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Questions and Answers

What is the most common cyanotic congenital heart disease?

  • Coarctation of the Aorta
  • Aortic Stenosis
  • Tetralogy of Fallot (correct)
  • Transposition of the Great Arteries

What clinical feature is most associated with Tetralogy of Fallot?

  • Egg on a string appearance on CXR
  • Lower extremity cyanosis
  • Hypoxic tet spells (correct)
  • Upper extremity hypertension

Which distinguishing feature is characteristic of Transposition of the Great Arteries?

  • Ventriculoarterial discordance (correct)
  • Right ventricular outflow tract obstruction
  • Boot shaped heart on CXR
  • Aorta overriding the VSD

What primary effect does coarctation of the aorta have on the body, particularly in adults?

<p>Upper extremity hypertension (A)</p> Signup and view all the answers

What is the primary clinical finding in patients with congenital heart disease characterized by right-to-left shunts?

<p>Cyanosis (A)</p> Signup and view all the answers

Which clinical condition is associated with hypoplasia of the aortic arch proximal to the PDA?

<p>Infantile coarctation of the aorta (C)</p> Signup and view all the answers

Which of the following is a common cause that contributes to congenital heart disease?

<p>Genetic and environmental factors (B)</p> Signup and view all the answers

What kind of cardiac chamber overload occurs due to aortic stenosis?

<p>Left ventricular hypertrophy (B)</p> Signup and view all the answers

What is the phenomenon called that describes greater local damage due to late restoration of blood flow in ischemic tissues?

<p>Reperfusion Injury (D)</p> Signup and view all the answers

Which factor contributes to increased intracellular calcium during reperfusion injury?

<p>Myocyte Hypercontracture (B)</p> Signup and view all the answers

What is considered the best biomarker for acute myocardial infarction?

<p>Cardiac Troponins T and I (TnT, TnI) (B)</p> Signup and view all the answers

Which condition can lead to occlusion of the microvasculature during reperfusion injury?

<p>Leukocyte Aggregation (D)</p> Signup and view all the answers

What is a common clinical manifestation of myocardial infarction?

<p>Chest Pain (A)</p> Signup and view all the answers

What is the expected time frame for CK-MB levels to peak after myocardial infarction?

<p>24 to 48 hours (D)</p> Signup and view all the answers

Which group is more likely to experience silent infarcts?

<p>Patients with diabetes mellitus (D)</p> Signup and view all the answers

What is a potential consequence of a large myocardial infarction?

<p>Cardiogenic Shock (C)</p> Signup and view all the answers

Which type of non-ischemic cardiomyopathy is characterized by progressive cardiac dilation and contractile dysfunction?

<p>Dilated Cardiomyopathy (A)</p> Signup and view all the answers

What is a common symptom of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?

<p>Ventricular Arrhythmias (A)</p> Signup and view all the answers

What percentage of patients with Hypertrophic Cardiomyopathy have the obstructive type?

<p>24% (A)</p> Signup and view all the answers

Which of the following is NOT an etiology of Dilated Cardiomyopathy?

<p>Erectile Dysfunction (A)</p> Signup and view all the answers

What test uses an ultrasound beam to examine the heart's functioning?

<p>Transthoracic Echocardiography (C)</p> Signup and view all the answers

Which of the following is a symptom of Hypertrophic Cardiomyopathy?

<p>Shortness of breath during mild exercise (C)</p> Signup and view all the answers

Which non-ischemic cardiomyopathy involves replacement of normal heart muscle with fatty fibrous tissue?

<p>Arrhythmogenic Right Ventricular Cardiomyopathy (B)</p> Signup and view all the answers

What is a common cause of peripartum cardiomyopathy?

<p>Pregnancy (B)</p> Signup and view all the answers

What is a common source of bacteremia leading to infective endocarditis?

<p>Intravenous drug use (A)</p> Signup and view all the answers

Which heart valves are most commonly affected by infective endocarditis?

<p>Aortic and mitral valves (B)</p> Signup and view all the answers

What clinical feature is most consistently associated with infective endocarditis?

<p>Fever (A)</p> Signup and view all the answers

What is characteristic of the vegetations seen in acute endocarditis?

<p>Friable and bulky (B)</p> Signup and view all the answers

Which of the following statements about subacute endocarditis is true?

