Ward Prep: Brs Ch 10 The Heart

Front 1

What is angina pectoris? What are the 3 types? Define them

Back 1

Angina pectoris is episodic chest pain due to myocardial ischemia. Stable angina (precipated by exertion = inc demand, and relieved by vasodilators), unstable angina (occurs at rest; due to thrombosis or embolism), prinzmetal angina (intermittent, at rest, due to vasospasm)

Front 2

Morphological changes post MI. When: nphil? Mphage? Granulation? Fibrosis?

Back 2

nphil day 1, mphage day 3, granulation 1 wk, fibrosis months

Front 3

2 distinct patterns of myocardial infarction

Back 3

transmral infarction (endocardium to epicardium), subendocardial infarction (interior 1/3 LV)

Front 4

6 complications of MI

Back 4

1) arrhythmia (hours) 2) pump failure 3) papillary muscle tear 4) free wall rupture (4-7d => bleed into pericardium => tamponade) 5) mural thrombus 6) ventricular aneurysm

Front 5

cardiac enzymes in serum after MI. which two are most useful? When do they become positive, peak, and become negative?

Back 5

CK-MD: 6hr, 1d, 2d. Troponin 6hr, 1d, 1wk

Front 6

Define Rheumatic fever

Back 6

multisystem inflammatory dz w/ major cardiac manifestations and sequelae occuring in children. Often manifested by migratory polyarthritis 1wk-1mo after infection with group a beta hemolytic streptococcus (pyogenes)

Front 7

Labs in rheumatic fever

Back 7

elevated ESR, antistreptolysin O abs

Front 8

myocardial histology in rheumatic fever

Back 8

aschoff bodies: patches of inflammation with aschoff cells (multinucleated giant cells)

Front 9

Etiology of rheumatic fever

Back 9

cross reactive antibodies against streptococal ags and host ags

Front 10

cardiac manifestations of rheumatic fever

Back 10

pancarditis. Pericarditis (can lead to pericardial or pleural effusions). Myocarditis (mcc death in early RF. => HF). Endocarditis: inflammation leads to long term fibrosis; mitral valve most frequently affected (stenosis or insufficiency), +/- aortic > TC > pulmonic

Front 11

noncardiac manifestations of rheumatic fever

Back 11

1) migratory polyarthritis. 2) skin: subcutaneous nodules, erythema marginatum. 3) CNS: Sydenham chorea

Front 12

Most common cause of death in early phase of rheumatic fever

Back 12

Myocarditis

Front 13

Manifestations of bacterial endocardititis?

Back 13

"bacteria FROM JANE". Fever, Roth spots (retinal spots: white w/ surrounding hemorrhage), Osler's nodes (painful raised lesions on finger/toe pads), Murmur, Janeway lesions (erythematous lesions on palms/soles), Anemia, Nail-bed hemorrhages (splinter), Emboli. also, cordae tendinae rupture, pericarditis

Front 14

Mcc acute endocarditis

Back 14

staph aureus

Front 15

mcc subacute bacterial endocarditis

Back 15

strep viridans. Usually on preexisting valvular lesions/damage

Front 16

complications of bacterial endocarditits

Back 16

septic emboli/infarcts of brain, spleen, etc., focal glomerulonephritis from IC or septic emboli

Front 17

nonbacterial thrombotic endocarditis. What happens to the valves? Complications? Occurs in what setting?

Back 17

Fibrin deposits form on valves => sterile emboli. A/w metastic cancer, renail failure

Front 18

Libman-Sacks endocarditis. What is it? A/w?

Back 18

sterile vegetations on both sides of leaflets in setting of systemic lupus erythematosus

Front 19

Endocarditis of carcinoid sydrome. Pathophys? Which valves?

Back 19

Carcinoid tumors (appendix > ileum > colon) produce seratonin which causes endocarditis of right sided valves (detox in lung). Must be liver mets because liver also detox (ileum is most likely if liver mets).

Front 20

Who gets right sided endocarditis?

