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FA - Cardiovascular > Card - Path (Part 5: Cardiac Infections, Tamponade, & Tumors) > Flashcards

Card - Path (Part 5: Cardiac Infections, Tamponade, & Tumors) Flashcards

Pg. 292-294 in First Aid 2014 Pg. 274-275 in First Aid 2013 Sections include: -Bacterial endocarditis -Rheumatic fever -Acute pericarditis -Cardiac tamponade -Syphilitic heart disease -Cardiac tumors -Kussmaul's sign

1
Q

What is the most common symptom associated with bacterial endocarditis? What are other symptoms associated with endocarditis? What is a way to remember them?

A

(1) Fever; (2) Roth’s spots (round white spots on retina surrounded by hemorrhage) (3) Osler’s nodes (tender raised lesions on finger or toe pads) (4) New murmur (5) Janeway lesions (small, painless, erythematous lesions on palm or sole) (6) Anemia (7) Splinter hemorrhages; bacteria FROM JANE = Fever, Roth’s spots, Osler’s nodes, Murmur, Janeway lesions, Anemia, Nail-bed hemorrhage, Emboli

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2
Q

What is necessary for diagnosis of bacterial endocarditis?

A

Multiple blood cultures

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3
Q

What pathogen causes acute endocarditis? Describe its virulence.

A

S. aureus (high virulence)

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4
Q

What pathogen causes subacute endocarditis? Describe its virulence.

A

Viridans streptococci (low virulence)

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5
Q

What is the onset like in acute versus subacute endocarditis?

A

Rapid onset in acute endocarditis; Gradual onset in subacute endocarditis

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6
Q

What is the major pathological finding in acute endocarditis?

A

Large vegetations on previously normal valves

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7
Q

What is the major pathological finding in subacute endocarditis?

A

Smaller vegetations on congenitally abnormal or diseased valves.

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8
Q

Of what kind of procedures is subacute endocarditis a sequela?

A

Sequala of dental procedures

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9
Q

What are nonbacterial causes of endocarditis? What kind of endocarditis is this called?

A

Endocarditis may also be nonbacterial secondary to malignancy, hypercoagulable state, or lupus; Marantic/thrombotic endocarditis

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10
Q

What pathogen is present in colon cancer?

A

S. bovis

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11
Q

What pathogen is present on prosthetic valves?

A

S. epidermidis

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12
Q

Which valve is most frequently involved in bacterial endocarditis?

A

Mitral valve

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13
Q

With what patient population is tricuspid valve endocarditis associated? What is a way to remember part of this?

A

Tricuspid valve endocarditis is associated with IV drug abuse; don’t TRI DRUGS

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14
Q

With what pathogens is tricuspid valve endocarditis associated?

A

Associated with S. aureus, Pseudomonas, & Candida

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15
Q

What are complications of bacterial endocarditis?

A

(1) Chordae rupture (2) Glomerulonephritis (3) Suppurative pericarditis (4) Emboli

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16
Q

Again, what are the symptoms associated with bacterial endocarditis, and what is a way to remember them?

A

(1) Fever; (2) Roth’s spots (round white spots on retina surrounded by hemorrhage) (3) Osler’s nodes (tender raised lesions on finger or toe pads) (4) New murmur (5) Janeway lesions (small, painless, erythematous lesions on palm or sole) (6) Anemia (7) Splinter hemorrhages; bacteria FROM JANE = Fever, Roth’s spots, Osler’s nodes, Murmur, Janeway lesions, Anemia, Nail-bed hemorrhage, Emboli

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17
Q

Of what is rheumatic fever a consequence?

A

A consequence of pharyngeal infection with group A Beta-hemolytic strepotococci

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18
Q

What causes early deaths in rheumatic fever patients?

A

Myocarditis

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19
Q

What is a major late sequela of rheumatic fever?

A

Rheumatic heart disease

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20
Q

In rheumatic heart disease, what is the order of heart valves according to which are most affected? What is the general basis behind this order?

A

Mitral > Aortic&raquo_space; Tricuspid; High pressure valves affected more

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21
Q

What is an early lesion in rheumatic fever? What is a late lesion in rheumatic fever?

A

Mitral valve regurgitation; Mitral stenosis

22
Q

With what 3 histological/lab findings is rheumatic fever associated? Briefly describe histologic findings.

A

(1) Aschoff bodies (granuloma with giant cells) (2) Anitschkow’s cells (enlarged macrophages with ovoid, wavy, rod-like nucleus) (3) Elevated ASO titers

23
Q

What is the mechanism of rheumatic fever? How does it relate to the infecting bacteria?

A

Immune mediated (type II hypersensitivity); not a direct effect of bacteria. Antibodies to M protein

24
Q

In rheumatic fever, what are antibodies made against, and how does this lead to disease?