<p>It may not exhibit fever in older adults. (A)</p> Signup and view all the answers

What complication may arise from the shedding of emboli in infective endocarditis?

<p>Development of septic infarcts (C)</p> Signup and view all the answers

Which type of tissue is often found at the base of vegetations in subacute endocarditis?

<p>Granulation tissue (A)</p> Signup and view all the answers

What may be present in 90% of patients with left-sided lesions in infective endocarditis?

<p>Heart murmurs (D)</p> Signup and view all the answers

What is one of the clinical features associated with septicemia in untreated infective endocarditis?

<p>Petechial rash (B)</p> Signup and view all the answers

Which statement accurately describes the prognosis of infective endocarditis?

<p>Low-virulence organisms often have high cure rates. (C)</p> Signup and view all the answers

Which type of endocarditis is characterized by sterile thrombi on cardiac valves?

<p>Nonbacterial thrombotic endocarditis (C)</p> Signup and view all the answers

Which organism is associated with the lowest cure rates in infective endocarditis?

<p>Aerobic gram-negative bacilli (C)</p> Signup and view all the answers

What condition is NOT typically associated with nonbacterial thrombotic endocarditis?

<p>Renal failure (D)</p> Signup and view all the answers

What is the typical size of vegetations in nonbacterial thrombotic endocarditis?

<p>1 to 5 mm in diameter (D)</p> Signup and view all the answers

What complication can arise from infective endocarditis due to glomerular trapping?

<p>Hematuria (D)</p> Signup and view all the answers

Which of the following is NOT a common clinical feature of infective endocarditis?

<p>Nausea (A)</p> Signup and view all the answers

What is the primary cause of ischemic heart disease (IHD) in 90-95% of cases?

<p>Atherosclerosis (B)</p> Signup and view all the answers

Which of the following is a characteristic of stable angina?

<p>Triggered by physical or emotional stress (A)</p> Signup and view all the answers

What occurs with prolonged ischemia of myocardial tissue?

<p>Infarct formation (B)</p> Signup and view all the answers

Which syndrome is NOT classified under acute coronary syndrome (ACS)?

<p>Stable angina (C)</p> Signup and view all the answers

What is one effect of reduced nitric oxide in endothelial dysfunction?

<p>Decreased vascular relaxation (A)</p> Signup and view all the answers

What feature is NOT characteristic of vulnerable plaques?

<p>High numbers of smooth muscle cells (C)</p> Signup and view all the answers

Which risk factor is associated with an increased chance of myocardial infarction?

<p>Hypercholesterolemia (B)</p> Signup and view all the answers

What is the earliest detectable feature of myocyte necrosis during myocardial infarction?

<p>Sarcolemmal membrane disruption (D)</p> Signup and view all the answers

Which mechanism can attribute to reduced coronary blood flow besides atheromatous plaques?

<p>Vasospasm (D)</p> Signup and view all the answers

In the gross morphology of myocardial infarction, which artery is most commonly involved?

<p>Left anterior descending artery (A)</p> Signup and view all the answers

What is a defining feature of complicated atherosclerotic lesions?

<p>Thrombosis and fissure formation (B)</p> Signup and view all the answers

What is the function of activated platelets during the formation of a thrombus?

<p>Aggregate by binding to fibrinogen (D)</p> Signup and view all the answers

Which histological feature indicates an increase in chronic ischemic heart disease?

<p>Smooth muscle cell proliferation (B)</p> Signup and view all the answers

What is the role of tissue factor in the process of myocardial infarction?

<p>It activates the coagulation cascade. (C)</p> Signup and view all the answers

Flashcards

Reperfusion Injury

Increased tissue damage after restoring blood flow to ischemic tissue.

Mitochondrial Dysfunction (MI)

Damaged mitochondria let proteins leak in, disrupting their function during ischemia.

Myocyte Hypercontracture

Muscle cell (myocyte) tightening due to calcium build-up and membrane damage, causing cell damage.

Free Radicals in Reperfusion

Molecules produced during reperfusion that damage myocytes (muscle cells) by altering cell structures.

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Cardiac Troponins

Proteins released into the bloodstream when heart muscle cells are damaged, highly specific for MI.

