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DIT Cardiology > Car 21 - Cardiomyopathies and Endocarditis > Flashcards

Car 21 - Cardiomyopathies and Endocarditis Flashcards

1
Q

What are the four most common bacteria in infective endocarditis?

A

Staphylococcus aureus. Viridans streptococci. Enterococci. Staphylococcus epidermidis.

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2
Q

What are the three types of cardiomyopathies? Which one is the most common of the three?

A

Dilated. Hypertrophic. Restrictive. Dilated is the most common of them.

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3
Q

What do you see in the histology of hypertrophic cardiomyopathy?

A

Disorganized hypertrophy of the left ventricle; tangled, disordered myosites. It also causes hypertrophy of the intraventricular septum.

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4
Q

What clinical findings do we find in hypertrophic cardiomyopathy?

A

Apical impulse enlarged and diffuse. S4 heart sound due to stiff ventricle. Systolic murmur due to outflow obstruction from the hypertrophied septum pushing the on the mitral valve; louder w/ valsalva (reduces preload that makes worsening of LV outflow tract obstruction) and softer w/ squatting (increasing the afterload decreases obstruction).

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5
Q

What is the most common cause of sudden death among younf healthy athletes in the USA?

A

Hypertrophic cardiomyopathy.

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6
Q

What is the treatment for hypertrophic cardiomyopathy?

A

Beta-blocker. Non-dihydropyridine calcium channel blocker (Verapamil). Restrict physical exertion and avoid volume depletion.

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7
Q

What is restrictive cardiomyopathy?

A

Deposition in myocardium disrupts diastolic function.

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8
Q

What are the causes of restrictive cardiomyopathy?

A

[LEASH] Loeffler syndrome. Endocardial fibroelastosis. Amyloidosis. Sarcoidosis. Hemochromatosis (Usually dilated by can cause restrictive).

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9
Q

What are the clinical findings of Dilated cardiomyopathy?

A

S3 heart sound. Apical impulse is displaced laterally.

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10
Q

What are 7 causes of Dilated Cardiomyopathy?

A

Chronic myocardial ischemia. Hemochromatosis. Doxorubicin, daunorubicin. Chronic cocaine and alcohol use. Wet beri beri (thyamine (B1) deficiency). Chagas disease (Trypanosoma cruzi). Myocarditis from Coxasackie B virus.

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11
Q

What is Myocarditis? What is the most common cause in the US and what do we find in histology?

A

Generalized inflammation of the myocardium (not resulting from ischemia). Most common cause of this in the US is from Coxsackie B virus. Histo: diffuse interstitial infiltrate of lymphocytes, with myocyte necrosis.

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12
Q

What cardiomyopathy would Chronic alcohol use cause?

A

Dilated cardiomyopathy.

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13
Q

What cardiomyopathy would Loeffler’s syndrome?

A

Restrictive cardiomyopathy.

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14
Q

What cardiomyopathy would T.cruzi cause?

A

Dilated cardiomyopathy.

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15
Q

What cardiomyopathy would sarcoidosis cause?

A

Restrictive.

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16
Q

What cardiomyopathy would cocaine cause?

A

Dilated cardiomyopathy.

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17
Q

What cardiomyopathy would cause S3 heart sound?

A

Dilated cardiomyopathy.

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18
Q

What cardiomyopathy would cause an S4 heart sound?

A

Hypertrophic cadiomyopathy.

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19
Q

What cardiomyopathy would cause a systolic murmur?

A

Hypertrophic cardiomyopathy.

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20
Q

What cardiomyopathy would cause sudden death?

A

Hypetrophic cardiomyopathy.

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21
Q

What cardiomyopathy would Beriberi cause?

A

Dilated cardiomyopathy.

22
Q

What cardiomyopathy is hereditary?

A

Hypertrophic cardiomyopathy.

23
Q

What cardiomyopathy would Doxorubicin cause?

A

Dilated Cardiomyopathy.

24
Q

What cardiomyopathy would Coxsackie B virus cause?

A

Dilated cardiomyopathy.

25
Q

What cardiomyopathy would amyloidosis cause?

A

Restrictive cardiomyopathy.

26
Q

What cardiomyopathy would diffuse PMI cause?

A

Hypetrophic cardiomyopathy.

27
Q

What is endocarditis?

A

Inflammation of the endocardium, usually the valves but can involve the septum or the cords. Characterized by lesions (vegetations) on the heart valves.

