[02.01] CMD - Approach to Cardiovascular Disease V2.pdf

Sept 29

When is World Heart Day celebrated annually?

Management is easier once a diagnosis is found

Why is early diagnosis of heart problems prioritized?

18 million

Approximately how many deaths occur globally each year from cardiovascular diseases?

Cardiovascular disease

What is the number one leading cause of death in both the world and the Philippines?

Elevated LDL cholesterol

Which modifiable risk factor is associated with 3.8 million global CVD deaths?

High Fasting Plasma Glucose

Which metabolic risk factor causes 2.3 million CVD deaths annually?

Air Pollution

Which risk factor in the CVD deaths table is identified as not modifiable?

4.8 million

How many deaths are attributed to air pollution annually?

3.0 million

How many deaths are caused by tobacco use globally each year?

10.8 million

Which risk factor contributes to the highest number of CVD deaths in the provided table?

Silent disease with no symptoms

Why is it critical to monitor raised blood pressure?

Ischaemic heart disease

What was the leading cause of death in the Philippines in 2023?

Diseases when early are difficult to diagnose but easy to treat; diseases when late are easy to diagnose but difficult to treat

What is the specific adage regarding the timing of diagnosis and ease of treatment?

Common things become common

What is the clinical pearl regarding how frequently diseases occur?

Think of horses and not zebras

When you hear hoofbeats in a medical context, what should you think of?

Uncommon manifestation of a common disease

Is it more likely to see a common manifestation of an uncommon disease or an uncommon manifestation of a common disease?

Occams Razor or Law of Parsimony

Which principle states that the simplest solution tends to be the right one?

Hickams Dictum

What principle states that a patient can have as many diseases as he damn well pleases?

History

Which part of the diagnostic approach includes symptoms, PMH, family history, and social history?

Physical Exam

Which part of the diagnostic approach includes signs, BP, HR, BMI, and waist to hip ratio?

Lab Test 1

Which category of testing includes CBC, blood chemistries, lipid profile, urinalysis, 12 lead ECG, and chest X ray?

Lab Test 2

Which category includes ambulatory BP, ankle brachial index, echocardiogram, and stress tests?

Congenital in etiology

In an 18 year old female feeling blue, what is the most likely disease etiology?

Schamroths window or Schamroths sign

What is the small diamond shaped window looked for when testing for clubbing?

Chronic hypoxia

What physiological state does the disappearance of Schamroths window point to?

COPD

Name a non cardiac chronic condition that can lead to clubbing.

Coeur En Sabot or Boot shaped heart

What specific chest X ray finding is indicative of Tetralogy of Fallot?

5 Ts and 2 Es

What is the mnemonic for cardiac defects leading to central cyanosis?

Transposition of the great arteries

What is the first T in the mnemonic for cyanotic cardiac defects?

Tetralogy of Fallot

What is the second T in the mnemonic for cyanotic cardiac defects?

Tricuspid atresia

What is the third T in the mnemonic for cyanotic cardiac defects?

Truncus arteriosus

What is the fourth T in the mnemonic for cyanotic cardiac defects?

Total anomalous pulmonary venous return

What is the fifth T in the mnemonic for cyanotic cardiac defects?

Ebstein anomaly

What is the first E in the mnemonic for cyanotic cardiac defects?

Eisenmenger physiology

What is the second E in the mnemonic for cyanotic cardiac defects?

Ventricular septal defect, Pulmonary stenosis, Overriding of the aorta, Right ventricle hypertrophy

What are the four hallmarks of Tetralogy of Fallot?

Staged procedure

What approach is taken if the pulmonary artery is too small for immediate repair in TOF?

Palliative shunt

What is performed first in a staged TOF operation to prepare the artery?

Tetralogy of Fallot

If you see someone with a cyanotic congenital heart disease, what should be your top suspicion?

Ventricular septal defect or Atrial septal defect

If you suspect an acyanotic congenital heart disease, which two conditions should you consider?

Maladie de Roger

What is the specific name of the murmur associated with a VSD?

A very loud murmur

What is unique about the intensity of a very small VSD?

Left to right

In which direction does blood naturally shunt through a VSD during systole?

Right ventricle

Which heart chamber is most affected in a VSD?

Holosystolic

What type of murmur is typically heard in a VSD?

Right ventricular diseases

Pediatric cardiologists are described as experts in which type of diseases?

Left ventricular diseases

Adult cardiologists usually deal with which type of heart diseases?

A hole between the right atrium and left atrium

What is an atrial septal defect?

Fixed split S2

What is the hallmark heart sound finding in an ASD?

Equalization of pressure between chambers prevents valves from separating during closing

Why is the splitting of S2 fixed in ASD?