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CK-MB

Heart-specific enzyme released into the blood after a heart attack, aiding diagnosis.

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Myocardial Infarction (MI)

Heart attack: Blockage of blood flow to the heart muscle, leading to cell death.

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Silent Infarcts in MI

Heart attacks that show no symptoms, often found in people with diabetes or older adults.

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Tetralogy of Fallot

A common cyanotic congenital heart defect characterized by four key features: ventricular septal defect, right ventricular outflow tract obstruction, aorta overriding the VSD, and right ventricular hypertrophy.

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Transposition of the Great Arteries (TGA)

A congenital heart defect where the positions of the aorta and pulmonary artery are switched, causing the blood to circulate in two separate non-communicating pathways.

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Obstructive congenital heart lesions

Congenital heart defects causing resistance to blood flow through the heart, leading to pressure overload in the chamber before the obstruction.

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Coarctation of the Aorta (Infant)

Narrowing of the aorta proximal to the ductus arteriosus in infants, often associated with Turner syndrome.

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Coarctation of the Aorta (Adult)

Narrowing of the aorta distal to the arch vessels in adults. Characterized by upper extremity hypertension and lower extremity cyanosis, plus rib notching.

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Right to Left Shunts

Congenital heart defects that allow deoxygenated blood to flow from the right side of the heart to the left side, thus reducing oxygenated blood in the systemic circulation.

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Cyanotic Congenital Heart Disease

Congenital heart defects resulting in bluish discoloration of the skin due to reduced oxygenated blood in the body.

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Congenital Heart Disease (CHD)

Birth defects of the heart's chambers or great vessels, leading to either blood shunting between sides or outflow obstruction.

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Ischemic Heart Disease (IHD)

A condition where the heart doesn't get enough blood flow, often due to narrowed arteries.

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Myocardial Ischemia

A decreased blood supply to the heart muscle.

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Atherosclerosis

Buildup of plaque in the arteries that narrows them and reduces blood flow.

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Angina Pectoris

Chest pain caused by reduced blood flow to the heart muscle.

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Acute Coronary Syndrome (ACS)

A group of conditions where the heart doesn't get enough blood. Severe cases can cause a heart attack.

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Endothelial Dysfunction

Damaged or malfunctioning inner lining of blood vessels.

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Platelet Aggregation

Platelets clump together to form a blood clot.

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Vulnerable Plaque

A plaque with a thin cap that is easily broken causing a blood clot to form.

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Transmural MI

Whole thickness of the heart muscle is affected.

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Subendocardial MI

Inner layer of the heart muscle affected.

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Coronary Artery Occlusion

Blocking of a coronary artery, restricting blood flow to the heart.

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Vasospasm

Spasms or tightening of the coronary arteries.

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Myocyte Necrosis

Death of heart muscle cells.

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Coagulative Necrosis

A specific type of cell death where the tissue proteins are broken down.

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Bacteremia

The presence of bacteria in the bloodstream. This can be caused by various factors like infections, dental procedures, or intravenous drug use, and is a risk factor for endocarditis.

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Endocarditis

Inflammation of the inner lining of the heart, specifically affecting the heart valves. It is usually caused by bacteria entering the bloodstream and attaching to the heart valves.

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Vegetations

Abnormal growths on the heart valves that are characteristic of endocarditis. They contain fibrin, inflammatory cells, and bacteria.

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Aortic and Mitral Valves

The most commonly affected valves in endocarditis. These valves are located on the left side of the heart.

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Ring Abscess

An abscess (collection of pus) that forms within the heart muscle when vegetations erode into the myocardium.

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Emboli

Fragments of vegetations that break off and travel through the bloodstream, potentially lodging in other organs and causing damage.

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Mycotic Aneurysms

Aneurysms (weak areas in arterial walls) caused by bacterial infection of the artery, often resulting from emboli.

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Fever

A common symptom of infective endocarditis, especially in acute cases. However, in subacute cases, fever may be absent or mild.

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Infective Endocarditis

A serious infection of the heart's inner lining (endocardium), often involving the heart valves. It occurs when bacteria or other microbes enter the bloodstream and attach to the heart's inner lining, forming vegetations.

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Microemboli in IE

Tiny blood clots (emboli) formed by bacteria and immune cells in infective endocarditis. They can travel to different parts of the body, causing damage.

