CARDIO PATH 3

Dilated Cardiomyopathy

A condition characterized by the dilation of the ventricles and systolic dysfunction, leading to heart failure.

Causes of Dilated Cardiomyopathy

Genetic factors, alcohol abuse, viral infections, and pregnancy.

Clinical Findings in Dilated Cardiomyopathy

Symptoms include fatigue, dyspnea, and edema; physical exam may reveal a gallop rhythm, S3 heart sound, and cardiomegaly.

Treatment for Dilated Cardiomyopathy

Includes ACE inhibitors, beta-blockers, diuretics, and, in severe cases, heart transplantation.

Stress Cardiomyopathy

Also known as takotsubo cardiomyopathy, it is a temporary heart condition usually triggered by extreme emotional or physical stress.

Pathological Findings in Dilated Cardiomyopathy

Myocyte hypertrophy, interstitial fibrosis, and ventricular dilation.

Hypertrophic Cardiomyopathy

A condition characterized by unexplained left ventricular hypertrophy, often leading to outflow obstruction.

Causes of Hypertrophic Cardiomyopathy

Genetic mutations typically affecting sarcomere proteins.

Clinical Findings in Hypertrophic Cardiomyopathy

Symptoms include exertional dyspnea, angina, syncope; may detect a systolic ejection murmur.

Treatment for Hypertrophic Cardiomyopathy

Includes beta-blockers, calcium channel blockers, and surgical myomectomy in obstructive cases.

Pathological Findings in Hypertrophic Cardiomyopathy

Myocyte disarray, fibrosis, and hypertrophy.

Hypertrophic Obstructive Cardiomyopathy

A form of hypertrophic cardiomyopathy wherein the hypertrophy causes obstruction of the outflow tract.

Concentric LV Hypertrophy Causes

Hypertension, aortic stenosis, and other forms of pressure overload.

Restrictive/Infiltrative Cardiomyopathy Causes

Amyloidosis, sarcoidosis, and hemochromatosis.

Clinical Findings in Restrictive/Infiltrative Cardiomyopathy

Symptoms include fatigue, dyspnea, and signs of heart failure; physical examination may reveal a stiff or fibrotic ventricle.

Loffler Endocarditis

A type of restrictive cardiomyopathy associated with eosinophilia and endocardial fibrosis.

Heart Failure with Systolic Dysfunction

A condition where the heart has decreased contractility, leading to reduced ejection fraction.

Heart Failure with Diastolic Dysfunction

A condition characterized by impaired ventricular filling, often with normal ejection fraction.

Cor Pulmonale

Right heart failure secondary to lung disease, leading to increased pulmonary artery pressure.

Drugs Decreasing Mortality in HFrEF

ACE inhibitors, ARBs, beta-blockers, and aldosterone antagonists.

Drugs for Symptomatic Relief in HFrEF

Diuretics and digoxin.

Discuss the symptoms of left heart failure and the pathophys behind the symptoms

Include dyspnea, orthopnea, and pulmonary congestion; caused by decreased cardiac output and increased pulmonary venous pressure.

Discuss the symptoms of right heart failure and the pathophys behind the symptoms

Include peripheral edema, ascites, and jugular venous distention; caused by increased systemic venous pressure.

Cardiac Remodeling Mechanisms

Includes neurohormonal activation, pressure overload, and myocardial injury.

What is high output heart failure? Causes?

A condition where the heart pumps an adequate amount of blood but cannot meet the body's increased demands. Causes include anemia, hyperthyroidism, and arteriovenous fistulas.

What is cardiac shock? List the different types.

Severe condition resulting from inadequate perfusion; includes cardiogenic, distributive, hypovolemic, and obstructive shock.

Mechanism of Hypovolemic Shock. Describe the changes in a) CVP b) PCWP c) CO d) SVR e) SVO2

Loss of blood volume leads to decreased cardiac output, elevated systemic vascular resistance, and compensatory mechanisms.

Causes of Hypovolemic Shock

Hemorrhage, dehydration, and severe burns.

Mechanism of Cardiogenic Shock. Describe the changes in a) CVP b) PCWP c) CO d) SVR e) SVO2

Failure of the heart to pump adequately despite normal blood volume, leading to low cardiac output.

Causes of Cardiogenic Shock

Myocardial infarction, myocarditis, and severe heart failure.

Mechanism of Obstructive Shock. Describe the changes in a) CVP b) PCWP c) CO d) SVR e) SVO2

Blockage of blood flow leading to decreased cardiac output; caused by tension pneumothorax or massive pulmonary embolism.

Causes of Obstructive Shock

Pulmonary embolism, cardiac tamponade, and tension pneumothorax.

Mechanism of Distributive Shock. Describe the changes in a) CVP b) PCWP c) CO d) SVR e) SVO2

Widespread vasodilation leading to relative hypovolemia; low vascular resistance despite normal or increased cardiac output.

