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Flashcards by ecmarchese, updated more than 1 year ago
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Created by ecmarchese
about 10 years ago
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| Question | Answer |
| An inflammation of the lining of the heart. | Endocarditis |
| Can endocarditis effect the lining of the heart and vessels? | Yes |
| Where is endocarditis generally confined to? | External lining of the valve |
| An invasion of microorganism a | Endocarditis |
| What is an example of infective endocarditis? | Staphylococcus aureus |
| What are some other sites that primary infection can occur? | Dental work, trauma, surgery, IV drug abuse |
| A _______ is the classic manifestation of endocarditis | Vegetation |
| What are vegetations generally attracted to? | A pre existing valve abnormality. |
| What are some pre existing valve abnormalities that a vegetation can occur? | Prosthetic valve, bicuspid AOV, MVP, VSD |
| The majority of organisms attach to the __________ | Flow side of the valve |
| Where are the flow sides on the atrioventricular and semilunar side? | Atrioventricular- atrial side, semilunar - ventricular side |
| This is a highly virulent with a sudden onset with rapid deconstruction of cardiac tissue. | Acute endocarditis |
| What does acute endocarditis present as? | Skin and mucus membranes (boils and internal abscesses) |
| What is the problem with acute endocarditis? | These pathogens eat away at the valves |
| This is a subtle presentation that is sub clinical for as long as 8 weeks with invasion of abnormal valves. | Sub acute endocarditis |
| This infection is found in the respiratory tract, enters through blood stream to attack, and is caused by streptococcus viroid ants | Sub acute endocarditis |
| What are the sign and symptoms of endocarditis? | FUO, janeway lesions, positive blood cultures, new heart murmur, night sweats, tachycardia, joint pain |
| Small painless red-blue spots on palms of hands or feet. | Janeway lesions |
| Endocarditis must be what size before it is detectable? | Greater than 3mm |
| What are the 2D findings of endocarditis? | Thickened, shaggy, swinging, greater than 3mm in size, structural or hemodynamics changes |
| What is the best modality to see endocarditis in 2D? | TEE |
| Is the LV function normal when you have endocarditis? | Normal due to hyper dynamic due to volume overload |
| How do you measure the size of vegetations? | Use calipers to measure all four sizes, use plain entry to trace the structure |
| How do fresh vegetations appear? | Localized with soft reflectance |
| How do old vegetations appear? | Dense and bright |
| What will you see in m-mode with endocarditis? | Oscillations, hyper dynamic LV function, AOV opens early and the MV closes early |
| Severe acute AI from vegetations could cause LV end diastolic pressure to exceed the aorta causing? | AOV opening early, MV closes early |
| What are you looking for in Doppler with endocarditis? | Stenosis, regurgitation |
| What do you utilize color flow to evaluate for? | Turbulent flow through infected valves, regurgitation, with abscess check to see flow through and around the abscess |
| What are some complications of endocarditis? | Valve regurgitation, embolization, CHF, cardiac muscle or valve ring abscess, peripheral abscess formation due to embolization |
| What are the treatments for endocarditis? | Prevention ( endocarditis prophylaxis) and valve repair or replacement |
| Does a negative echo/ Doppler study exclude the diagnosis of endocarditis? | No |
| What are some etiology of cardiac tumors? | Primary- benign or malignant, metastatic, thrombus formation. |
| Are a majority of primary cardiac tumors benign? | Yes 70-80% |
| This is the most common benign tumor found in adults, and it is 80% of all cardiac tumors | Myxoma |
| Myxomas generally range from? | 2-8 cm |
| What does a Myxomas look like? | Pedunculated and attached to the IAS, soft, gray, lobulated, may drop into MV during diastole and mimic MS and create MR |
| What do you evaluate for when you find a Myxoma? | Evaluate movement and size, and measure the size by planimetry. |
| What are the signs and symptoms of a Myxoma? | CP, dyspnea, Orthopnea, syncope, fever, chills, rash, Raynaud's phenomenon |
| What are the complications of Myxomas? | Embolization, infected Myxoma, anemia, arthralgia, complications of MS/ MR, sudden death |
| Why might a person suddenly die when they have a Myxoma? | It can mess up the conduction system causing you to go into a fib |
| What are the treatments for a Myxoma? | Surgical removal, and follow up studies to see for reoccurrence (rare) |
| What is the second most common benign tumor? | Papillary fibroelastoma (papilloma) |
| What is the most common valvular tumor? | Papillary fibroelastoma |
| With a papillary fibroelastoma, what is effected in adults? Children? | Adults- AOV and MV are usually involved, children- TV is most common location. |
| What is the size of a papillary fibroelastoma? | rarely exceeds 1cm |
| What does a papillary fibroelastoma look like? | Dense mobile mass looks like chordae, and has a wart like appearance |
| What are the signs and symptoms of papilloma? | Asmptomatic, and associated with dyspnea, CP, cyanosis, emboli, CVA, TIA, CHF, sudden death |
