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Cardiac IntMed Rot
| Question | Answer |
|---|---|
| Most common type of cardiomyopathy | Dilated cardiomyopathy. An insult (eg ischemia, infxn, ETOH, etc) causes dysfunction of left ventricular contractility. CAD with prior MI is the most common cause. |
| Clinical features and dx of Dilated Cardiomyopathy | sx and signs of L and R CHF, S3 and S4 and murmurs of insufficiency might develop. ECG, CXR (enlarged heart, pulm. htn) and echo (LV dilation, systolic dysfxn EF<50%)thinning, global dysfxn) results consistent with CHF |
| Tx of Dilated Cardiomyopathy | ACEI, BB, diuretic, and an aldosterone antagonist. Digoxin is a second-line drug but reamins favored as an adjunct by some clinicians. AVOID CCBs.Limit sodium. If Afib present, rate control. Anticoag as emboli more likely than in ischemic cardiomyopathy |
| Transient cardiomyopathy due to high catecholamine discharge | Tako-Tsubo cardiomyopathy. Acute chest pain or SOB. Predominately affects postmenopausal women. Presents as an acute anterior MI, but coronaries are nl at cardiac catheterization. Imaging reveals apical LV ballooning d/t stunning of myocardium |
| Tx of takotsubo cardiomyopathy | initial therapy is similar to any acute MI. Long term therapy initiation depends on whether LV dysfunction persists. Most ppl receive ASA, BB, ACE until LV fully recovers. |
| Loud S4, bisferiens carotid pulse (carotid pulse with two upstrokes), LVH, Systolic ejection murmur that varies with position, "empty ventricle" at end-systole are suggestive of | Hypertrophic Cardiomyopathy. Sx include: doe, angina, syncope, palpitations, arrythmias, cardiac failure d/t increased diastolic stiffness; the first manifestation may be death in a young athlete. |
| Tx of hypertrophic cardiomyopathy (most cases are inherited as an autosomal dominant trait) | BB (resulting slower hr allows for improved diastolic filling of the stiff LV). CCB, Negative inotropes (Disopyramide/Norpace). Dual chamber pacing may prevent progression of hypertrophy and obstruction |
| Obstruction in HOCM | The LV outflow tract is often narrowed during systole between the bulging septum and an anteriorly displaced anterior mitral valve leaflet, causing a dynamic obstruction. This is the reason why you see a double carotid pulse |
| In this type of cardiomyopathy, the RA and LA are increased in size w/ nl LV and RV size. Thickened myocardium. Elevated filling pressures cause dyspnea and exercise intolerance | Restrictive Cardiomyopathy.Causes: Amyloidosis,Sarcoidosis Hemochromatosis, Scleroderma, Carcinoid Syndrome, Idiopathic. Tx:tx underlying disorder.Use diuretics & vasodilators cautiously(for edema) b/c a decrease in preload may compromise cardiac output. |
| Cardinal manifestations of acute pericarditis | 1.chest pain often severe and pleuritic(positional:relieved by sitting up and forward), 2.Pericardial friction rub, 3. diffuse S-T elevation and PR depression, 4.Pericardial effusion |
| Common cause of acute pericarditis | post viral; preceded by a recent flulike illness, URI or GI sx. |
| Tx for acute pericarditis | Most cases are self-limited and resolve in 2-6 weeks. NSAIDs are the mainstay of therapy. |
| Pericardial effusion can worsen and develop into | cardiac tamponade. |
| Atheromatous occlusion of the distal aorta just above bifurcation causing bilateral claudication, impotence, and absent/diminished femoral pulses. | Leriche's Syndrome |
| PVD is an occlusive atherosclerotic disease of the lower extremities. The most common site is | the superficial femoral artery. Sx:intermittent claudication reproduced by walking and relieved by rest. Rest pain (continuous):often at night and awakes pt.Signs:diminished/absent pulses,muscle atrophy,ulcers.Pallor elevated; rubor of dependency |
| Dx of PVD | Ankle to brachial index (ABI). Nl ABI>/= 1.0. Claudication ABI<0.7, Rest pain ABI <0.4. Pulse volume recordings. Arteriography (goldstandard) |
| Tx of PVD | STOP SMOKING. Gradual exercise program. Foot care. Atherosclerotic risk factor reduction (control of hyperlipidemia, HTN, weight, DM, etc). Avoid extremes of temperature. ASA. Surgery |
| Claudication in the buttocks suggests | Aortoiliac occlusive disease (buttock and hip claudication in addition to the calves). Femoral or popliteal disease cause calf claudication |
| Virchow's triad gives rise to | Venous thrombosis. Stasis, hypercoagulable state, venous injury. Risk factors: >60yo, malignancy, prior hx of VTE, varicose veins, Hereditary hypercoagulable states, prolonged immobilization, cardiac dz, obesity, major surgery, trauma, pregnancy, estrogen |