28
Q

What is the most common site of endocarditis?

A

Mitral valve.

29
Q

What is the most common site of endocarditis in drug users? What does this lead to?

A

Tricuspid is most common in IV drug users. Can lead to pulmonary infarcts.

30
Q

What are Osler nodes?

A

Painful red nodules on fingers and toe pads. Seen in endocarditis.

31
Q

What are Janeway lesions?

A

Painless erythematous macules on palms and soles. Seen in endocarditis.

32
Q

What are Roth spots?

A

Retinal hemorrhages w/ clear central areas. Seen in endocarditis.

33
Q

What are clinical symptoms of endocarditis?

A

Fever, chills, weakness, anorexia. Splinter hemorrhages in fingernails. Osler nodes, Janeway lesions, Roth spots. New regurgitation heart murmur or heart failure. Can cause embolisms or systemic immune reactions (glomerulonephritis, arthritis).

34
Q

How do we diagnose Infective endocarditis?

A

Blood cultures. Echocardiogram (Transesophageal).

35
Q

What would an endocardial infection by Stpahylococcus aureus look like?

A

30% of endocarditis cases. They cause an acute reaction and large vegetations on previously normal valves.

36
Q

What would an endocardial infection by viridans streptococci look like?

A

20-30% of endocarditis cases. They cause a subacute reaction and smaller vegetations on valves that were already abnormal (bicuspid aortic valve, prosthetics). Associated w/ dental procedures.

37
Q

What would an endocardial infection by Enterococcus look like?

A

10% of endocarditis cases. Some strains developing resistance to vancomycin (VRE).

38
Q

What would an endocardial infection by Coagulase-negative staphylococci look like?

A

Staphylococcus epidermidis the most common. Causes 5-10% of endocarditis cases. Associated w/ IV drug users.

39
Q

What is the name of endocardititis with vegetation on the heart valves but blood cultures are negative?

A

It is called culture negative endocarditis. [HACEK] Haemophilus. Actinobacillus. Cardiobacterium. Eikenella. Kingella.

40
Q

What are the complications of endocarditis?

A

Embolic complications. Glomerulonephritis. Structural damage to infected valve. Valvular regurgitation or stenosis. Ruptured chordae tendineae. Suppurative pericarditis.

41
Q

What is Libman-Sacks endocarditis?

A

Sterile vegetations caused by systemic lupus erythematosus. Occur on both sides of the valve simultaneously.

42
Q

What is Marantic endocarditis?

A

Sterile vegetations caused by Metastatic cancer cells. Platelet-fibrin aggregates in patients w/ hypercoagulable states.

43
Q

What are the differences b/w acute and subacte infective endocarditis?

A

Acute: Staphylococcus aureus, rapid onset (days), affects normal valves. Subacute: Viridans streptococci. Insidious onset (weeks to months). Affects previously damaged or congenitally abnormal valves.

44
Q

An IV drug user presents w/ chest pain, dyspnea, tachycardia, and tachypnea. What is the most likely the cause?

A

Right-sided infective endocarditis w/ embolization into pulmonary arteries causing septic pulmonary emboli.

45
Q

A patient in a MVA presents w/ chest pain, dyspnea, tachycardia, and tachypnea. What is the most likely cause?

A

Tension pneumothorax or fat embolus.

46
Q

A post-op patient present w/ chest pain, dyspnea, tachycardia and tachypnea. What is the most likely cause?

A

Pulmonary embolism.

47
Q

A young girl w/ congenital valve disease is given penicillin prophylactically. In the ER, infective endocarditis is diagnosed. What is the next step in her management?

A

Empiric IV vancomycin pending culture results.

48
Q

RFF: Splinter hemorrhages under the fingernails.

A

Infective endocarditis.

49
Q

RFF: Retinal hemorrhages w/ pale centers.

A

Roth spots (infective endocarditis).

50
Q

RFF: Heart valve most commonly involved in infective endocarditis.

A

Mitral valve.

51
Q

RFF: Heart valve most commonly involved in an IV drug user w/ infective endocarditis.

A

Tricuspid valve.

52
Q

What are the symptoms of bacterial endocarditis?

A

[FROM JANE] Fever. Roth spots. Osler nodes. Murmur. Janeway lesions. Anemia. Nail-bed hemorrhage. Emboli.

DIT Cardiology (22 decks)

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