4.2 Rheumatic Heart Disease and Infective Endocarditis Flashcards
Major criteria for rheumatic heart disease (Jones criteria)
- Arthritis
- Chorea
- Erythema marginatum
- Subcutaneous nodules
- Carditis
Minor criteria for rheumatic heart disease
- Arthralgia
- Fever
- Elevated inflammatory markers
Why does rheumatic heart disease impact all heart valves, not just one? Regardless, which are the most commonly affected valves?
Because the strep A antibodies are reactive to all valves, it just happens to be the mitral and aortic valves.
How long after the onset of symptoms in rheumatic valve disease do patients survive without significant interventions?
Not very long
What are the main risks following rheumatic valvular disease?
- Heart failure
- AF/Stroke
- Infective Endocarditis (increased risk)
- Pregnancy issues (warfarin also prevents)
What 2 factors can increase someone’s risk of seeding on heart valves (and thus infective endocarditis)?
- Heart valve replacement
- Immunocompromised state
What causes splinter hemorrhages
Emboli under the nail bed
List some findings that support the diagnosis of infective endocarditis on physical examination
- Fever
- Osler’s Nodes
- Janeway Lesions
- Splinter hemorrhages
- Roth spots
List the 6 minor criteria for infective endocarditis
- Predisposition (valve abnormality)
- Fever > 38°C
- Vascular phenomena
- Elevated CRP (C-reactive protein)
- Immunological phenomena (Osler’s, Roth Spots)
- Blood culture not fitting into major criteria
List the two major criteria for infective endocarditis
- Evidence of endocarditis in blood culture (causative organism)
- Positive echo showing vegetation and valve damage
List some bacteria that can cause infective endocarditis
- Staph. Aureus
- Coagulase-negative staphylococcus
- Enterococcus
Provide a basic outline of the treatment of infective endocarditis
- Antibiotics
- Heart failure management (if needed)
- Surgery (if needed)
What percentage of patients with infective endocarditis will need surgery? What is the mortality rate?
About 50% (!) rate of surgery
20% to 30% mortality rate
What three conditions predispose someone to non-infective endocarditis?
- Autoimmune conditions
- Malignancy
- Hypercoagulable states
Differences between infective and non-infective endocarditis
- Different predisposing factors
- Less likelihood of heart failure and valve dysfunction in non-infective
- Less likely fever in non-infective
- Negative culture in non-infective, positive in infective