| Only a 50% of pts with DVT will present with the classic findings: | LE pain and swelling, Homan's sign (calf pain on ankle dorsiflexion), Palpable cord, Fever. |
| DX of DVT | Doppler US is the initial test. Venography is the most accurate test. CTA |
| Tx for VTE | Anticoagulation (IV UFH). Switch to lovenox and Coumadin after Heparin drip for 48 hours with aPTT in goal. INR goal 2-3 for 3-6 months. Thrombolytic tx, IVC filter. Complications: postthrombotic syndrome (chronic venous insufficiency) |
| LMWH | longer half-life than heparin (cannot stop it on the spot), dosed once daily, can give outpt, no need to follow aPTT levels, much more expensive than UFH. |
| Ambulatory venous HTN leading to: 1)interstitial fluid accumulation which causes edema, 2) extravasation of plasma proteins and RBCs into subcutaneous tissues, resulting in brawny induration and pigmentation; CAUSED BY | Chronic venous insufficiency (Venous Stasis Disease). Tx: leg elevation above the heart, avoiding long periods of sitting, ted hose. Ulcer management |
| What is the most common organism in native valve endocarditis? Occurs on damaged heart valves, "subacute endocarditis" | Strep viridians. HACEK group of organisms: Haemophilis, Actinobacillus, Cardiobacterium, Eikenella, Kingella |
| Most common cause of acute endocarditis | Staphylococcus aureus. especially in IVDU |
| Always suspect __________ in a patient with a new heart murmur and unexplained fever | endocarditis |
| Which is better to dx endocarditis, TEE or TTE? | TEE (transesophageal echocardiogram) |
| Tx for endocarditis | Abx based on culture results for 4-6 wks. If culture negative, but there is a high clinical suspicion, treat empirically with a penicillin (or vancomycin) plus an aminoglycoside until the organism can be isolated.Usually fatal if untreated. |
| Rheumatic heart disease occurs as a complication of | Streptococcal pharyngitis (Group A Strep). Chronic valvular abnormalities secondary to acute rheumatic fever. Most common valvular abnormality is mitral stenosis. |
| Tx for rheumatic heart disease (beyond prevention: Treat strep pharyngitis with penicillin or erythromycin to prevent rheumatic fever) | Acute rheumatic fever treated with NSAIDs. Monitor tx with c-reactive protein.Treat valvular pathology.Pts with a hx of rheumatic fever should receive prophylactic abx for procedures. |
| Pts with genetic tissue disorders, such as Marfan's syndrome, osteogenesis imperfecta, and Ehler's-Danlos syndrome often have which valvular abnormality? | Mitral Valve Prolapse. Redundant leaflets prolapse toward the left atrium in systole, which results in the auscultated click and murmur. Mid-late systolic murmur. If asx, resassurance is tx. |
| Mitral regurgitation murmur | Holosystolic murmur (starts with S1 and continues on through S2) at the apex, which radiates to the back or clavicular area depending on which leaflet is involved. Echo shows dilated LA and LV with decreased LV fxn. |
| Tx for mitral regurgitation | Medical: afterload reduction with vasodilators (also, salt reduction, diuretics, digoxin, antiarrhthmics), chronic anticoagulation if pt also has Afib. Surgical: MV replacement or repair |
| With severe ___, LV dilatation pulls the mitral valve annulus apart, causing mitral regurgitation | Aortic stenosis. Pts often asx for years despite severe obstruction. Clin features: angina, syncope, heart failure sx:doe, orthopnea, PND. |
| Murmur of Aortic stenosis | Harsh crescendo-decrescendo systolic murmur, radiates to carotid arteries, heard in second right intercostal space. Associated sounds: s4, precordial thrill |
| Definitive diagnositc test for AS | Cardiac catheterization. Measures valve gradient. Tx: If asymptomatic - no tx. If symptomatic - surgery; aortic valve replacement is the treatment of choice. |
| Widened pulse pressure, De Musset's sign: head bobbing, Muller's sign: uvula bobs, Duroziez's sign: pistol shot heard over the femoral arteries, Corrigan's pulse (water hammer pulse), Austin-Flint murmur are all suggestive of | Aortic Regurgitation. CXR and ECG: LVH. Tx: Conservative if stable and asx - diuretics, vasodilators, afterload reduction with ACEI or arterial dilators. Definitive tx: aortic valve replacement. Acute AR: emergent Aortic valve replacement |
| Which heart arrhthymias require pacemaker implantation? | Second-degree Mobitz Type II and third-degree AV block. Sick sinus syndrome and Sinus bradycardia may also require pacemaker. |
| Which heart arrhythmias are benign? | First degree and second degree type I (Wenckebach) |
| What does a valsalva maneuver cause in AS vs HOCM? | Decreases the murmur in AS; increases the murmur in HOCM |
Created by:
ltm12