Back 20

IVDU, carcinoid sydrome

Front 21

Blood smear in valvular heart dz could show

Back 21

schistocytes (hemolytic anemia from mechanical disruption)

Front 22

what is the most common valvular lesion

Back 22

mitral valve prolapse

Front 23

mitral valve prolapse on auscultation

Back 23

systolic murmur with mid systolic click (from floppy mv)

Front 24

MVP predisposes to

Back 24

bacterial endocarditis

Front 25

mitral valve stenosis is almost always due to

Back 25

rheumatic heard disease

Front 26

causes of mitral valvue sufficiency

Back 26

MVP, bacterial endocarditis, papillary muscle rupture (post-MI), LV dilation=>MV ring stretching

Front 27

causes of aortic stenosis

Back 27

degenerative calcific aortic stenosis (in elderly), congenital bicuspid av calcification, rheumatic heart dz (+/- calcifications)

Front 28

causes of pulmonary valvular disease

Back 28

congeintal malformation (alone or in combo eg tetrology of fallot), carcinoid syndrome, rarely rheumatic heart disease

Front 29

which forms of congenital heart disease cause early cyanosis

Back 29

those that start with a R=>L shunt. tetrology of fallot, transposition of the great arteries, truncus arteriosus

Front 30

which forms of congenital heart disease cause late cyanosis

Back 30

those that start with a L=>R shunt that switch to R=>L shunt. ASD, VSD, patent ductus arteriosus

Front 31

manifestations of ASD

Back 31

late cyanosis from eisenmenger's syndrome, paradoxical embolism

Front 32

what is eisenmenger's syndrome

Back 32

L=>R shunt causes inc R P's, RVH, shunt switches to R=>L. cyanosis

Front 33

what is Lutembacher syndrome

Back 33

ASD + MV S

Front 34

manifestation in VSD? Murmur?

Back 34

late cyanosis from eisenmenger's syndrome. Holosystolic

Front 35

what are the tetrology of fallot? Manifestation?

Back 35

1) pulmonary infundibular or valve stenosis. 2) RVH. 3) VSD. 4) overriding aorta. Early cyanosis

Front 36

How does the ductus arteriosus stay open in fetal life? How to close? Manifestations of PDA?

Back 36

Low O2 tension in pulmonary circuit, prostaglandin synthesis. Close it surgically or with indomethacin (NSAID => dec prostaglandin production). Late cynaosis from eisenmenger's syndrome.

Front 37

Coarctations of the aorta. Where does it usually occur? Implication of location? What to check for on PE? Radiographic finding? Infant vs. Adult type? A/w what genetic dz?

Back 37

Distal to subclavian arteries => cerebral and upper limb htn. Dilation of intercostal arteries => notching of ribs on xray. Adult is post-ductal, infantile is preductal. Turner syndrome (XO)

Front 38

Transposition of the great vessels. What is it? How can survive?

Back 38

Aorta arises from RV, pulmonary artery arises from LV. 2 closed loops. Must have compensatory anomaly (patent ductus arteriosus).

Front 39

DiGeorge syn a/w which congenital heart defects?

Back 39

truncus arteriosus and tetrolog of fallot

Front 40

Turner syn a/w which congenital heart defect?

Back 40

coarctation of the aorta

Front 41

Maternal diabetes a/w which congenital heart defect?

Back 41

"DM <=> MD" transposition of great arteries

Front 42

Congenital rubella a/w which congenital heart defects

Back 42

"red => blue". Late cyanotic: ASD, VSD, PDA

Front 43

Marfan syn a/w which congenital heart defects

Back 43

mARfan: Aortic regurgitation

Front 44

Down syn a/w which congenital heart defects?

Back 44

endocardial cushion defects: ASD, VSD

Front 45

What is congenital rubella syndrome

Back 45

caused by materal rubella infection during first trimester. IgM indicates recent 1° infection, IgG indicates recent 1° inf, reinfection, or remote infection. Syn: mental/growth retardation, microcephaly, deafness, cataracts, heart defects (ASD, VSD, PDA)

Front 46

Define cardiomyopathy. Name the 3. Which is most common?

Back 46

Noninflammatory dz of myocardium not a/w htn, CAD, Congenital HD, valvular dz. Dilated (mc), restrictive, hypertrophic

Front 47

Dilated cardiomyopathy. Causes? What happens to myocardium? Type of heart faliure? Radiographic appearance?

