Cardiology Carditis & Aorta
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- What is the most common etiology for myocarditis?
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⬢ viral etiology (recent viral upper respiratory infection)
⬢ coxsackie virus is the most common virus - What are some of the clinical manifestation of myocarditis?
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⬢ 2/3 have flu-like symptoms
⬢ 1/3 have chest pain
⬢ variable symptoms like heart failure, conduction abnormalities - What type of myocarditis are steroids effective?
- peripartum myocarditis
- What may be the initial and only clinical finding with myocarditis?
- ventricular ectopy
- What are some lab test that would be ordered with myocarditis?
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⬢ no specific test
⬢ increased WBC and ESR (sed rate)
⬢ possible rise in cardiac enzymes
⬢ abnormal T and B cell counts
⬢ cardiac specific antibodies in blood - What is the best test to confirm myocarditis?
- MRI
- What is the treatment for myocarditis?
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⬢ antibiotics if bacterial infection
⬢ CHF treatment if the patient is in failure
⬢ arrhythmia control
⬢ transplant only after inflammation is completly gone
⬢ avoid exercise - What is the most common viral etiology for pericarditis?
- - coxsackie and echovirus
- What is the presentation of pericarditis?
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⬢ fever
⬢ plueritic chest pain
⬢ dypsnea
⬢ better with leaning forward
⬢ pain radiates to the back, shoulder, neck, and epigastrum - What is the most important physical finding of pericarditis on physical examination?
- friction rub over the left sternal border
- How would pericarditis look on Xray? on EKG? on Echo?
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⬢ Xray - water bottle configuration
⬢ EKG - diffuse ST elevation or T wave inversion; or possible PR depression
⬢ Echo - usually normal with fluid noted - What is the treatment for pericarditis?
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⬢ NSAIDs
⬢ treat underlying cause - What is Kussmauls effect?
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⬢ seen with cardiac tamponade
⬢ paradoxical neck vein behavior
⬢ jugular vein distends upon inspiration - What is Dressler's Syndrome?
- pericarditis weeks to months s/p MI or cardiac surgery
- What is the most common cause of cardiac tamponade?
- malignant pericarditis (neoplasm)
- What is Beck's triad?
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3 symptoms associated with cardiac tamponade
⬢ JVD
⬢ hypotension
⬢ muffled heart sounds - What is pulsus paradoxus?
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⬢ an exaggeration of the normal inspiratory decrease in systemic blood pressure
⬢ seen in cardiac tamponade - What does an EKG of cardiac tamponade look like?
- low voltage on EKG
- What is the treatment of cardiac tamponade?
- pericardiocentesis
- What are the 2 types of endocarditis?
- acute and subacute
- How do patients with endocarditis present?
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⬢ fever
⬢ preexisting heart lesion
⬢ murmur - True/False: Endocarditis is more commonly caused by bacteria than a virus
- The correct answer is: True
- What groups are at risk for endocarditis?
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⬢ IV drug users
⬢ post-open heart surgery
⬢ alcohol abusers
⬢ infected shunts/IV lines - How does acute endocarditis present?
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⬢ abrupt onset, acutely ill
⬢ fever, chills, petechiae
⬢ murmurs, petechiae, splinter hemorrhages, Janeway lesions, Roth spots, Oslers nodes - What is the Duke Criteria?
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⬢ used to diagnose bacterial endocarditis
⬢ major criteria include
1) multiple positive blood cultures for the infecting organism
2) echocardiographic evidence of endocardial involvement
3) a new regurgitant murmur on physical examination - What is the treatment of endocarditis?
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⬢ aggressive antibiotics IV for 2-4 weeks, 4-6 weeks with fungal infection
⬢ Nafcillin + PCN + gentamicin - What is the common bacterial etiology of endocarditis with IV drug users and what valve is usually most effected?
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⬢ S. aureus is the most common bacterial cause of endocarditis with IV drug users
⬢ Tricuspid valve is usually affected - What is the difference between a true and false aneurysm?
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⬢ a true aneurysm involves all 3 walls due to destruction of media elastic fibers
⬢ a false aneurysm - intima and media disrupted but only adventitia bulges out - What is the difference betweehn a fusiform and saccular aneurysm?
