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PATHOphys Exam 2 > Cardiac 5 Shea > Flashcards

Cardiac 5 Shea Flashcards

1
Q

What are the 4 major extracardiac findings in RHD?

A
  • Polyarthritis
  • Subcutaneous Nodules
  • Erythema Marginatum
  • Sydenhams Chorea
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2
Q
  • migratory in nature
  • causes pain and swelling in one joint. It subsides, then reappears in another joint.
  • Lasts 1-4 wks. Then subsides without residual deformity.
A

Polyarthritis, a finding in RHD

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3
Q
  • most common in children
  • overlies extensor tendons of the extremities (wrists, elbows, knees, and ankles)
  • Firm, non-tender nodules that are usually recurrent.
A

Subcutaneous Nodules (RHD)

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4
Q
  • A maculopapular, erythematous rash appearing mostly on the trunk and proximal extremities, sparing the face.
  • The rash is also migratory and leaves no residual scarring.
A

Erythema Marginatium

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5
Q
  • a neurologic disorder characterized by involuntary movements that are continuous, non-repetitive, purposeless, jerky movements of the limbs, trunk and face muscles.
  • Causes impaired speech and gait .
A

Sydenhams Chorea

20%

RDH

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6
Q
  • Sxs of Rheumatic Fever occur how many weeks after a strep throat infection?
  • During this time, will the strep culture be + or - ?
A
  • 2 - 3 weeks after
  • Negative
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7
Q

ASO titerss provide concrete evidence that there has been a recent infection w/ strept pyogenes. What other 3 labs are consistent findings of RHD/inflammation?

A
  • Increased sedimentation rate
  • Leukocytosis
  • Positive C- reactive protein (CRP)
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8
Q

How is RHD diagnosed?

A

Clinical dx is based on “Jones Criteria”

(split into major and minor criteria)

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9
Q

What are the 5 Major Criteria of Jones to dx RHD?

A
  1. Pancarditis
  2. Polyarthritis
  3. Sydenhams Chorea
  4. Subcutaneous Nodules
  5. Erythema Marginatum (rash which spares the face)
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10
Q

What are the 5 Minor Criteria of Jones to dx RHD?

A
  1. Previous hx of RF
  2. Fever
  3. Arthragias (mild inflammation of joints)
  4. EKG signs of heart damage
  5. Evidence of prior strept infection (ASO titers, CRP, increased sedimentation rate)
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11
Q

The clinical dx of RHD is made when which Jones Criteria are met?

A
  • 2 major

Or

  • 1 major and 2 minor
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12
Q

What is the most common complication of RHD?***

A

Secondary bacterial endocarditis (bc/ thrombotic vegetations on the valve can become infected)

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13
Q

Valvular vegetations of RHD can give rise to what?

A

Emboli, which can cause infarcts of brain, kidney, or extremities

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14
Q

Tx for RHD

A

Cannot be cured. Most lesions are irreversible, tx only w/ surgery

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15
Q

RHD

Calcified, deformed valves can be excised and replaced w/ artificial valves that are surgically implanted into the heart. What are the 3 valves from best to worst?

A
  1. Human valve (donor)
  2. Pig
  3. Mechanical
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16
Q

How can RHD be prevented?

A

Prompt tx of strep pharyngitis w/ specific abx (prevents initial attack of RF which could lead to RHD)

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17
Q
  • Bacterial or fungal infections of the cardiac valves causing erosions of the surface layers, allowing entry of bacteria into the valves.
  • Colonization or invasion of heart valves
  • Bulky/friable vegetations made of thrombotic debris and bacterial organisms
  • Associated w/ destruction of underlying cardiac tissue
  • Can embolize at any time
A

Infective Endocarditis

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18
Q

What organism causes acute bacterial endocarditis?

A

Staphylococcus aureus

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19
Q

What % of Acute Bacterial Endocarditis due to Staph aureus breaks off and goes to brain?

(can cause brain abscess)

A

70%

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20
Q

Gram positive cocci in grape like clusters

A

Staph aureus

21
Q

What 4 things cause Infective Endocarditis?

A
  • Pyogenic Bacteria #1 is Staph aureus
  • Fungi
  • Rickettsia
  • Chlamydiae
22
Q

Infective Endocarditis is classified into which 2 clinical categories?