Causes of Distributive Shock

Septic shock, anaphylaxis, and neurogenic shock.

What is cardiac tamponade? Treatment?

Accumulation of fluid in the pericardial space leading to restricted heart filling; treatment includes pericardiocentesis.

Clinical Findings in Cardiac Tamponade

Pulsus paradoxus, muffled heart sounds, and jugular venous distension.

Pulsus Paradoxus. Associated conditions?

A decrease in blood pressure during inspiration more than 10 mmHg; associated with cardiac tamponade and severe asthma.

Infective Endocarditis

Infection of the heart valves or endocardium; often caused by bacteria.

Acute vs Subacute Infective Endocarditis

Acute is rapidly progressive; subacute is insidious and often occurs in patients with preexisting heart conditions.

Presentation of Infective Endocarditis

Fever, heart murmurs, petechiae, and embolic phenomena.

Vascular Phenomena in Infective Endocarditis

Emboli to peripheral organs, Janeway lesions, and petechiae.

Immunologic Phenomena in Infective Endocarditis

Osler nodes, glomerulonephritis, and rheumatoid factor.

Give the common organisms implicated in infective endocarditis and their common associations

Streptococcus viridans, Staphylococcus aureus, and Enterococcus.

Common Sites for Infective Endocarditis

Mitral and aortic valves.

Diagnosis of Infective Endocarditis

Blood cultures, echocardiography, and clinical criteria.

Nonbacterial Thrombotic Endocarditis. Associated conditions?

A condition often associated with malignancy, leading to sterile vegetations on valves.

Rheumatic Fever. Treatment?

An inflammatory disease that can develop after streptococcal throat infection; treatment includes antibiotics and anti-inflammatories.

Common Sites for Rheumatic Fever

Mitral and aortic valves.

JONES Criteria

Criteria for diagnosing rheumatic fever: Joint involvement, Carditis, Nodules, Erythema marginatum, and Sydenham's chorea.

Pathologic Findings in Rheumatic Fever

Aschoff bodies, fibrinous pericarditis, and valve fibrosis.

Hypersensitivity Reaction in Rheumatic Fever

Type II hypersensitivity against streptococcal antigens leading to autoimmune response.

What is syphilitic heart disease? Complications?

Syphilitic heart disease is a condition resulting from tertiary syphilis, characterized by aortitis, aortic regurgitation, and coronary artery involvement. It can lead to heart failure, aneurysm formation, and ischemic heart disease.

Pathological Findings in Syphilitic Heart Disease

Aortitis with fibrous tissue proliferation and vasculitis.

Acute Pericarditis Presentation. ECG findings?

Pleuritic chest pain, fever, and pericardial friction rub; ECG shows ST elevation.

What are some causes of acute pericarditis? Complications?

Acute pericarditis can be caused by viral infections, bacterial infections, autoimmune diseases, or post-myocardial infarction. Complications may include cardiac tamponade, constrictive pericarditis, and recurrent pericarditis.

Examination Findings in Acute Pericarditis. Treatment?

Friction rub, decreased heart sounds, and possible signs of heart failure; treatment includes NSAIDs.

Myocarditis. Clinical presentation?

Inflammation of the myocardium, leading to chest pain and heart failure symptoms.

Causes of Myocarditis

Viral infections (e.g., Coxsackievirus), autoimmune diseases, and toxic drug effects.

Complications of Myocarditis

Heart failure, arrhythmias, and sudden cardiac death.

Most Common Cardiac Tumor

Metastasis

Myxoma

A benign tumor usually found in the left atrium; may lead to obstructive symptoms.

Cytokine Produced by Myxomas

Interleukin-6 (IL-6).

What is the clinical presentation of a myxoma? Possible examination finding?

Symptoms of obstruction or systemic emboli; may present with a 'tumor plop' on auscultation.

Histological Findings of a Myxoma

Gelatinous stroma, abundant blood vessels, and myxoid changes.

Rhabdomyoma

A benign pediatric cardiac tumor often associated with tuberous sclerosis.

Histological Findings of Rhabdomyoma

Spider cells and myocyte hypertrophy.

Outline the physiology behind the Kussmaul sign

Paradoxical rise in jugular venous pressure during inspiration, indicative of impaired filling of the right ventricle.

Conditions Associated with Kussmaul Sign

Restrictive cardiomyopathy, cardiac tamponade, and pericarditis.

Hereditary Hemorrhagic Telangiectasia

A genetic disorder characterized by abnormal blood vessel formation, leading to bleeding and telangiectasias.

Clinical Findings in Hereditary Hemorrhagic Telangiectasia

Nasal bleeds, mucosal bleeding, and skin telangiectasia.