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⬢ a fusiform aneurysm involves the entire curcumference of the vessel
⬢ a saccular aneurysm extends over part of the circumference of the vessel and appears saclike - What are some etiologies of aneurysms/dissection?
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⬢ arteriosclerosis
⬢ cystic medial necrosis
⬢ trauma
⬢ syphillis - What is the size of a normal abdominal aorta?
- 2 cm
- By definition, what is the size of an aneurysm?
- > 3 cm
- What is the treatment of choice for an aneurysm greater than 5 cm?
- surgery
- What percentage of aortic aneurysms are thoracic?
- < 10%
- What is the presentation of ascending aortic dissection?
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⬢ abrupt onset severe "ripping" back pain
⬢ possible neuro signs (syncope, hemiplegia, lower extremity paralysis) - What is the diagnostic study of choice for aortic aneurysm/dissection?
- transesophageal echo (TEE)
- What is the medical treatment for aortic aneurysm?
- aggressive control of BP (ex. nitroprusside, Beta blocker)
- What should you be suspicious of in a patient with severe hypertension in shock?
- Aortic dissection until proven otherwise
- List some causes of aneurysms (5)
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⬢ connective tissue disorders
⬢ infection (syphillis)
⬢ arteritis (Takayasu)
⬢ trauma
⬢ athersclerosis - What is the triad of signs and symptoms of a ruptured AAA?
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⬢ abdominal pain
⬢ hypotension
⬢ pulsatile abdominal mass - What are the most common sites of aortic occlusive disease?
- abdominal and terminal aorta, common illiac and femoral arteries
- What are common signs and symptoms of aortic occlusive disease?
- claudication, buttock pain, and impotence
- What substances can act as an emboli/thrombosis?
- plaque, blood, fat, air, cancer cells, foreign body
- What are some characteristics of Takayasu's Aortitis?
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⬢ referred to as a "pulseless disease
⬢ autoimmune panarteritis (all arteries become inflammed) - What is the most common etiology for inflammation of the aorta?
- syphilis
- List 5 peripheral vascular conditions
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⬢ acute occlusions
⬢ arteriosclerotic obliterans
⬢ thromboangitis obliterans
⬢ arteriovenous fistulas
⬢ vasospastic disorders - What are the 6 P's of acute ischemia/occlusions?
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⬢ pain
⬢ pallor
⬢ pulselessness
⬢ paresthesias
⬢ poikilothermia/polar (cold)
⬢ paralysis - What are some characteristics of arteriosclerotic obliterans?
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⬢ atheromatous disease (build-up of plaque) in the peripheral arteries
⬢ produces intermittent claudication that occurs predictably with activity and is relieved with 1-2 minutes rests
⬢ related to smoking - What are some characteristics of Thromboangitis Obliterans?
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⬢ aka Buerger's disease
⬢ non-atheromatous
⬢ related to smoking
⬢ intense inflammation of the vessels
⬢ cold sensitivity
⬢ triphasic color scheme (skin turns white > blue> red)
⬢ decreased or absent distal pulses - What are some characteristics of an arteriovenous fistula?
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⬢ arterial flow enters vein
⬢ may cause CHF and venous hypertension - Name 3 types of arterial vasospastic disorders
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⬢ cold-sensitivity of Raynaud's type
⬢ Livedo reticularis
⬢ Acrocyanosis - What are some characteristics of cold-sensitivity of Raynaud's type?
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⬢ common in young females
⬢ triphasic color response (white, blue, red) - What are some characteristics of Livedo reicularis?
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⬢ persistent cyanotic mottling of skin
⬢ accentuated by cold
⬢ all parts of extremities and trunk may be involved - What are some characterisitics of acrocyanosis?
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⬢ most common arterial vasospastic disoder
⬢ persistent, diffuse cyanosis of fingers, toes, hands, and feet - What is the treatment of vasculitis?
- steroids or immunosuppresion
- What are some characteristics of giant cell arteritis (temporal arteritis)?
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⬢ systemic inflammatatory vasculitis of unknown etiology
⬢ affects medium and large-sized arteries
⬢ presents with new onset headache, vision loss (most common cause of morbidity) - What is most common cause of vision loss in temporal arteritis?
- anterior ischemic optic neuropathy (AION)