Icm Lecture- Cardio, Vasculitis, Pericard, Pvd

Front 1

what are the 3 classifications of cardiomyopathy

Back 1

dilated
restrictive
hypertrophic

Front 2

what is the most common cause of heart transplant

Back 2

idiopathic dilated cardiomyopathy

Front 3

at what age do you typically see idiopathic dilated cardiomyopathy

Back 3

20 to 40

Front 4

though 80% of the causes of idiopathic dilated cardiomyopathy are idiopathic, what is a major contributing factor *

Back 4

Alcohol

Front 5

*what are the symptoms of idiopathic dilated cardiomyopathy*

Back 5

Dyspnea, DOE, PND***

edema
wt. gain
fatigue
Sudden death
systemic embolization

Front 6

what are the signs of idiopathic dilated cardiomyopathy on PE*

Back 6

Holosystolic regurg Murmur*
S3, S4
JVD-HJR, edema
Tachycardia/pnea
bibasilar crackles

Front 7

blood work for idiopathic dilated cardiomyopathy

Back 7

BNP (B-naturetic peptide)
SMA-20 (full chem pannel)
TSH
CBC
Preg test
Toxicology

Front 8

Diagnostic tests for idiopathic dilated cardiomyopathy*

Back 8

*ECHO- LV dilation = decreased EF***
CXR- cardiomegaly and vasc redistro
EKG- nsp ST and T chg

Front 9

**Prognosis for idiopathic dilated cardiomyopathy

Back 9

usually die of CHF w/in 4 years of Dx***
African Americans have a worse prog

Front 10

treatment for idiopathic dilated cardiomyopathy

Back 10

*Transplantation*
ACE inhib
Dig, Diuretics, B-block

Front 11

Prognosis and treatment of alcoholic dilated cardiomyopathy

Back 11

not a bad prognosis IF the STOP DRINKING

Front 12

when does peripartum dilated cardiomyopathy happen **

Back 12

last trimester
OR
w/in 5 months of delivery**

Front 13

sympt of peripartum dilated cardiomyopathy

Back 13

CHF
LV dysfunction c EF < 45%
systemic nd pulmonary emboli

Front 14

Prognosis for peripartum dilated cardiomyopathy

Back 14

10% mortality
4% required transplant

Front 15

what drugs can induce dilated cardiomyopathy

Back 15

anthracycline
Trastuzumab
cocaine
Heavy metals (cadmium, thalium)
Meth

Front 16

etiology and physiology of hypertrophic cardiomyopathy*

Back 16

hypertrophy of LV- mostly the septum**
anterior leaflet of mitral valve will press up against the hypertrophic septum** (occ. sudden death from dynamic obstruction)
30 to 40 yr old M's
25-50% occurrence with FH

Front 17

signs and sympt of hypertrophic cardiomyopathy*

Back 17

typically a healthy, active individual

Sudden death
arrhythmias
CHF (late in disease)
syncope or presyncope
angina in older pts

Front 18

PE of hypertrophic cardiomyopathy**

Back 18

crescendo-decrescendo murmur at apex radiating to left sternal border (like aortic murmur, but without radiation to carotids)
Bisferiens pulses- double peak in carotid pulse

Front 19

what changes the murmur in hypertrophic cardiomyopathy

Back 19

valsalva makes it louder

squatting makes it softer

Front 20

therapy for hypertrophic cardiomyopathy

Back 20

Use: B-blockers, poss surgical myotomy of septum

Do Not use: vasodilators, B-agonists

Front 21

* how often do you see restrictive cardiomyopathy

Back 21

least common form*
~5%

Front 22

*pathophys of restrictive cardiomyopathy

Back 22

Heart looks normal
impaired diastolic filling of LV*

No hypertophy, but slight increase in wall thickness due to infiltrates

systolic fxn normal until late in disease

Front 23

PE of restrictive cardiomyopathy

Back 23

JVD c HJR
edema and ascites
Loud S3
cardiac cachexia

Front 24

classification of restrictive cardiomyopathy

Back 24

infiltrative- amyloid and saroid
non-infil- idio and fam
storage- hemochromo, fabray

Front 25

**diagnostic tools for restrictive cardiomyopathy

Back 25

**ECHO- diastolic dysfxn, atrial enlargement, Dilated IVC, norm looking ventricles

EKG- low voltage and aFib

Front 26

therapy for restrictive cardiomyopathy

Back 26

hemochromotosis- deferoxamine, phleb
amyloidosis- chemo
sarcoidosis- steroids

anticoagulation therapy

Front 27

what is the most common form of vasculitis?

Back 27

giant cell arteritis

Front 28

what size vessels does Wegners attack?

Back 28

medium to capillary

Front 29

**key words to remember for Giant cell arteritis

Back 29

Minnisota
Scandinavian

Front 30

epidemiology of Giant cell arteritis

Back 30

avg 70 yrs
F 2x as likely
Northern european

Most common type

Front 31

what must you do to diagnose Giant cell arteritis

Back 31

temporal artery biopsy- 2cm

get w/in 14 days of starting corticosteroids

Front 32

Key components to Takayasu arteritis

Back 32

Asian disease*
young women
Aorta and mjr branches (pulseless disease) *

Front 33

what type of ANCA elevation would you see with Wegners

Back 33

c-ANCA

Front 34

Signs of Wegners disease

Back 34

bloody nasal discharge, nasal crusting, septal perforation
thick walled, cavitary lesions on CXR
mononeuritis
patches of discoloration on extremities
palpable purpura

