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Cardiology Carditis & Aorta


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What is the most common etiology for myocarditis?
⬢ viral etiology (recent viral upper respiratory infection)
⬢ coxsackie virus is the most common virus
What are some of the clinical manifestation of myocarditis?
⬢ 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?
⬢ 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?
What is the treatment for myocarditis?
⬢ 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?
⬢ 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?
⬢ 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?
⬢ treat underlying cause
What is Kussmauls effect?
⬢ 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?
3 symptoms associated with cardiac tamponade
⬢ hypotension
⬢ muffled heart sounds
What is pulsus paradoxus?
⬢ 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?
What are the 2 types of endocarditis?
acute and subacute
How do patients with endocarditis present?
⬢ 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?
⬢ IV drug users
⬢ post-open heart surgery
⬢ alcohol abusers
⬢ infected shunts/IV lines
How does acute endocarditis present?
⬢ abrupt onset, acutely ill
⬢ fever, chills, petechiae
⬢ murmurs, petechiae, splinter hemorrhages, Janeway lesions, Roth spots, Oslers nodes
What is the Duke Criteria?
⬢ 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?
⬢ 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?
⬢ 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?
⬢ 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?
⬢ 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?
⬢ 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?
What percentage of aortic aneurysms are thoracic?
< 10%
What is the presentation of ascending aortic dissection?
⬢ 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)
⬢ connective tissue disorders
⬢ infection (syphillis)
⬢ arteritis (Takayasu)
⬢ trauma
⬢ athersclerosis
What is the triad of signs and symptoms of a ruptured AAA?
⬢ 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?
⬢ referred to as a "pulseless disease
⬢ autoimmune panarteritis (all arteries become inflammed)
What is the most common etiology for inflammation of the aorta?
List 5 peripheral vascular conditions
⬢ acute occlusions
⬢ arteriosclerotic obliterans
⬢ thromboangitis obliterans
⬢ arteriovenous fistulas
⬢ vasospastic disorders
What are the 6 P's of acute ischemia/occlusions?
⬢ pain
⬢ pallor
⬢ pulselessness
⬢ paresthesias
⬢ poikilothermia/polar (cold)
⬢ paralysis
What are some characteristics of arteriosclerotic obliterans?
⬢ 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?
⬢ 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?
⬢ arterial flow enters vein
⬢ may cause CHF and venous hypertension
Name 3 types of arterial vasospastic disorders
⬢ cold-sensitivity of Raynaud's type
⬢ Livedo reticularis
⬢ Acrocyanosis
What are some characteristics of cold-sensitivity of Raynaud's type?
⬢ common in young females
⬢ triphasic color response (white, blue, red)
What are some characteristics of Livedo reicularis?
⬢ persistent cyanotic mottling of skin
⬢ accentuated by cold
⬢ all parts of extremities and trunk may be involved
What are some characterisitics of acrocyanosis?
⬢ 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)?
⬢ 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)

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