Back 47

ABCCCDmph: Alcohol, Beriberi, Coxsackievirus, Chagas dz (trypanosoma cruzi), Cocaine, Doxorubicin, myocarditis, peripartum cardiomyopathy, hemochromatosis. Hypertrophy + dilation of all 4 chambers => systolic HF. Radiograph: balloon.

Front 48

Restrictive cardiomyopathy. Pathophys? Type of heart failure? Causes?

Back 48

infiltrative process => stiffened walls => dec pump action (sys HF? R+L). Causes: amyloidosis, sarcoidosis, fibrosis (e.g. radiation induced).

Front 49

Hypertrophic cardomyopathy. Process? Type of HF? Murmur? Who dies?

Back 49

Disordered hypertrophy => diastolic HF. Also, left ventricular outflow tract obstruction. Murmur: systolic, inc w/ valsalva (dec return => ventricle collapse => more obstruction. Vs. AS)

Front 50

Myocarditis. Process? Px w/? Causes?

Back 50

Inlammation => necrosis => biventricular HF (px). South america: often viral (e.g. coxsackie); Chagas dz (trypanosoma cruzi)

Front 51

Causes of hydropericardium? What type of fluid?

Back 51

Serous transudate. Inc hydrostatic p in vasculature (CHF), or dec oncotic P (liver dz, nephrotic syn)

Front 52

Causes of hemopericardum?

Back 52

heart wall rupture (MI, trauma), aorta rupture (aneurysm/dissection, trauma)

Front 53

Types of acute pericarditits?

Back 53

Serous (protein-rich, straw colored; SLE, RF, virus, uremia), Fibrinous (uremia, MI, acute RF) Purulent (bacterial infection), Hemorrhagic (blood +inflammatory cells: tumor invasion or TB or other bac)

Front 54

Serous pericarditis. Appearance, causes?

Back 54

Protein-rich, straw colored. Systemic lupus erythematosus, Rheumatic fever, viral infection, uremia.

Front 55

Fibrinous pericarditis. Appearance, causes?

Back 55

Fibrin-rich. Uremia, MI, acute RF

Front 56

Purulent pericarditis. Appearance, causes?

Back 56

Cloudy =pus (bacteria, inflammatory cells). Bacterial infection

Front 57

Hemorrhagic pericarditis. Contents, causes?

Back 57

Blood + inflammatory cells. Tumor invasion, TB (or other bacterial infection)

Front 58

Name 2 1° cardiac tumors. Distinguish between them

Back 58

myxoma (adults, LA, ball in valve => ~mitral stenosis, CHF), rhabdomyosarcoma (kids, a/w tuberous sclerosis). Both rare (2° more common. E.g. melanoma met)

Front 59

DDx dyspnea

Back 59

Pulmonary embolism, asthma, COPD, acute coronary syndrome, CHF

Front 60

causes of CHF

Back 60

IHD (MI), htn, av or mv dz, cardiomyopathy, myopathy

Front 61

manifestations of LHF, labs

Back 61

dyspnea/orthopnea (pulmonary congestion/edema), pleural effusion. Labs: B-type natiuretic peptide elevated

Front 62

RHF. Mcc, causes

Back 62

MCC = LVH. Also: pulmonary htn, cardiomyopathy, myocarditis, TCV or PV dz.

Front 63

Manifestations of RHV, labs

Back 63

Hepatosplenomegaly (nutmeg liver from chronic passive congestion), pitting edema in dependent areas (ankles), ascites, JVD Volume overload by activation of the renin-angiotensin system. ALSO: pleural effusion. Labs: elevated B-type natriuretic peptide.

Front 64

Causes of LVH

Back 64

htn, mitral valve insufficiency, (aortic stenosis)

Front 65

Causes of RVH

Back 65

LVH, cor pulmonale (RVH from inc pulmonary P), mitral valve stenosis, congenital heart dz w/ L=>R shunt (ASD, VSD, PDA).

Front 66

Cor pulmonale. What is it? Examples of causes?

Back 66

RVH <= pulmonary artery htn (common feature) <= lung dz (e.g. emphysema, 1° pulm htn)