Cardiovascular USMLE

Vasculitis characterized by necrotizing inflammation of small and medium vessels of the renal and visceral vessels except for the pulmonary vessels. Has 3 stages 1) acute (necrosis w/ PMNs, mononuclear cells and eosinophils) 2) healing (scarring and continued necrosis) 3) healed (fibrotic scar. Process causes thickening of the vessels wall causing a “node” on palpation. NO Glomerulonephritis. Young Adults. Signs are fever, wt loss, ab pain, melena, and myalgia. Many pts have chronic hep B. Treated w/ cyclophosphamide.

Vasculitis similar to PAN. Associated w/ asthma, allergic rhinitis, peripheral eosinophilia, granulomas, eosinophil infiltration of vessels and perivascular tissue, peripheral neuropathy causing wrist and foot drop. Can cause GI bleeding as well as renal and cardiac symptoms. P-ANCA present in 50% of cases

Autoimmune phenomenon that occurs several wks following an MI. Results in fibrinous pericarditis.

Possible complication of β-hemolytic strep infection. High pressure heart valves affected mitral> aortic>> tricuspid. Associated w/ Aschoff bodies, Antischkow’s cells and elevated ABO titer. Type II hypersensitivity reaction or antibodies to protein M. Pneumonic is FEVERSS
Fever
Erythema marginatum
Valvular damage with mitral> aortic>> tricuspid
ESR ↑
Red Hot Joints (polyarthritis)
Subcutaneous nodules
St. Vitus’ dance (chorea)

Can be either chronic, subacute or acute.
Acute is most likely caused by staph aureus and is characterized by large vegetations that are fragile and break off forming emboli
Subacute is caused by strep viridians and creates smaller vegetations that staph aureus.
Mitral valve is the most commonly affected valve, but tricuspid is affected in IV drug users
Mnemonic FROM JANE
Fever
Roth spots
Osler’s Nodes
Murmur
Janeway lesion: erythematous lesions on the soles and palms
Anemia
Nail-bed hemorrhages (splinter hemorrhage)
Emboli

Characterized by inability of the heart to pump enough blood.
Decreased CO causing increase in RALDO system increasing fluid retention and compounding the problem.
Edematous (heavy) lungs. Hemosiderin laden macrophages. Nutmeg liver.
Resultant right sided failure.
Treated w/ ACE and ARBs and other drugs to decrease fluid.