Inflammatory, neoplastic, and thrombotic disease

Pregunta	Respuesta
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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