US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Hx
• 41 y/o Kenyan Male with 3d hx/o wheezing,
low intensity cou...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Physical Exam
• B/P 150/104 P 64 RR 20
• mild wheezing diffusely...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
EKG
• NSR
• LVH with QRS widening and ST segment
strain
• Abnorm...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Tropical Cardiology
Frank Meissner, MD, FACP, FACC, FCCP
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Nutritional Cardiac Diseases
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Protein-Calorie Malnultrition
• Vacuolar degeneration of myofibr...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Beriberi Heart Disease
• Thiamine deficiency 2° ingesting highly...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Beriberi - diagnostic criteria
• Hx/O Thiamine Deficiency
• Excl...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Beriberi- treatment
• Thiamine hydrochloride 100 mg IV QD X 5
da...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Non-infectious
Myocardiopathic Diseases
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Idiopathic Congestive
Cardiomyopathy- Epidemiology
• Worldwide d...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Idiopathic Congestive
Cardiomyopathy- Epidemiology
• Nigeria - 2...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Idiopathic Congestive
Cardiomyopathy- Etiology
• Multifactorial ...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Idiopathic Congestive
Cardiomyopathy- Pathology
• Low output fai...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Idiopathic Congestive
Cardiomyopathy-
Clinical Findings• Fatigue...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Tropical Endomyocardial
Fibrosis- Epidemiology
• Uganda, Kenya, ...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Tropical Endomyocardial
Fibrosis- Epidemiology
• In Uganda - as ...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Tropical Endomyocardial
Fibrosis- Etiology
• Tropical environmen...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Tropical Endomyocardial
Fibrosis- Pathology
• Fibrosis of mural ...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Tropical Endomyocardial
Fibrosis- Pathology
• Valvular regurgita...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Tropical Endomyocardial
Fibrosis- Clinical Findings
• May manife...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Tropical Endomyocardial
Fibrosis- Clinical Findings
• Ascites al...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Tropical Endomyocardial
Fibrosis- Clinical Findings
• Hyperdynam...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Pericardial Disease
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Acute Pericarditis
• Fibrinous
– Friction rub in acute rheumatic...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Acute Pericarditis
• Suppurative
– Common in tropics - most comm...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Rheumatic Fever
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Rheumatic Fever -
Epidemiology
• 0.05% of Strep infections lead ...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Rheumatic Fever- Etiology
• Nonsuppurative immunologic complicat...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Rheumatic Fever- Pathology
• Endocardium, myocardium, pericardiu...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Rheumatic Fever-
Clinical Findings
• 1-4 wks post URI
• Revised ...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Major
• Carditis
• Polyarthritis
• Syndenham’s chorea
• Erythema...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Carditis
• Cardiac enlargement
• Pericardial friction rub
• Mitr...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Minor
• Hx/o previous RF or RVD
• Fever
• Polyarthralgia
• Nonsp...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Rheumatic Fever-
Treatment
• Bed rest
• ASA
• Rheumatic Fever- P...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Infectious
Myocardiopathic
Diseases
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Bacterial
• Diphtheria
• Tuberculosis
• Typhoid Fever
• Psittaco...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Bacterial
• Tetanus
• Tularemia
• Meliodosis
• Legionaires Disea...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Spirochetal
• Syphilis
• Leptospirosis
• Relapsing Fever
• Lyme ...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Rickettsial
• Typhus
• RMSF
• Q Fever
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Mycotic
• Blastomycosis
• Candidiasis
• Aspergillosis
• Histopla...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Protozoal
• Chagas Disease
• African Sleeping Sickness
• Toxopla...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Helminthic
• Trichinosis
• Echinococcosis
• Schistosomiasis
• As...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
Helminthic
• Filarisis
• Paragonimiasis
• Strongylodiasis
• Cyst...
US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb
HIV - A completely Seperate
Lecture!!!!!!
Upcoming SlideShare
Loading in …5
×

Tropical Cardiology

397 views
311 views

Published on

Dated but relevant discussion of Tropical Diseases and their cardiac manifestations.