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Janeway Lesions

Painless, red spots on the palms or soles of the feet caused by microemboli in infective endocarditis.

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Osler Nodes

Painful, tender nodules on the fingertips caused by microemboli in infective endocarditis.

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Nonbacterial Thrombotic Endocarditis

A condition where non-infectious blood clots (thrombi) form on heart valves. It usually occurs in individuals with a hypercoagulable state.

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NBTE and Hypercoagulability

Nonbacterial thrombotic endocarditis (NBTE) frequently occurs in those with an underlying hypercoagulable state, such as those with chronic disseminated intravascular coagulation, malignancy or hyperestrogenic conditions.

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Marantic Endocarditis

An alternate term for Nonbacterial Thrombotic Endocarditis (NBTE), often associated with general debility or wasting diseases.

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NBTE Vegetations

The blood clots (vegetations) in Nonbacterial Thrombotic Endocarditis (NBTE) are typically small and do not damage the heart valves.

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Dilated Cardiomyopathy (DCM)

A heart condition where the heart chambers enlarge and weaken, making it harder to pump blood efficiently.

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Causes of Dilated Cardiomyopathy

Conditions that can lead to DCM include inflammation of the heart (myocarditis), toxins (cocaine, chemotherapy drugs), muscle disorders (muscular dystrophy), pregnancy complications, alcohol abuse, high blood pressure, and existing heart conditions like valve disease.

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Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

A rare genetic heart condition where the heart muscle in the right ventricle is replaced with fatty tissue, causing irregular heart rhythms and heart failure.

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Symptoms of ARVC

Common symptoms include irregular heartbeats, fluttering in the chest, dizziness or fainting, sudden cardiac death, and signs of heart failure like shortness of breath, fatigue, and swelling in the legs.

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Hypertrophic Cardiomyopathy (HCM)

A condition where the heart muscle thickens abnormally, making it harder for the heart to pump blood effectively.

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Types of HCM

HCM can be obstructive, where the thickened septum blocks blood flow in the left ventricle, or non-obstructive, where the entire ventricle or just a portion thickens.

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Symptoms of HCM

Common symptoms include shortness of breath during exercise, fatigue, chest pain, fainting, and high blood pressure.

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Diagnosis of HCM

HCM is typically diagnosed using echocardiography (ultrasound imaging of the heart), electrocardiogram (ECG), and cardiac MRI.

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Study Notes

Pathology of the Cardiovascular System

  • This presentation outlines the pathology of the heart and blood vessels.

I. Pathology of the Heart

  • Ischemic Heart Disease (IHD): a broad term encompassing several syndromes caused by myocardial ischemia (imbalance between cardiac blood supply and myocardial oxygen/nutritional needs). It accounts for 80-90% of heart disease mortality. Common causes include atherosclerosis (90-95%), vasospasm, thrombosis, stenosis, and inflammatory arteritis.
  • Ischemia: refers to reduction in blood supply to an organ. If ischemia is reversed quickly, there is no permanent damage. Prolonged ischemia can cause necrosis, which is called an infarct.
  • Symptoms (IHD): Symptoms range from asymptomatic with exertion to pain levels increasing with less exertion or even at rest.
  • Syndromes under IHD: Angina Pectoris (reversible), Stable/Typical Angina, Prinzmetal/Variant Angina, Unstable/Crescendo Angina, Myocardial Infarction
  • Myocardial Infarction (MI): Myocardial infarction, where ischemia causes frank cardiac necrosis. Angina pectoris describes chest pain. Chronic IHD with heart failure, and sudden cardiac death (SCD).
  • Acute Coronary Syndrome (ACS): A catastrophic form of IHD. Includes MI, where ischemia causes necrosis and angina pectoris.

II. Pathology of the Blood Vessels

  • Arterial Disorders: This section covers conditions affecting the arteries.
  • Venous Disorders: This section covers conditions affecting the veins.
  • Tumors of Blood Vessels: This section describes tumors that can arise in blood vessels.
  • Vasculitides: This section covers various inflammatory diseases of blood vessels.
  • Functional Vascular Disorders: This section covers various functional disorders
  • Hypertension: Related to blood pressure disorders.

