3.1.1 Infectious and Valvular Heart Disease Flashcards

1
Q

Differentiate b/t Osler’s nodes and Janeway Lesions, both of which are associated with embolic complications of infectious endocarditis?

A

Osler’s nodes - tender, red, raised punctate lesions of the hands and feet (painful - Ouch, Ouch, Osler)

Janeway lesions - painless hemorrhagic raised areas on the palms and soles

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2
Q

What is this and what is it caused by?

(hint: bacterial culture is negative)

A

Non-bacterial thrombotic endocarditis

Caused by pro-coagulatory state like pregnancy

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3
Q

What is this an image of? When is the typical onset of this condition?

A

Calcific Aortic Stenosis

Occurs in late 50s to early 70s

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4
Q

How can infective endocarditis lead to this?

A

Septic emboli leading to vascular occlusion

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5
Q

What is valvular insufficiency (regurg)?

A

Failure of a valve to close completely, thereby allowing reverse flow

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6
Q

What are some risk factors for endocarditis?

A

Rheumatic heart dz, small VSD, PDA, degerative calcific valvular stenoses, bicuspid aortic valve, artificial valves, drug abuse

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7
Q

Rheumatic fever results in fibrinous vegetation. This causes what type of appearance?

A
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8
Q

What is this?

A

Calcific stenosis of the mitral valve

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9
Q

What is this?

When might this person require surgical intervention?

A

Calcific stenosis of congenitally bicuspid aorta valve (most frequent congenital CV malformation in humans)

Typically needs replaced around 50, which is when they’ll become symptomatic

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10
Q

What condition to a click-like murmur?

A

Mitral valve prolapse

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11
Q

What are the fastidious organisms that can cause endocarditis?

A

HACEK group

Hemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

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12
Q

What are two unique features found in histologic slides of Rheumatic Fever?

A

Aschoff bodies: foci of chronic inflammation

Anitschow Cells: histiocytes w/ abundant basophilic cytoplasm w/ slender, wavy nuclei

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13
Q

What are the pathologic criteria for infective endocarditis?

A
  1. Microorganisms demonstrated by blood culture or septic embolus
  2. Active endocarditis
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14
Q

What is the most common bacterial cause of sub-acute bacterial endocarditis (SBE)?

A

Streptococcus Viridans

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15
Q

What are the two types of valvular disorders?

A

Stenosis and Insufficiency (regurgitation)

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16
Q

What is Libman-Sack endocarditis associated with?

A

SLE

17
Q

What are the major JONES criteria for acute rheumatic fever?

A

J - Joints (migratory polyarthritis (knee))

O - Heart, pancarditis

N - Nodules - subcutaneous

E - Erythema marginatum

S - Sydenham’s Chorea

18
Q
A
19
Q

What is the most commonly affected valve?

A

Aortic valve

20
Q

Rheumatic fever can have what effects on the mitral valve leaflets? chordae tendinae?

A

Mitral valve leaflets: Thickening and fusion

Chordae tendinae: shortening, thickening, and fusion

21
Q

What is the prevalence of mitral valve prolapse? What is its typical clinical presentation?

A

20% of women; usually asymptomatic but on rare occasion can lead to sudden death

22
Q

What are some major and minor clinical criteria in identifying infective endocarditis?

A
23
Q

What condition does this illustrate? What does the blood tissue represent?

A

Mitral valve prolapse

Myxomatous degeneration

24
Q

What do the terms isolated and combined meaned in terms of valvular disorders?

A

Isolated: 1 valve

Combined: > 1 valve

25
Q

What process causes the body to attack the valves (mitral > aortic) rather than the streptococcus? What are some of the bacterial Ag’s that the body might try to be targeting?

A

Molecular mimicry

Streptococcal M proteins (streptolysin O and DNAseB)

26
Q

What the terms mixed and pure mean in relation to valvular disorders?

A

Pure: only stenosis or only insufficiency

Mixed: Stenosis w/ regurgitation

27
Q

Describe the virulence of Staph Aureus

A

High virulence. Leading cause of acute infectious endocarditis

28
Q

What is this?

A

Infective endocarditis

29
Q

What are some common contaminants of blood cultures?

A

Coag-neg staphylococcus, Bacillus spp, Corynebacterium spp, Propionibacterium spp

30
Q

What disease preferentially affects the mitral valve?

A

Rheumatic Fever

31
Q

If a woman is diagnosed with a mitral valve prolapse, what is different about the approach to dental procedures or GI surgery?

A

Anti-microbial prophylaxis (These procedures are notorious for increasing blood borne microbes)

32
Q

What is valvular stenosis?

A

Failure of a valve to open completely, thereby impeding forward flow

33
Q

What are the two broad categories of endocarditis?

A

Acute and sub-acute infectious endocarditis (SABE)