Term
| Acute rheumatic fever, seen mostly in ages 5-15, is an inflammatory disease of the heart, joints, CNS, and subcutaneous tissue that develops after an infection with ________? |
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Definition
| Group A beta hemolytic S. pyogenes; 50% recurrent ARF causes rheumatic heart disease |
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Term
| The mean latency after infection of group a b-hemolytic strep is 3 weeks despite 2/3 having no symptoms. What is pathogenesis of acute rheumatic fever? |
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Definition
| Rheumatogenic strains with virulence factors like M proteins, antigenic subs, emm genes in a susceptible host trigger an exaggerated T cell and humorla response vs host myosin and laminin tissues that are similar to strep M protein |
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Term
| What is the name of the granulomatous nodules with giant cells seen in myocardium of rheumatic fever patients? |
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Definition
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Term
| What does the FEVERSS acronym stand for in rheumatic heart disease? |
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Definition
| Fever, Erythema Marginatum, Valve vegetation, up ESR, Red hot joints (polyarthritis), Subcut nodules, Syndenhams chorea |
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Term
| Positive throat culture or ASO titer and 2 major or 1 major and 2 minor manifestions are the Jones requirements for diagnosing what? |
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Definition
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Term
| The primary phophylaxis management of ARF is to treat with penicillin within 9 days to repvent fever, however to prevent secondary infections for pateitns who already had ARF what is protocol? |
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Definition
| IM penicillin G every month, daily penicillin for 5 years after alst attack or age 21 |
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Term
| What is the major causative organism in infective endocardidits? |
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Definition
| Streptococci followed by staph |
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Term
| Infective endocarditis can infect more native and prosthetic valves, but what are special risk factors? |
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Definition
| IV drug use, nosocomial bacteremia |
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Term
| Endocarditis in IVDU S. aureas predominates with pseudomonas being common, but what are the typical outcomes? |
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Definition
| Right sided endo most common |
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Term
| What is the predom organism is prosthetic valve endocard in first 60 days? |
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Definition
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Term
| T or F: patho of endocarditis exposing endothelium is from turbulent flow due to CHD, RHD scarring, prosthetic valves, mechanical damage, inflammatory lesions of IVDU. |
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Definition
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Term
| What are the host and bacterial factors that are the patho of endocard? |
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Definition
| Host is exposed fibronectin, laminin, Von Willebrand produced by endothelial cells due to vascular injury, bacteria can bind to these molecules and resist complement |
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Term
| What are the two most common lab findings is bacterial endo? |
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Definition
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Term
| T or F: Prophylaxis in Infective endo is for the highest risk group only, but no data actually demonstrates that prophylactic antibiotics prevent IE. |
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Definition
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Term
| Bacterial endo can be remembered as FROM JANE. What is it? |
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Definition
| Fever, Roths spots (white spots retina/hemorrhage), Oslers nodes (IC deposition on figer pads), Murmur, Janeway Lesions (embolis induced lesions of palm or sole), Anemia, Nail-bed hemorrhage, Emboli |
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Term
| What are the indications for a carotid endartectomy? |
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Definition
| Symptomatic and >70 occluded |
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Term
| Which arteries are affected in claudication and TIA? |
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Definition
| Femoral/peroneal and carotid |
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Term
| What is the diff btw fusiform, saccular and pseudo-anuerysm? |
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Definition
| Fusiform is all the way around the vessel, saccualr is partially around, pseudo is a hole in the intima causing a hematoma contained by adventia |
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Term
| What is the etiology of true versus false aneurysms? |
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Definition
| True: atherosclerotic, abdominal>thoracic aorta, older males, HTN; Flase: infection trauma |
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Term
| The risks of aortic aneurysms are 25% at 3 years, diastolic HTN, size >6cm, trauma. What is tx? |
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Definition
| Surgery; or aggressive BP reduction in type B distal dissections |
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Term
| Aortic dissection can result from atherosclerosis, HTN, catheders, >40, but what happens to the tissue? |
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Definition
| Intimal tear and cystic media necrosis causing blood to flow between media and adventitia |
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Term
| What two connective tissue diseases have a high likelihood of aortic dissection? |
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Definition
| Marfans poor coding for fibrillin-1 (dilatation greatest at aortic root) and bicuspid aortic valve |
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Term
| The major risk of DVT is PE. What is tx? |
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Definition
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Term
| Venous thrombosis like varicose veins caused by preggers, standing, obese, DVT are not caused by atherosclerosis but by Virchows triangle. What is that? |
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Definition
| Stasis, hypercoaguable, vascular damage; tx with anticoags, where calf>popliteal>femoral>iliac |
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Term
| T or F, tachycardia progressively shortens diastolic filling time and each diastolic filling period. |
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Definition
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Term
| Why is transthoracic ultrasound limited whereas transesophageal isnt? |
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Definition
| ultrasound cant go thru bone or air so less windows to see heart in chest |
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Term
| Valvular lesions that cause obstruction lead to _______ overload leading to hypertrophy, whereas lesions of regurg cause _______ overload leading to dilated heart. |
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Definition
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Term
| What are some common causes of mitral stenosis? |
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Definition
| Rheumatic disease (most common),congenital such as parachute mitral valve, systemic disease like SLE |
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Term
| In mitral stenosis there is commissural fusion, scarring, calc of leaflets, or subvalvular pathology. What two processes puts the patient at risk for embolism? |
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Definition
| Stagnation of blood in atrium due to backup and atrial fib due enlargement of chamber due to higher pressures |
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Term
| Describe the heart murmur in mitral stenosis. |
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Definition
| Loud S1. Opening snap after S2 followed by delayed mid-diastolic rumbling. LA>>LV pressure where mitral valve opens earlier and closes later |