III. Introduction

  • Cardiovascular dysfunction can be attributed to one or more of six principal mechanisms:
    • Pump failure (weak myocardial contraction, inadequate output)
    • Flow obstruction (lesions obstruct blood flow, e.g., atherosclerotic plaque)
    • Regurgitant flow (portion of output flows backward through an incompetent valve)
    • Shunted flow (blood diverted between heart chambers or blood vessels)
    • Disorders of cardiac conduction (automaticity of the pacemakers, conduction defects, or arrhythmias)
    • Rupture of the heart or major vessel.

IV. Ischemic Heart Disease (IHD)

  • Broad term encompassing several syndromes caused by myocardial ischemia, an imbalance between cardiac blood supply (perfusion) and myocardial oxygen/nutritional requirements. A major cause of death in developed countries.

V. Rheumatic Fever & Infective Endocarditis

  • Rheumatic Fever: An inflammatory disease that can damage the heart. It's an immunologic disease, not infectious.

  • Streptococcal Pharyngitis: The cause of rheumatic fever. A throat infection.

  • Molecular Mimicry: Pathogenesis of rheumatic fever where immune cells mistaken body tissues for foreign invaders and an immune response ensues.

  • Infective Endocarditis: A microbial infection of heart valves and mural endocardium, characterized by vegetations.

    • Acute: Commonly caused by S. aureus, common in IV drug users. More pronounced tissue destruction.
    • Subacute: Commonly caused by Viridans Streptococci and HACEK organisms. Seen in previously diseased valves. Less pronounced tissue destruction.

VI. Valvular Heart Disease

  • Stenosis: Incomplete valve opening, impeding forward blood flow.
  • Insufficiency (Regurgitation): Incomplete valve closing, permitting backflow.
  • Aortic Stenosis: Often caused by calcification of normal valves.
  • Aortic Insufficiency: Commonly caused by dilation of the ascending aorta, often secondary to hypertension and aging.
  • Mitral Stenosis: Usually seen in Rheumatic Heart Disease and is relatively common in developed countries.
  • Mitral Insufficiency: Seen in mitral valve prolapse.

VII. Congenital Heart Disease

  • Diseases of heart and great vessels present at birth.
  • Most arise at 3-8 weeks after conception (AOG).
  • Most common genetic cause: Trisomy 21 (Down syndrome).
  • Left-to-right shunts: Blood flows from higher pressure to lower pressure.
  • Right-to-left shunts: Blood flows from lower pressure to higher pressure.
  • Obstructive lesions: A common cause is a defect in the structure of the heart.

VIII. Myocardial Infarction (MI)

  • Death of cardiac muscle due to prolonged ischemia.
  • Loss of contractility: Occurs within 1-2 minutes of severe ischemia onset.

IX. Cardiac Arrhythmias

  • Aberrant rhythms can originate from the SA node or individual myocytes.
  • Myocardial Infarction associated arrhythmias:
  • Tachycardia (fast heart rate)
  • Bradycardia (slow heart rate)
  • Ventricular fibrillation (chaotic depolarization w/o functional contraction)
  • Asystole (no electrical activity)

X. Cardiac Tumors

  • Metastatic Neoplasms: The most common heart malignancy.
  • Primary Neoplasms: Uncommon compared to metastasis. Almost always benign. Common benign ones include myxomas, fibromas, lipomas, papillary fibroelastomas, rhabdomyomas. The most common malignant tumor is angiosarcoma.

XI. Cardiac Transplantation

  • A surgical procedure for patients with end-stage heart failure or severe coronary artery disease when other treatments have failed. Common indications are dilated or ischemic cardiomyopathy, intractable angina, and/or malignant arrhythmias. Contraindications include age more than 65, active systemic infection or disease, active malignancy, history of substance abuse, and/or psychosocial instability.

XII. Pericardial Disease

  • Pericardial effusion: Accumulation of fluid in the pericardium, often with inflammatory conditions.
  • Pericarditis: Inflammation of the pericardium, often secondary to viral infections, MI, or cardiac surgery.
  • Uremia: A systemic disorder, most common systemic cause of pericarditis, with fluid accumulation, and consequent shock. Chronic constrictive pericarditis is a more chronic form, presenting with symptoms similar to restrictive cardiomyopathy.

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