Front 35

therapy for Wegners

Back 35

cytoxan and steroids
Rituxan- IV
Methotrexate
Plasma exchg
IVIG

Front 36

what type of vessels does Henoch-Schoenlein purpura (HSP) affect

Back 36

small vessels

Front 37

criteria for Henoch-Schoenlein purpura (HSP)

Back 37

palpable purpura
<20 yrs
intussusception
WBC and granulocyts in vessel walls
glomerulonephritis, arthralgias

Front 38

treatment of Henoch-Schoenlein purpura (HSP)

Back 38

good prognosis

observation and NSAIDs

Front 39

common signs of vasculitis

Back 39

purpura, petichiae, skin ulceers
pulmonary infiltrates
micro hematuria or GN
mononeuritis
digital ischemia
stroke in young pt
arthralgias
vision chg c elevated ESR

Front 40

pertinent etiology of pericarditis

Back 40

idiopathic 85 % of time*
Renal failure c uremia 12% *

Front 41

pericarditis Hx**

Back 41

chest pain- sharp or dull, ache, burning
worse with respiration or laying flat***
dyspnea
fever

Front 42

PE for pericarditis

Back 42

Friction rub- heard best when leaning forward
tachycardia/pnea
fever

Front 43

what are the criteria for pericarditis and how many of them must you have for the diagnosis

Back 43

typical chest pain
friction rub
typical EKG chgs
pericardial effusion

2/4

Front 44

What are the EKG findings of acute pericarditis

Back 44

stage 1: ST elevation c concavity
stage 2: (days) baseline ST, flattened T
Stage 3: inverted T waves
stage 4: baseline EKG

Front 45

pericarditis imaging

Back 45

ECHO; may see effusion
CT: 50cc of fluid
MRI: 30 cc of fluid
CXR: poss cardiomegaly

Front 46

management of pericarditis

Back 46

NSAIDs**
pericardiocentesis

Front 47

Bad signs for a pt c pericarditis

Back 47

Fever*
Hx of cancer*
tamponade
immunocomp
trauma
anticoag pts

Front 48

what is the becks triad for cardiac tamponade***

Back 48

1. hypotension
2. JVD
3. distant heart sounds

Front 49

when is cardiac tamponade most commonly seen

Back 49

neoplasms
uremia
idiopathic

Front 50

how much fluid is too much fluid in cardiac tamponade

Back 50

150 ml very quickly
1000 ml very slowly

Front 51

what kind of pulse will you see with cardiac tamponade

Back 51

paradoxical pulse
-weaker on inhalation
-stronger on exhalation

10mmHg

Front 52

EKG findings for cardiac tamponade

Back 52

tachy
low voltage
electrical alternans**
-QRS 2:1 alternating size ratio

Front 53

treatment for cardiac tamponade

Back 53

IV fluid bolus
pericardiocentesis
ICU to be monitored

Front 54

what is the most common cause of constrictive pericarditis in developing nations

Back 54

TB

Front 55

symptoms of constrictive pericarditis

Back 55

dyspnea
fatigue
edema
orthopnea
ascites

Front 56

PE for constrictive pericarditis

Back 56

Kussmal sign***
JVD
distant heart sounds
ascites
edema
pericardial knock
plueral effusion

Front 57

what is Kussmals sign

Back 57

increased JVD with inhalation

Front 58

what is the diagnostic of choice in constrictive pericarditis

Back 58

MRI
- thickened pericardium c norm ventricular walls

HRCT
- pericardial Ca++
-pericardial thickness > 6mm
- impaired RV filling c dilated vena cava

Front 59

what type of ECHO is more reliable when looking for constrictive pericarditis

Back 59

TEE- transesophageal echo

Front 60

treatment of constrictive pericarditis

Back 60

usually ineffective

Pericardectomy
-5-15% mortality
-80-90% achieve NYHA class I or II

Front 61

what is the most common cause of cardiac tamponade

Back 61

neoplasm

Front 62

what is claudication

Back 62

pain in the legs that causes a "Limp"

Front 63

what is the main cause of claudication*

Back 63

atherosclerosis

Front 64

what are the risk factors for claudication*

Back 64

SMOKING***
DM*

Front 65

what is Leriche synd

Back 65

Aortoiliac occlusive disease
butt, hip, & thigh pain c erectile dysfxn

Front 66

what are the common DDx fo intermittent claudication and how do you differentiate it from these

Back 66

*Lumbar spinal stenosis
DVT
peripheral neuropathy

you check for a decrease in peripheral pulses

Front 67

what does an ABI (ankle-brachial index) of less than .9 indicate

Back 67

peripheral artery disease (like claudication)

Front 68

what does an ABI >1.3 indicate?

Back 68

calcified vessels
seen in DM

Front 69

*what is the 5 year Hx of peripheral artery disease

Back 69

80%- stable claudication
20%- worsening claudication

critical claudication
-50% alive c 2 limbs
-25% alive c amputation
-25% dead

Front 70

** how do you treat PAD

Back 70

STOP SMOKING!!!

exercise
aspirin
plavix (clopidogril)

Front 71

what is thromboangitis obliterans (bergers disease)

Back 71

thrombotic disease of small and medium sized arteries and veins of the extremities

Front 72

** what causes thromboangitis obliterans (bergers disease)

Back 72

SMOKING*

Front 73

signs and sympt of thromboangitis obliterans (bergers disease)

Back 73

20 to 40yr M
Smoker
distal ischemia- pain, ulcers, gangrene, and amputation of extremities (esp. fingers and toes)

Front 74

what might you see in an angiogram of thromboangitis obliterans (bergers disease)

Back 74

corkscrew collaterals

Front 75

what is the treatment of thromboangitis obliterans (bergers disease)

Back 75

STOP SMOKING!!!