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Term
| T or F: mitral stenosis is considered severe when resting mean pressure gradient >10, mitral valve area<1, PHT>220msec |
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Definition
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Term
| Controlling HR in mitral stenosis with digoxin/b-blockers is imperative to prevent pulmonary edema and increase diastole, why not use vasodilators? |
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Definition
| Lower SVR provoking tachycardia and decreased diastolic filling time |
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Term
| What is the surgical treatment of first choice for mitral stenosis? |
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Definition
| Ballon valvuloplasty>valve repair |
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Term
| Chronic mitral regurg is usually well-tolerated but can decompensate with time due to volume overload. Describe the murmur heard. |
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Definition
| Holosystolic blowing murmur loudest at the apex and radiates to the axilla. S3 is heard. Can cause outward excursion of stheoscope |
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Term
| Mitral valve prolapse usually has symptoms which are out of proportion to the mild heomdynamic impairment. What is sound heard? |
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Definition
| Mid-systolic click with late systolic murmur loudest at S2. Most frequent valvular lesion and predisposes to infective endo |
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Term
| Med therapy for chronic mitral regurg is the same as HF, which is? |
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Definition
| Afterload reducing agents ACEi/ARB, Diuretics and nitrates for preload, b-blockers and digitalis to increase contracitlity |
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Term
| What are the most common causes of aortic stenosis? |
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Definition
| Congenital bicuspid aorta(young), acquired senile calcifications(in old), rheumatic disease |
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Term
| Describe aortic stenosis murmur. |
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Definition
| Ejection click followed by crescendo that ends before S2. LV>>aortic pressure, radiates to carotids, pulses weak |
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Term
| In aortic stenosis when does it present due to Rheumatic, Bicuspid, or Senile Calcific causes? |
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Definition
| Age 50, either childhood or >40, >65 |
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Term
| Which of the following are causes of aortic regurg from scarring or dilated aortic root pathology - congential bicuspid, rheumatic scarring, tertiary syphilis, marfan? |
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Definition
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Term
| What is the sound heard in aortic regurg? |
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Definition
| Midsystolic murmur and blowing diastolyic murmur. to-Fro murmur Wide pulse pressure when chronic. |
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Term
| T or F: Patients with Valvar heart disease should see a dentist every 6 months and need antibiotic prophylaxis to prevent endocarditis. |
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Definition
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Term
| What is the medical management of chronic aortic regurg? |
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Definition
| Afterload reducing agents may delay progression to ventricular failure; surgery is warranted and acute severe AR |
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Term
| Tetraology of Fallot has PROVe. What is that? |
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Definition
| Pulmonary stenosis, RVH, Overriding aorta of VSD, VSD |
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Term
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Definition
| VSD, PDA, Tetraology of Fallot |
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Term
| Name this CHD - uncorrected VSD, ASD, or PDA causes vascular hypertrophy, resulting in progressive pulmonary HTN. As pulmonary resistance increases, shunt goes from L-R to R-L causing late cyanosis. |
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Definition
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Term
| The cyanotic CHD differential for R->L shunts causing early cyanosis blue babies is the 5 Ts. What are they? |
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Definition
| Tetraology of Fallot, Transposition of Great Vessels, Truncus arteriosus, Tricuspid atresia, Total Anomalous Pumonary Venous Return; children find they can squat to incrase SVR and feel better |
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Term
| T or F, The tetraology of Fallot can have a benign course or the patient can suffer from progressive cyanosis/ cyanotic spells. |
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Definition
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Term
| Describe a patient with refractory end-stage HF. |
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Definition
| Symptoms at rest despite maximum med management |
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Term
| What ist eh 5 year mortality rate for HF and who bodes worse men or women? |
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Definition
| 50% survival with men worse |
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Term
| What medicines are the cornerstone of therapy for HF? |
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Definition
| ACEi/ARBs, B-blockers (carvedilol best), Aldosterone antags (minimum moderate symptoms) ; note digoxin minimal effects |
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Term
| Why is it that beta-blockers are used in HF? |
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Definition
| Chronic SNS stim causes myocyte death, arry, vasoconstriction, sodium retention - reveres remodeling and improves ventricular function over time |
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Term
| HF with poor diastolic function have not been studied well. What is treatment? |
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Definition
| Same as LV dysfunction, ACEi/B-blockers/aldos antags |
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Term
| T or F: Target cholesterol in a patient with CAD should be <100. |
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Definition
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Term
| What drug will most rapidly and safely relieve pulmonary edema in a patient with mitral stenosis and rapid atrial fibrillation? |
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Definition
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Term
| Which valvular lesion is most likely to cause an ejection sound? |
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Definition
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Term
| What is the least common cause of acute MI? |
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Definition
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Term
| What is most commonly associated with classic Braunwaldian cardiogenic shock in AMI? |
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Definition
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Term
| Congenital VSD, ASD, and PDA all result in which type of shunt causing late cyanosis and blue kids? |
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Definition
| Left to right; but can Eisenmenger and shift directions |
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Term
| What is not required for re-entry: unidirectional block, slow pathway, scar, L>CVxRP? |
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Definition
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Term
| Which of the following is not part of patho for chronic CHF - endothelin, natruietic peptides, RAAS, SNS? |
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Definition
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Term
| What is not implicated in atherosclerotic plaques - fibroblasts, smooth mucle, collagen atrix, macros. |
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Definition
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Term
| In an ecg one large box horizontally is how much time? |
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Definition
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