Patent Ductus Arteriosus or PDA

If you hear a continuous machinery like murmur, what condition should you think of?

Aorta and pulmonary artery

A PDA is an abnormal connection between which two major vessels?

Right ventricle

Which part of the heart is most affected in a PDA?

Continuous gradient in both systole and diastole

Why is the murmur of a PDA continuous?

1/3 of systemic BP or 30/10

What is the typical pressure of pulmonary circulation compared to systemic BP?

Erythema Marginatum

What are pink macules that clear centrally with serpiginous edges seen in Rheumatic Fever?

Subcutaneous nodules

What are the painless small lumps over extensor surfaces of joints in Rheumatic Fever?

Chorea or Sydenhams chorea

What are the abnormal involuntary jerking movements seen in Rheumatic Fever?

Jones Criteria

What is the specific criteria set used to diagnose Rheumatic Fever?

Streptococcal pharyngitis

A typical attack of Rheumatic Fever follows which specific type of infection?

2 to 3 weeks

What is the typical latent period between pharyngitis and a Rheumatic Fever attack?

4 and 15 years

Rheumatic Fever occurs most frequently in children within which age range?

Past history of rheumatic fever or presence of valvular abnormality

What is the typical history of a patient presenting with Infective Endocarditis?

Janeway lesions

What are macular, blanching, nonpainful lesions on the palms and soles in IE?

Oslers nodes

What are tender papulopustules on the pulp of the finger in IE?

Splinter hemorrhages

What are linear reddish brown lesions in the nail bed seen in IE?

Roths spots

What findings might be seen in the fundoscopy of a patient with IE?

Jane, No Pain

What is the mnemonic for the sensation of Janeway lesions?

Osler, Ouch!

What is the mnemonic for the sensation of Oslers nodes?

Apex of the heart

Where is the mitral area located for auscultation?

Systolic murmur

What type of murmur is mitral regurgitation?

Diastolic murmur or rumble

What type of murmur is mitral stenosis?

4th intercostal space, lower left parasternal border

Where is the tricuspid area located?

Carvallo Sign

What is the term for a tricuspid regurgitation murmur that changes in intensity with respiration?

Louder

Does the Carvallo sign murmur become louder or quieter when the patient inhales?

Negative pressure facilitates venous return

Why does inhalation increase the intensity of right sided murmurs?

2nd intercostal space

Where is the aortic area located?

Neck

Where does the murmur of aortic stenosis typically radiate?

Crescendo decrescendo or diamond shaped

How is the systolic murmur of aortic stenosis described?

Diastolic

What type of murmur is aortic regurgitation?

Modified Dukes Criteria

What criteria set is used to diagnose Infective Endocarditis?

Turbulent flow

What mechanical factor allows bacteria to lodge in valves with regurgitation or stenosis?

Definitive IE

Which diagnostic category requires 2 major criteria or 1 major and 3 minor or 5 minor?

Possible IE

Which diagnostic category requires 1 major and 1 minor or 3 minor criteria?

Microorganisms demonstrated by culture or histology

What is the pathologic criteria for definitive IE?

Positive blood culture and Evidence of endocardial involvement

What are the two primary Major Criteria categories in Duke's?

Viridans streptococci, S. gallolyticus, S. aureus, HACEK group

Name typical microorganisms consistent with IE in Duke's criteria.

Two separate blood cultures

Typical microorganisms must be found in how many cultures to be a major criterion?

More than 12 hours apart

To be major criteria, 2 positive blood samples must be drawn how far apart?

Coxiella burnetii

A single positive blood culture for which organism is a major Duke's criterion?

Transesophageal echocardiography or TEE

What imaging is recommended for patients with prosthetic valves or complicated IE?

Transthoracic echocardiography or TTE

What is the first imaging test used in most patients suspected of IE?

Oscillating intracardiac mass, Abscess, or New partial dehiscence of prosthetic valve

Name three echo findings positive for IE.

New valvular regurgitation

What clinical change in a murmur is considered a major Duke criterion?

IV drug use and Rheumatic heart disease

Name two predisposing conditions listed under Duke's minor criteria.

Greater than 38 degrees Celsius

What temperature constitutes a fever in Duke's minor criteria?

Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, Janeway lesions

Name four examples of vascular phenomena in IE.

Glomerulonephritis, Oslers nodes, Roth spots, Rheumatoid factor

Name four examples of immunologic phenomena in IE.

Duke's criteria is for IE while Jones is for Rheumatic Fever

How do you differentiate the use of Duke's and Jones criteria?

Pericarditis

If chest pain is aggravated by lying down and relieved by sitting up, what should you think of?