditis due to RA?

Back 34

a. NSAIDs
b. Then prednisone

Front 35

35. What causes myocarditis due to RA?

Back 35

a. Inflammatory granulomas

Front 36

36. What is the most commonly affected valve in SLE?

Back 36

a. Mitral
b. Leads to murmurs

Front 37

37. What is Libman-Sacks endocarditis?

Back 37

a. MCC of aortic and mitral valve damage in SLE
b. Typically asymptomatic

Front 38

38. How do you dx Libman-Sacks endocarditis?

Back 38

a. Negative blood cultures
b. Trans-esophageal echo

Front 39

39. How do you tx Libman-Sacks endocarditis?

Back 39

a. Abx prophylaxis in SLE valvular disease
b. Valve replacement in those with severe disease

Front 40

40. What is the most common cardiac manifestation of SLE?

Back 40

a. Pericarditis

Front 41

41. What can SLE myocarditis cause?

Back 41

a. AV block
b. BBB
c. **1st degree heart block**

Front 42

42. When should you suspect SLE myocarditis?

Back 42

a. Resting tachycardia with unexplained cardiomegaly

Front 43

43. What is the danger of SLE for neonates?

Back 43

a. Congenital heart block
b. Anti-Ro and anti-La antibodies
c. No tx

Front 44

44. What does severe protein calorie malnutrition cause in the heart?

Back 44

a. Weakened, hypokinetic heart muscle
b. Generalized edema
c. AIDS, anorexia, HF patients, cancer

Front 45

45. What does a thiamine deficiency cause in the heart?

Back 45

a. Wet beriberi
b. High output failure
c. Tachycardia, elevated ventricular filling pressures

Front 46

46. What does a vitamin B6/folate deficiency cause in the heart?

Back 46

a. Hyperhomocysteinemia-- increased atherosclerotic risk