2nd Exam: Pathology of Endocarditis

Question 1

When talking about endocarditis we are most often talking about:

Answer 1

disease of the valves

Question 2

Indicate endocarditis in slides:

Answer 2

Fibrin, PMNs, bacteria (not NBTE, right? More lymphos)

Question 3

Surgical specimen of NBTE:

Answer 3

incompetent valves, leaflets thickened, fibrotic, covered w sterile fibrinous vegetations

Question 4

TF? All forms of endocarditis involved inflammation of the endocardium.

Answer 4

F. NBTE does not

Question 5

How to id splenic infarct:

Answer 5

wedge shaped palor

Question 6

NBTE leads to:

Answer 6

hypercoaguability and abnormal clot formation

Question 7

Found in area of splenic infarct:

Answer 7

debris, dead tissue

Question 8

Gross appearance of spleen w infarct:

Answer 8

Discreet area of coagulation necrosis

Question 9

Infective endocarditis is characterized by:

Answer 9

microbial invasion of heart valves or mural myocardium

Question 10

characteristic feature of endocardidits:

Answer 10

vegetations

Question 11

Ex’s of vegetations:

Answer 11

necrotic debris, microorganisms, fibrin, inflammatory cells

Question 12

Causes of infective endocarditis:

Answer 12

usually bacteria, but also fungi, Chlamydia, Coxiella, Bartonella

Question 13

Predisposing factors to infective endocarditis:

Answer 13

degenerative valve disease (older pts), valve lesions at birth, IV drugs, before surgery and prosthetic valve replacement, vascular shunts/ grafts, vascular instrumentation, indwelling lines and catheters, systemic infections, poor oral health, chronic valve disease + dental procedures, neutropenia, immune suppression

Question 14

Ex’s of indwelling lines and catheters:

Answer 14

PADS: pacemakers, angioplasty, dialysis, stents

Question 15

Clinical presentation of infective endocarditis:

Answer 15

elevated ESR and CRP, EKG abnormalities, pos blood culture (10% come back neg, septic emboli, fuo, chills, fatigue, heart murmur, known source of infection, evidence of emboli, pathologic evidence of endocarditis

Question 16

TF? Blood cultures of a pt w IE will come back positive almost all the time.

Answer 16

F. some difficult to be cultured/ sequestered in valve leaflet

Question 17

Main organism that causes IE:

Answer 17

staph a., over 50%, high mortality w sepsis, IV drug users, acute

Question 18

Infective endocarditis via Staph a., effects normal or abnormal valves?

Answer 18

normal

Question 19

This organism is part of the normal flora, but can cause IE:

Answer 19

Strep viridians (and all HACEK?)

Question 20

Strep viridians:

Answer 20

subacute (prolonged course), less virulent than Staph a., damaged valve, normal oral flora,

Question 21

Infective endocarditis via Strep v., effects normal or abnormal valves?

Answer 21

abnormal

Question 22

Organisms that lead to subacute IE:

Answer 22

Strep v., Strep bovis (gallolyticus), HACEK organisms (usually)

Question 23

Strep bovis (gallolyticus):

Answer 23

subacute IE, from GI tract, (ca, polyp IBD)

Question 24

HACEK organisms:

Answer 24

usually subacute IE, about 5%, most commonly oral source

Question 25

List HACEK organisms:

Answer 25

Hemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

Question 26

Vegetations form here with IE:

Answer 26

Valves, esp. mitral and aortic

Question 27

TF? Subacute IE agents have to be more virulent than those that cause acute.

Answer 27

F. vice-versa

Question 28

What causes heart murmur in IE?

Answer 28

valve leaflets covered by plaque, blood flow altered

Question 29

Complications of IE:

Answer 29

Local extension, embolic complications

Question 30

Ex's of local extension of IE:

Answer 30

ring abscess, valve perforation, and insufficienty

Question 31

Ex's of embolic complications of IE:

Answer 31

septic emboli, distant infarcts and abscesses, splinter hemmorhages, Janeway lesions, Osler nodes, conjunctival hemmorhages/ petechiae

Question 32

non-painful, small red or bleeding macular (distinct spots) or nodular lesions on palms or soles, few mm, indicative of infective endocarditis:

Answer 32

Janeway lesion abscess can happen in any organ

Question 33

small areas of bleeding under fingernails or toenails:

Answer 33

splinter hemmorhages

Question 34

osler nodes:

Answer 34

painful, red, raised lesions found on the hands and feet

Question 35

In which organs can abscess form (from septic emboli?)?

Answer 35

any

Question 36

What type of vegetation is there on the aortic valve with IE:

Answer 36

destructive

Question 37

Acute Staph a. IE of aortic valve can lead to:

Answer 37

valve cusp destruction, ring abscess

Question 38

Lesions in valve and myocardium, think:

Answer 38

IE, septic emboli, left sided endocarditis

Question 39

Gives rise to persistent bacteremia in endocarditis:

Answer 39

organisms w/in vegetations

Question 40

What are required for subacute endocarditis:

Answer 40

damaged valve or abnormal endothelium

Question 41

difference between acute and subacute endocarditis:

Answer 41

time frame, not amount of damage

Question 42

Why is it normally hard to get infections in heart?

Answer 42

Normally smooth, insult promotes clot formation and bacteria set up

Question 43

Pathogenic mechs for endocarditis:

Answer 43

bacteremia, predisposition to infection-abnormality of endothelium, virulent microorganism in body, organisms w vegetations = persistent bacteremia

Question 44

NBTE:

Answer 44

row of non-infective vegetations on border of valve leaflets, more lymphos than neutrophils, not inflammation/ wall to wall w cells, bland thrombus loosely attached to valve

Question 45

Are neg blood cultures reliable w NBTE?

Answer 45

no

Question 46

Basic pathological process in heart:

Answer 46

thombosis, NBTE

Question 47

Most malignancies can make you:

Answer 47

hypercoagulable

Question 48

Causes of cadiac valve lesions:

Answer 48

hypercoagulable state, aseptic thrombi on valve

Question 49

Symptoms of IE are similar to:

Answer 49

emboli-infarcts and ischemia

Question 50

How is a spleen lesion related NBTE

Answer 50

Infarct attributed to embolism from valve lesion

Question 51

Causes of systemic emboli:

Answer 51

mural thrombi in heart, IE, NBTE, ath plaque

Question 52

Why is difficult to fight infection in heart?

Answer 52

Does have its own blood supply to get pmns to fight