Cardio minia2.

jdlevenson's version from 2015-06-21 02:57


Question Answer
Rheumatoid disease happens as a result ofBacterial and human epitope homology; particularly with human cardiac, CNS and cutaneous tissue
Left sternal border with patient leaning forward and at end expiration AR will be loudest there.
Early diastolic high pitched and blowing descrescendo murmurAR
Squatting has what effectIncreases SVR and increases preload/ venous return
Aortic regurg, what adaptation maintains forward left ventricular stroke volume?Increase in left ventricular preload, in association with eccentric left ventricular hypertrophy. As well as an acute, but not sustained, increase in HR.
Water-hammer pulses (bounding femoral and carotid pulses with quick collapse) are result ofLarge pulse pressure*. Seen in AR. May also see head bobbing /de muret’s sign from transfer of momentum
Pulsus tardus and parvusAS
Systolic vibrations or carotid thrillAS
AR has small or large stroke volumeLARGE
Small sterile non-invasive fibrinous vegetations along lines of closure of cardiac valve cuspsNon-bacterial thrombotic endocarditis/ NBTE. Bland thrombus without any accompanying inflammation or valvular damage. Usually from hypercoagulable state.
NBTE are a/wVisceral cancers such as mucinous adenocarcinomas of the pancreas and adenocarcinomas of the lung, perhaps from circulating mucin.
Marantinc endocarditisSame as non-bacetrial thrombotic endocarditis but only used when it is associated with disseminated cancer such as pancreatic or lugn


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Varicose veins; valves in superficial, perforating and deep veins prevent backflow from deep to superficial but when valves incompetent, retrograde flow into superficial veins can occur leading to venous htn, with superficial veins dilating and not moving blood out as well. Can cause...Stasis dermatitis – erythema and scaling with progressive dermal fibrosis and hyperpigmentation.
Varicose veins results afterDVT, pregnancy or by genetic predisposition
DVT blood findingsRespiratory ALKALOSIS since hypoxemia stimulates respiratory drive and thus hyperventilation
A perfusion defect that is not anatomicallym matched by a ventilation defectSpecific for PE
A ventilation defect anatomically matched by a perfusion defect (matched defect)Lung collapse or consolidation
DVT symptomsPleuritic chest pain, SOB, tachycardia, tachyapnea, hypotension
PE diagonsosiPulmonary angiograpy -> CT angiography -> V/Q scan
Paradoxical embolism happens in setting of itnracardiac or intrapulmonary shunt, usually patent foramen ovale, ASD or VSD or large pulmonary AV malformation. Even though these shunts are usually Left to Righttransient reversal of the shunt duringp periods of elevated right sided pressure can cause paradoxical embolism


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Wide splitting of SI accentuated by inspirationDelayed closure of Tricuspid valve; RBBB or TS


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Vegetations associated with bacterial endocarditis represent ?Fibrin and platelet deposition at a site of colonization
Key predisposing insult to endocarditisUnderlying host endothelial damage, even minor
45 year old male complaining of fatigue and exertional dyspnea after tooth extractionS. Viridans -> most common cause of subacute bacterial endocarditis following dental work; most frequently infects those with preexisting valv abnormality such as from CHD or ARF
Strep Viridans produce dextrans from glucose which helpsColonize host surfaces suc has dental enamel and heart valves. Subacute BE usually in patients with preexisting cardiac valvular defects. May also cause deep wound infections, abdominal abscesses and septicemia.
Bacteremia or endocarditis caused by S. Bovis25% chance of colon cancer
S. Bovis is what group strepGroup D
S. Bovis do or do not occur in patients who preexisting valvular abnormalityDo not. But do cause subacute. Role with subacute bacterial endocarditis unclear. All patients with S. Bovis should be evaluated for GI malignancy.
Right sided endocarditisStaph aureus; drug user (or surgical I and D of an abscess or infected IV catheters such as central lines and via hematogenous spread)
S. Aureus can do what to heartSettle on leaflets and cause perforations in valves, rupture the chordae tendoneae, send septic emboli to lung or to brain depending on side
S. Aureus can invade normal endothelium due toExpression of multiple surface adhesins -> following binding, tissue factor expression results in PLT and fibrin deposition and formation of vegtations
Culture negative endocarditis, HACEK and ...Coxiella, Bartonella, Mycoplasma, Histoplasma and Chlamydia. Fever fatigue malaise + mitral valve vegetations.
Non-bacterial wart lke vegetations on both side of valve with or without thickeningLibman-Sacks endocarditis. Typically asymptomatic but may lead to valvular insufficiency or embolism.
Prosthetic valvesS. Epidermidis is most common cause of infective endocarditis
Prosthetic jointsS. Epidermidis is most common cause of septic arthritis
Staph Epidermidis vs Staph SaproStaph Sapro is novobiocin resistant.
IV drug users will have right heart/ tricuspid valve infective endocarditis, which may lead to...Septic embolization to distal pulmonary artery and pulmonary infarction. Hemorrhagic infarcts.
IVDU, think S. Aureus as cause of infective endocarditis, and then think #2 isPseudomonas Aeruginosa.
Catalase positive, coagulase negative Staph species are a major cause of infections in patients with in-dwelling catheters or implanted grafts becauseProduce a polysac slime facilitating prosthetic device adherence. Remember, these are part of normal skin flora.
Staph epidermidis and the like can do what to heartIndolent endocarditis, intracardiac abscess, prosthetic valve dehiscence, and septic embolization
Staph epidermidis and other catalase positive coagulase negative empiric treatmentVANCOMYCIN. And then if found to be sensitive to methicillin, switch to naficillin.
Gram positive cocci, catalase negative without hemolysis GROW IN BILE and NACL, PYR positiveEnterococci (IE after GU procedures; UTI; wound)
Gram positive cocci, catalase negative without/ gamma hemolysis GROW IN BILE but NOT NACL, PYR negativeStrep Bovis (bacteremia; IE a/w colonic cancer)
Enterococcal endocarditis, 30% of nosocomial endocarditis, usually inElderly men who have undergone manipulation of areas colonized by this organism such as cytosocopy*** (GU) but also maybe GI (colonoscopy) or obstetric procedures.
E. Faecium is less common butMore pathogenic. Vanco resistant.
Enterococcus is normal flora incolon and urogenital area.