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

Question 1

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

Answer 1

(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

Question 2

What is necessary for diagnosis of bacterial endocarditis?

Answer 2

Multiple blood cultures

Question 3

What pathogen causes acute endocarditis? Describe its virulence.

Answer 3

S. aureus (high virulence)

Question 4

What pathogen causes subacute endocarditis? Describe its virulence.

Answer 4

Viridans streptococci (low virulence)

Question 5

What is the onset like in acute versus subacute endocarditis?

Answer 5

Rapid onset in acute endocarditis; Gradual onset in subacute endocarditis

Question 6

What is the major pathological finding in acute endocarditis?

Answer 6

Large vegetations on previously normal valves

Question 7

What is the major pathological finding in subacute endocarditis?

Answer 7

Smaller vegetations on congenitally abnormal or diseased valves.

Question 8

Of what kind of procedures is subacute endocarditis a sequela?

Answer 8

Sequala of dental procedures

Question 9

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

Answer 9

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

Question 10

What pathogen is present in colon cancer?

Answer 10

S. bovis

Question 11

What pathogen is present on prosthetic valves?

Answer 11

S. epidermidis

Question 12

Which valve is most frequently involved in bacterial endocarditis?

Answer 12

Mitral valve

Question 13

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

Answer 13

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

Question 14

With what pathogens is tricuspid valve endocarditis associated?

Answer 14

Associated with S. aureus, Pseudomonas, & Candida

Question 15

What are complications of bacterial endocarditis?

Answer 15

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

Question 16

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

Answer 16

(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

Question 17

Of what is rheumatic fever a consequence?

Answer 17

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

Question 18

What causes early deaths in rheumatic fever patients?

Answer 18

Myocarditis

Question 19

What is a major late sequela of rheumatic fever?

Answer 19

Rheumatic heart disease

Question 20

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?

Answer 20

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

Question 21

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

Answer 21

Mitral valve regurgitation; Mitral stenosis

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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

Question 24

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

Answer 24

Antibodies to M protein cross-react with self antigens

Question 25

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

Answer 25

(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)

Question 26

How does acute pericarditis commonly present?

Answer 26

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

Question 27

What are the cardiovascular findings associated with acute pericarditis presentation?

Answer 27

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

Question 28

What causes acute fibrinous pericarditis?

Answer 28

Dressler's syndrome, uremia, radiation

Question 29

How does acute fibrinous pericarditis present?

Answer 29

Presents with loud friction rub

Question 30

What causes acute serous pericarditis?

Answer 30

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

Question 31

What usually causes acute suppurative/purulent pericarditis?

Answer 31

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

Question 32

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

Answer 32

Acute SEROUS pericarditis; Often resolves spontaneously

Question 33

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

Answer 33

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

Question 34

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

Answer 34

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

Question 35

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

Answer 35

Equilibration of diastolic pressures in all 4 chambers

Question 36

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

Answer 36

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

Question 37

What is pulsus paradoxus?

Answer 37

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

Question 38

What are 5 conditions in which pulsus paradoxus is seen?

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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

Answer 40

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

Question 41

What complications can result from syphilitic heart disease?

Answer 41

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

Question 42

What is the most common heart tumor?

Answer 42

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

Question 43

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

Answer 43

Myxomas; Rhabdomyomas

Question 44

Where do myxomas mostly occur, and at what percentage?

Answer 44

90% occur in atria (mostly left atrium)

Question 45

How are myxomas usually described?

Answer 45

"Ball valve" obstruction in the left atrium

Question 46

With what major symptom(s) are myxomas associated?

Answer 46

Associated with multiple syncopal episodes

Question 47

With what condition are rhadomyomas associated?

Answer 47

Associated with tuberous sclerosis

Question 48

What is Kussmaul's sign?

Answer 48

Increase in JVP on inspiration instead of normal decrease

Question 49

What is the mechanism behind Kussmaul's sign?

Answer 49

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

Question 50

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

Answer 50

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

Question 51

What are 2 likely pathogens causing culture-negative endocarditis?

Answer 51

Most likely Coxiella burnetii and Bartonella spp.

Question 52

What ECG findings are associated with cardiac tamponade?

Answer 52

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