A

Antibodies to M protein cross-react with self antigens

25
Q

What are the 7 symptoms/signs associated with rheumatic fever? What is a way to remember this?

A

(1) Fever (2) Erythema marginatum (3) Valvular damage (vegetation and fibrosis) (4) ESR increased (5) Red-hot joints (migratory polyarthritis) (6) Subcutaneous nodules (7) St. Vitus’ dance (Sydenham’s chorea)

26
Q

How does acute pericarditis commonly present?

A

Commonly presents with sharp pain, aggravated by inspiration, and relieved by sitting up & leaving forward

27
Q

What are the cardiovascular findings associated with acute pericarditis presentation?

A

Present with friction rub. ECG changes include widespread ST-segment elevation and/or PR depression

28
Q

What causes acute fibrinous pericarditis?

A

Dressler’s syndrome, uremia, radiation

29
Q

How does acute fibrinous pericarditis present?

A

Presents with loud friction rub

30
Q

What causes acute serous pericarditis?

A

(1) Viral pericarditis (often resolves spontaneously) (2) Noninfectious inflammatory diseases (e.g., rheumatoid arthritis, SLE)

31
Q

What usually causes acute suppurative/purulent pericarditis?

A

Usually caused by bacterial infections (e.g., Pneumococcus, Streptococcus)

32
Q

What kind of pericarditis do viruses typically cause? How it is often resolved?

A

Acute SEROUS pericarditis; Often resolves spontaneously

33
Q

What are the types of acute pericarditis? Which is rare, and why?

A

(1) Fibrinous (2) Serous (3) Suppurative/purulent; Suppurative/purulent (usually caused by bacterial infections - e.g., Pneumococcus, Streptococcus), rare now with antibiotics

34
Q

What is cardiac tamponade? What is its major effect on heart function?

A

Compression of heart by fluid (e.g., blood, effusions) in pericardium; Leading to decreased Cardiac Output (CO)

35
Q

What happens to the chambers of the heart during cardiac tamponade?

A

Equilibration of diastolic pressures in all 4 chambers

36
Q

What are 6 physical exam findings associated with cardiac tamponade? Which of these form a triad, and what is that triad called?

A

(1-3) Beck triad (hypotension, distended neck veins, distant heart sounds) (4) Increased HR (5) Pulsus paradoxus (6) Kussmaul sign

37
Q

What is pulsus paradoxus?

A

Decrease in amplitude of systolic blood pressure by greater than or equal to 10 mmHg during inspiration

38
Q

What are 5 conditions in which pulsus paradoxus is seen?

A

(1) Cardiac tamponade (2) Asthma (3) Obstructive sleep apnea (4) Pericarditis (5) Croup

39
Q

What part of the cardiovascular system does tertiary syphilis disrupt (be specific)? What are the consequences of this disruption?

A

Tertiary syphilis disrupts the vaso vasorum of the aorta with consequent atrophy of the vessel wall and dilation of the aorta and valve ring

40
Q

With what kind of vascular appearance is tertiary syphilis associated? What causes this appearance?

A

May see calcification of the aortic root and ascending aortic arch. Leads to “tree bark” appearance of aorta

41
Q

What complications can result from syphilitic heart disease?

A

Can result in aneurysm of the ascending aorta or aortic arch and aortic insufficiency

42
Q

What is the most common heart tumor?

A

Most common heart tumor is a metastasis (from melanoma, lymphoma)

43
Q

What is the most common primary cardiac tumor in adults? What is the most common primary cardiac tumor in children?

A

Myxomas; Rhabdomyomas

44
Q

Where do myxomas mostly occur, and at what percentage?

A

90% occur in atria (mostly left atrium)

45
Q

How are myxomas usually described?

A

“Ball valve” obstruction in the left atrium

46
Q

With what major symptom(s) are myxomas associated?

A

Associated with multiple syncopal episodes

47
Q

With what condition are rhadomyomas associated?

A

Associated with tuberous sclerosis

48
Q

What is Kussmaul’s sign?

A

Increase in JVP on inspiration instead of normal decrease

49
Q

What is the mechanism behind Kussmaul’s sign?

A

Inspiration –> negative intrathoracic pressure not transmitted to heart –> impaired filling of right ventricle –> blood backs up in the venae cavae –> JVD (increase)

50
Q

In what 4 conditions may Kussmaul’s sign be seen?

A

(1) Constrictive pericarditis (2) Restrictive cardiomyopathies (3) Right atrial or ventricular tumors (4) Cardiac tamponade

51
Q

What are 2 likely pathogens causing culture-negative endocarditis?

A

Most likely Coxiella burnetii and Bartonella spp.

52
Q

What ECG findings are associated with cardiac tamponade?

A

ECG shows low-voltage QRS and electric alternans (due to “swinging” movement of heart in large effusion)

FA - Cardiovascular (18 decks)

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