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1 CV, Myo/Valve Dys
Step Up to Medicine, Chap 1: Diseases of Myocardium and Valves
| Question | Answer |
|---|---|
| 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
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