| What are the treatments for papillomas? | Anticoagulation, surgical excision, valve repair |
| How is diagnosis of papilloma generally diagnosed? | Biopsy after surgical removal |
| A well encapsulated tumor that is composed of mature fat cells. | Lipoma |
| A lipoma is generally ______ in size and associated with ___________? | Larger in size, pericardial effusion |
| Where are lipomas generally located? | Most commonly seen on IAS as part of lipoma thus (dumbbell shape) |
| What is the treatment for a lipoma? | Surgical removal |
| This is a bulky tumor that is frequently embedded in the myocardial wall of the ventricles or IVS | Fibroma |
| When does a fibroma generally present? | Childhood |
| What are some complications of a fibroma? | Dysthymia, LVOTO, CHF, sudden death |
| What are the treatments for a fibroma? | Surgical removal, heart transplant if the child has a large fibroma |
| These are multiple yellowish gray tumors found in the ventricle walls. | Rhabdomyoma |
| What is the most common primary tumor found in children? | Rhabdomyoma |
| What are rhabdomyomas associated with? | Tuberous sclerosis |
| What are tuberous sclerosis? | Tumors found in kidneys and brain, usually symptoms are seizures or mental disorders |
| Are rhabdomyomas seen in adults or children? | Adults 8.5% |
| What are some complications of rhabdomyoma? | Heart failure due to obstruction of conduction pathway, also can cause inter cavity obstruction resulting in death. |
| What is the treatment for rhabdomyoma? | Surgical excision, though sometimes it is impossible to remove. |
| What is the most common primary malignant tumor? | Angiosarcoma |
| Where are angiosarcomas located? | RA |
| What are angiosarcomas associated with and what do they compromise? | Associated with PE/ tamponade and may compromise inflow portions of the ventricles |
| Due to the rapidness of angiosarcoma, what are the treatments? | Tumor excision, radiation, chemo |
| What is the prognosis for a angiosarcoma? | Poor |
| In what ways do metastatic tumors present? | Direct extension, hematogenous (blood), lymphatic spread, venous spread |
| What is a primary malignant tumor? | Angiosarcoma |
| Tumors from the chest initially invades the pericardium. | Direct extension |
| What do most direct extensions present with? | Pericardial effusion |
| What are some examples of direct extension? | Breast, lung, esophageal carcinoma, mediastinal tumor |
| Metastasis through the blood system | Hematogenous spread |
| With a hematogenous spread, what side will be effected? | Both sides |
| What are some examples of hematogenous spread? | Melanoma, breast, lung, GI tract |
| What are the most common cause for cardiac involvement? | Melanoma |
| Metastatic involvement of the mediastinal lymph nodes | Lymphatic spread |
| What are some examples of lymphatic spread? | Lymphoma and leukemia |
| What does stagnated lymph flow create? | Retrograde extension into the heart |
| Tumors invading through the venous system | Venous extension |
| What is the most common venous extension? | Abdominal masses via the ivc |
| What are some examples of venous extension? | Abdominal masses via the IVC, thyroid carcinoma via the SVC, lung carcinoma via the pulmonary veins |
| What does abdominal masses via the IVC invade? | Right atrium |
| What are some examples of abdominal masses via the IVC? | Renal adrenal, hepatocellular and uterine |
| Where does a thyroid carcinoma via the SVC invade? | Right atrium |
| Where does lung carcinoma via the pulmonary veins invade? | Left atrium |
| Pts present with PE/ tamponade, heart failure, dysrythmias, and the prognosis depends on the treatment of primary malignancy. | Metastatic cancer |
| Anywhere within the vicinity of the heart, not in the pericardium, and can push on and distort the heart. | Extra cardiac tumors |
| Generally with extra cardiac tumors which side is distorted? | Right side |
| What are some examples of extra cardiac tumors? | Hematoma, teratoma, pancreatic cysts, diaphragmatic hernia, mediastinal cysts. |
| Metastasizing tumor from the appendix or ileum | carcinoid heart disease |
| What do the tumors of carcinoid heart disease secrete? | Serotonin, bradykinin and they attack the valves |
| What does CHD cause? | TS, TP, PS, PI, right heart failure |
| Echogenic mass with defined margins | Thrombus |
| To diagnose a thrombus, how many views must you see it in? | 2 views |
| Where do thrombus form in the heart? | Areas of akinesis and dyskinesis |
| When you have a anterior MI where would you find the thrombus? | LV apex |
| Which side is more common for thrombus? | Left |
| What are left thrombus generally associated with? | MS, LAE, and afib |
| What is the most common site for thrombus? | Left atrial appendage |
| What are right thrombus generally associated with? | Peripheral embolus, phtn, RV infarct |
| What do you do to evaluate a thrombus in 2D? | Get a higher frequency transducer, ex 2.5 MHz to 5 |
| In 2D what do you evaluate for with a thrombus? | Chamber size and function, wall motion abnormalities, areas of akinesis/ dyskinesia, type of thrombus |
| What are the complications of a thrombus? | CVA, pulmonary embloism |
| What is the treatment for a thrombus? | IV heparin. Coumadin |
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