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1 CV, Myo/Valve Dys

Step Up to Medicine, Chap 1: Diseases of Myocardium and Valves

QuestionAnswer
MC type of cardiomyopathy? Dilated cardiomyopathy
Pathogenesis of dilated cardiomyopathy? Insult (alcohol, ischemia, infection) causes dysfunction of LV contractility
MCC dilated cardiomyopathy? CAD
Tx for dilated cardiomyopathy? dig, diuretics, vasodilators, cardiac transplantation
Inheritance for hypertrophyic cardiomyopathy? AD
Pathophys of HOCM? Diastolic dysfunction due to stiff, hypertrophied ventricle with elevated diastolic filling pressures. May also have dynamic outflow tract obstruction due to hypertrophied IV septum.
Abnormal heart sounds in HOCM? Systolic ejection murmur, S4. Also sustained PMI.
Standing, Vasalva, and leg raise maneuvers decrease the intensity of all murmurs EXCEPT which? HOCM and mitral valve prolapse (MVP)
Squatting increases the intensity of all murmurs except which? HOCM and MVP. These maneuvers decrease LV volume.
How can sustained handgrip differentiate between HOCM and MVP? Sustained handgrip increases intensity of MVP, but decreases intensity of HOCM murmur. Handgrip increases systemic resistance.
Pathophys of RESTRICTIVE cardiomyopathy? Infiltration of myocardium results in impaired diastolic ventricular filling due to decreased ventricular compliance.
Myocardium with bright or speckled appearance on echo? Amyloidosis
Chamber findings on echo with restrictive cardiomyopathy? Enlarged RA and LA with normal-sized ventricles bilaterally
For which etiology of restrictive cardiomyopathy is digoxin contraindicated to treat systolic dysfunction? Why? Amyloidosis. Increased incidence of dig toxicity.
Tx for this restrictive cardiomyopathy?: hemochromatosis Phlebotomy or deferoxamine
Tx for this restrictive cardiomyopathy?: sarcoidosis Glucocorticoids
Tx for this restrictive cardiomyopathy?: amyloidosis No tx available :(
Why should you be careful when treating pulmonary and peripheral edema in restrictive cardiomyopathy? Diuretics and vasodilators decrease preload and may compromise CO
Name 2 drugs that can cause drug-induced Lupus acute pericarditis. 1. procainamide, 2. hydralazine
How can you differentiate acute pericarditis pain from acute MI pain? Acute pericarditis pain tends to be pleuritic, radiates to trapezius ridge and neck, is positional (relieved by leaning forward)
During what phase of respiration is a pericardial friction rub best heard? During expiratory phase
Specific EKG finding in acute pericarditis? PR depression
Pathophys of constrictive pericarditis? Fibrous scarring of pericardium--> rigidity and thickening of pericardium--> obliteration of pericardial cavity
Describe the diastolic dysfunction in constrictive pericarditis. How does it compare to that seen in cardiac tamponade? Rapid filling during early diastole, but halted filling during late diastole. In tamponade, ventricular filling is halted throughout the entire diastolic cycle.
Most prominent physical finding in constrictive pericarditis? JVD. (Also Kussmaul's sign: no decrease in JVD during inspiration)
EKG findings in constrictive pericarditis? Flattened or inverted T waves
Imaging study of choice for pericardial effusion or cardiac tamponade? Echo
When does pericardial effusion become clinically important? Rapid development b/c can lead to tamponade.
Which lung base will have dullness in pericardial effusion? L
When to do pericardiocentesis in pericardial effusion? Only indicated if evidence of tamponade
What is Beck's triad? What condition is it seen in? Hypotension, muffled heart sounds, JVD
MCC mitral stenosis? Rheumatic heart disease (pt may not recall past h/o rheum fever though)
Name that murmur!: opening snap followed by low-pitched diastolic rumble Mitral stenosis
How to determine severity of mitral stenosis based on distance between S2 and opening snap? Shorter the distance, more severe the stenosis
Most prominent physical finding in mitral stenosis? Murmur followed by loud S1
Severe aortic stenosis can cause which secondary valvular dysfunction? Mitral regurg (LV dilation pulls MV annulus apart)
Angina + exertional syncope + heart failure symptoms (DOE, orthopnea, PND). Dx? Aortic stenosis
Name that murmur!: harsch crescendo-decrescendo systolic murmur radiating to carotids and best heard in 2nd R IC space Aortic stenosis
Name that murmur!: parvus et tardus (diminished and delayed carotid upstrokes), sustained, PMI, precordial thrill, S4 Aortic stenosis
Definitive diagnostic test for aortic stenosis? Cardiac cath (<0.8cm squared=severe stenosis)
Tx of choice for AS? Indications? Aortic valve replacement. Indicated in all symptomatic pts.
What is De Mussett's sign? What does it signify? Head bobbing. Aortic regurg
How should acute aortic regurg post MI be treated? With emergent aortic valve replacement! Medical EMERGENCY!
Name that murmur!: holosystolic murmur at the apex which radiates to back or clavicular area Mitral regurgitation
MCC tricuspid regurg? LV failure
Congenital malformation of tricuspid valve in which there is downward displacement of the valve into the RV. Epstein's anomaly; can cause tricuspid regurg
Name that murmur!: pulsatile liver with blowing holosystolic murmur Tricuspid regurg
Name that murmur!: midsystolic rumbling murmur that increases with standing and the Valsalva maneuver and increased hand grip, and decreases with squatting; systolic clicks Mitral valve prolapse
Rheumatic heart disease occurs as a complication of _______. Strep pharyngitis (group A streptococcus)
MC valvular disease in rheumatic heart disease? Mitral stenosis
Prevention of rehumatic fever? Tx strep pharyngitis with penicillin
Tx for acute rheumatic fever? What is used to monitor treatment? Tx= NSAIDs. C-reactive protein is used to monitor tx.
MCC subacute and native valve infective endocarditis? Strep viridans
MCC acute infective endocarditis? Staph aureus
HACEK organisms in infective endocarditis? Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella
2 leading causes of death in PDA? Heart failure and infective endocarditiss
Created by: sarah3148