A
  • Acute Bacterial Endocarditis (ABE)
  • Subacute Bacterial Endocarditis (SBE)
23
Q
  • Highly destructive infection of valves
  • Frequently infection forms from a previously normal heart valve
  • Can be seen in prosthetic heart valves
  • Usually due to high virulent organisms (staph aureus or gram negatives)
  • Can lead to death within days, despite abx
A

Acute Bacterial EndocarditisABE

24
Q
  • Develops in the course of intense bacteremia
  • Produces necrotizing, valvular lesions with chance of perforation of the valve
A

ABE

25
Q
  • Faster growing
  • High fevers, sweats, septic patient
  • Must get blood cultures before giving patient abx
  • Staph aureus destroys/erodes mitral valve
A

ABE

26
Q
  • Slower, less virulent disease
  • Caused by organisms of less virulence (Strep viridans, mutans, mitis, sangui, intermedius)
  • Can cause infection in previously ABNORMAL heart valves
A

Subacute Bacterial Endocarditis (SBE)

27
Q

SBE takes a longer/slower course than ABE

How long is the course of SBE?

A

Weeks to months

28
Q
  • Lesions are less destructive
  • shows evidence of healing
  • Patients recover after appropriate abx therapy
A

SBE

29
Q

Which type of endocarditis involved “normal valves?”

A

ABE

30
Q

What are the 5 “pre-existing causes” for endocarditis?

A
  • Artifical (prosthetic) valves *donated/mechanical*
  • Congenital defects (ASD or VSD)
  • Degenerative calcified valvular stenosis
  • Bicuspid aortic valves
  • Myxomatous mitral valve (mitral valve prolapse) = floppy
31
Q

“alpha - hemolytic”

A

St. viridans, which causes SBE

32
Q

Which organism causes the majority of prosthetic valve endocarditis?

A
  • Staph epidermidis (on our skin, IV drug users)
  • Staph aureus
33
Q

Which other 3 organisms are less common causes of infective endocarditis?

A
  • Enterococci
  • Gram negative bacteria
  • Fungi
34
Q

In 10% of cases, why can’t we identify the organism responsible for Infective Endocarditis?

A

Prior abx therapy

35
Q

Over 95% of endocarditis affects which valve?

A

Mitral Valve

36
Q

An IV drug user will likely present with vegetations on which valve?

A

Tricuspid valve, pt is using main line in vein

37
Q

What is the most consistent sign, present in almost all patients w/ Infective Endocarditis?

A

Fever

38
Q

In ____, there is a quick onset of fever, chills, night sweats, and weakness.

A

ABE

39
Q

The larger size of vegetations and/or leaflet destruction w/ Infective Endocarditis will lead to which 2 things?

A
  • Murmur
  • Embolization
40
Q

In ___ the fever is usually low grade, along w/ fatigue and flu like sxs

A

SBE

41
Q

What is the #1 complication of Endocarditis?***

A

Septic Emboli (1/3 of patients)

42
Q
  • Retinal (blindness)
  • Coronary (MI)
  • Cerebral (strokes)
  • Splenic
  • Pulmonary (from IV drug users)
  • Renal (renal abscess to glomerulonephritis)

Complications in the form of infarcts or abscesses

A

Complications of Endocarditis

43
Q
  • CHF due to valve destruction
  • Ruptured chordae tendinae
  • Myocardial muscle abscesses
  • MI
A

Complications of Endocarditis

44
Q
  • What 4 things contribute to dx of Endocarditis?
  • Which one is required for confirmation?
A
  • Clinical presentation
  • Complications
  • US of vegetations
    • blood culture (required)

(w/ repeated blood cultures, + cultures are obtained in 90% of cases)

45
Q
  • Bacteremia from cellulitis or phlebitis
  • Drug contamination
A

Endocarditis in IV drug abusers (IVDA)

46
Q

What are the 3 main organisms in patients w/ Endocarditis from IVDA?

A
  1. St. aureus (50 - 60%)
  2. Strept species
  3. Candida

(or any skin commensal)

47
Q

The ____ valve is infected in over ___% of all drug addicts (IV) w/ signs/sxs of pulmonary emboli and abscesses leading to PNA.

A
  • Tricuspid
  • 50%
48
Q
A

PATHOphys Exam 2 (22 decks)

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