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
397
On SlideShare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
14
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Tropical Cardiology

  1. 1. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Hx • 41 y/o Kenyan Male with 3d hx/o wheezing, low intensity cough and marked orthopnea • (-) hx/o asthma • (-) hx/o valvular heart disease • ETOH 4 beers/wk • (-) hx/o parasitic infection, fever, or jxt aches/skin rashes
  2. 2. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Physical Exam • B/P 150/104 P 64 RR 20 • mild wheezing diffusely • Nml PMI • Incr JVD (5 cm@45°), nml carotid pulse • Soft s2, nml physiologically split • (+) s4
  3. 3. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb EKG • NSR • LVH with QRS widening and ST segment strain • Abnormal EKG- No comparison EKG available
  4. 4. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Tropical Cardiology Frank Meissner, MD, FACP, FACC, FCCP
  5. 5. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Nutritional Cardiac Diseases
  6. 6. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Protein-Calorie Malnultrition • Vacuolar degeneration of myofibrils • Esp in conducting tissue • Sudden death common, possibly from arrythmia • During recovery findings of CHF often seen • Malnourished children sensitive to digoxin, use diuretic only
  7. 7. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Beriberi Heart Disease • Thiamine deficiency 2° ingesting highly milled rice as staple food • Also occurs in chronic alcoholism • Peripheral vasodilatation - high output state • Reduced renal blood flow with retention of Na+ & water • Increased blood volume & biventricular failure
  8. 8. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Beriberi - diagnostic criteria • Hx/O Thiamine Deficiency • Exclusion of other causes of heart disease • High output failure • Evidence of peripheral neuritis or pellagra • Rapid response to therapeutic trial of Thiamine
  9. 9. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Beriberi- treatment • Thiamine hydrochloride 100 mg IV QD X 5 days • Oral thiamine 50 mg qd X 1-2 weeks • Bed rest • ± diuretics
  10. 10. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Non-infectious Myocardiopathic Diseases
  11. 11. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Idiopathic Congestive Cardiomyopathy- Epidemiology • Worldwide distribution • High prevalence rates among blacks in tropical/subtropical Africa • Nigeria - 30-40% CV disease 2° idiopathic cardiomyopathy
  12. 12. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Idiopathic Congestive Cardiomyopathy- Epidemiology • Nigeria - 2nd most common cause of cardiac death after RVD • Southern Africa - 60% • Postmortem study of East Africans - most common fatal heart disease
  13. 13. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Idiopathic Congestive Cardiomyopathy- Etiology • Multifactorial disease - ETOH, HTN, Malnutrition, viral myocarditis • West African study 40% had chronic ETOH use + malnutrition • Grp B Coxsackieviruses implicated if febrile illness concurrent with CHF
  14. 14. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Idiopathic Congestive Cardiomyopathy- Pathology • Low output failure • Heart grossly enlarged - 500-600 gms • Trabeculae carneae are smoothed out • Thrombus often seen in apical region • Mitral/tricuspid rings dilated without evidence of intrinsic valvular disease • Often present with 1° or more often 2° HTN
  15. 15. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Idiopathic Congestive Cardiomyopathy- Clinical Findings• Fatigue • Dyspnea • Cardiomegaly • Diffuse Cardiac Impulse • Gallop Rhythm • Murmurs of MR/TR
  16. 16. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Tropical Endomyocardial Fibrosis- Epidemiology • Uganda, Kenya, Zambia (E. Africa); Nigeria, Ghana, Ivory Coast (W. Africa) • Brazil, Columbia, Venezuela, Mexico (S. & Cntrl America) • Kerala & Haryana (India)
  17. 17. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Tropical Endomyocardial Fibrosis- Epidemiology • In Uganda - as common a cause of cardiac failure as RHD • Uganda - seen in 25% of cardiac necropsies • More common in poorer socioeconomic conditions • In endemic areas 50% occur in persons < 15 yrs of age
  18. 18. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Tropical Endomyocardial Fibrosis- Etiology • Tropical environment • Familial occurrence • Circulating autoimmune heart antibodies • Deposition of immune complexes in heart • Elevated malaria antibody titers • Tropical spleenomegaly
  19. 19. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Tropical Endomyocardial Fibrosis- Pathology • Fibrosis of mural endocardium • Thrombus deposition followed by fibrotic organization • Early in disease embolization may occur • Usual extends to the mitral and tricuspid valve apparatus
  20. 20. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Tropical Endomyocardial Fibrosis- Pathology • Valvular regurgitation can often occur • Restriction of cardiac filling/cardiac output • R-ventricle infundibulum hypertrophied and dilated • Severe R-sided failure symptoms can be seen (ascites/hepatomegaly) • L-ventricular involvement results in MR & PAH
  21. 21. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Tropical Endomyocardial Fibrosis- Clinical Findings • May manifest in first several months in life • Usually recognized in advanced stages • Symptoms advance rapidly • Process is usually biventricular • High venous pressure causes exopthalmos, periorbital facial edema, jaundice
  22. 22. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Tropical Endomyocardial Fibrosis- Clinical Findings • Ascites almost always seen, but peripheral edema rare • Pericarditis present approx 40% cases - aggravates restrictive cardiomyopathy • Peripheral cyanosis and clubbing common 2° low cardiac output • Cachexia, protein-losing enteropathy, cardiac cirrhosis with hepatic failure - terminal events
  23. 23. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Tropical Endomyocardial Fibrosis- Clinical Findings • Hyperdynamic RV outflow - L upper parasternum • Murmur of TR + R-sided S3 • Early peaking systolic MR murmur • Late opening snap (MV) + L-sided S3 often heard • Early peaking systolic MR murmur + opening snap unique to LV endomyocardial fibrosis
  24. 24. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Pericardial Disease
  25. 25. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Acute Pericarditis • Fibrinous – Friction rub in acute rheumatic pericarditis – Viral pericarditis - grp B coxsackie virus • Serous – Childhood/adult pericardial TB – Endemic areas for endomyocardial fibrosis, childhood effusion implys this Dx
  26. 26. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Acute Pericarditis • Suppurative – Common in tropics - most commonly S. pneumoniae 2° pneumonia or S. aureus 2° osteo – Syndrome of cough + dyspnea + toxemia + friction rub + increasing heart size – Mortality > 35% even with prompt Dx/Rx • Amebic Pericarditis – Rare complication of liver abscess – Rupture into pericardial sac – “Anchovy paste” pus
  27. 27. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Rheumatic Fever
  28. 28. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Rheumatic Fever - Epidemiology • 0.05% of Strep infections lead to RF in developed world • 0.3 - 3% Strep infections lead to RF in third world
  29. 29. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Rheumatic Fever- Etiology • Nonsuppurative immunologic complication of ß-hemolytic Strep • Only URI give rise to RF, unlike, GN 2° skin or URI infections
  30. 30. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Rheumatic Fever- Pathology • Endocardium, myocardium, pericardium, synovial joint linings, lungs, or pleura • Characteristiclesion is perivascular granulomatous reaction/vasculitis • MV involved 75-80% cases • AoV involved 30% • TV &/or PV < 5% cases • Healing complete or progressive valvular disease over years and decades
  31. 31. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Rheumatic Fever- Clinical Findings • 1-4 wks post URI • Revised Jones Criteria - 2 major or 1 major & 2 minor criteria
  32. 32. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Major • Carditis • Polyarthritis • Syndenham’s chorea • Erythema marginatum • Subcutaneous nodules
  33. 33. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Carditis • Cardiac enlargement • Pericardial friction rub • Mitral or aortic vavlvular diastolic murmurs • Prolonged PR interval • Changing quality of heart sounds • Tachycardia out of proportion to fever
  34. 34. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Minor • Hx/o previous RF or RVD • Fever • Polyarthralgia • Nonspecific evidence of inflammation (increased sed rate, leukocytosis) • Prolonged P-R interval • Evidence of antecedent ß-hemolytic strp infection, i.e., increased ASO, recent scarlet fever
  35. 35. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Rheumatic Fever- Treatment • Bed rest • ASA • Rheumatic Fever- Prognosis
  36. 36. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Infectious Myocardiopathic Diseases
  37. 37. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Bacterial • Diphtheria • Tuberculosis • Typhoid Fever • Psittacosis • Brucellosis • Chylamdia trachomatis • Actinomycosis
  38. 38. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Bacterial • Tetanus • Tularemia • Meliodosis • Legionaires Disease • Mycoplasma
  39. 39. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Spirochetal • Syphilis • Leptospirosis • Relapsing Fever • Lyme Disease
  40. 40. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Rickettsial • Typhus • RMSF • Q Fever
  41. 41. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Mycotic • Blastomycosis • Candidiasis • Aspergillosis • Histoplasmosis • Sporotrichosis • Coccidoidomycosis • Cryptococcosis • Mucormycosis
  42. 42. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Protozoal • Chagas Disease • African Sleeping Sickness • Toxoplasmosis • Malariae • Leishmaniasis • Balantidiasis • Sarcosporidosis • Amebiasis
  43. 43. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Helminthic • Trichinosis • Echinococcosis • Schistosomiasis • Ascariasis • Heterophydiasis
  44. 44. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb Helminthic • Filarisis • Paragonimiasis • Strongylodiasis • Cysticercosis • Visceral larva Migrans
  45. 45. US Hospital, ZagrebUS Hospital, ZagrebUS Hospital, Zagreb HIV - A completely Seperate Lecture!!!!!!

×