Cardiac 5 Shea Flashcards
What are the 4 major extracardiac findings in RHD?
- Polyarthritis
- Subcutaneous Nodules
- Erythema Marginatum
- Sydenhams Chorea
- 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.
Polyarthritis, a finding in RHD
- most common in children
- overlies extensor tendons of the extremities (wrists, elbows, knees, and ankles)
- Firm, non-tender nodules that are usually recurrent.
Subcutaneous Nodules (RHD)
- 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.
Erythema Marginatium
- 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 .
Sydenhams Chorea
20%
RDH
- Sxs of Rheumatic Fever occur how many weeks after a strep throat infection?
- During this time, will the strep culture be + or - ?
- 2 - 3 weeks after
- Negative
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?
- Increased sedimentation rate
- Leukocytosis
- Positive C- reactive protein (CRP)
How is RHD diagnosed?
Clinical dx is based on “Jones Criteria”
(split into major and minor criteria)
What are the 5 Major Criteria of Jones to dx RHD?
- Pancarditis
- Polyarthritis
- Sydenhams Chorea
- Subcutaneous Nodules
- Erythema Marginatum (rash which spares the face)
What are the 5 Minor Criteria of Jones to dx RHD?
- Previous hx of RF
- Fever
- Arthragias (mild inflammation of joints)
- EKG signs of heart damage
- Evidence of prior strept infection (ASO titers, CRP, increased sedimentation rate)
The clinical dx of RHD is made when which Jones Criteria are met?
- 2 major
Or
- 1 major and 2 minor
What is the most common complication of RHD?***
Secondary bacterial endocarditis (bc/ thrombotic vegetations on the valve can become infected)
Valvular vegetations of RHD can give rise to what?
Emboli, which can cause infarcts of brain, kidney, or extremities
Tx for RHD
Cannot be cured. Most lesions are irreversible, tx only w/ surgery
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?
- Human valve (donor)
- Pig
- Mechanical
How can RHD be prevented?
Prompt tx of strep pharyngitis w/ specific abx (prevents initial attack of RF which could lead to RHD)
- 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
Infective Endocarditis
What organism causes acute bacterial endocarditis?
Staphylococcus aureus
What % of Acute Bacterial Endocarditis due to Staph aureus breaks off and goes to brain?
(can cause brain abscess)
70%
Gram positive cocci in grape like clusters
Staph aureus
What 4 things cause Infective Endocarditis?
- Pyogenic Bacteria #1 is Staph aureus
- Fungi
- Rickettsia
- Chlamydiae
Infective Endocarditis is classified into which 2 clinical categories?
- Acute Bacterial Endocarditis (ABE)
- Subacute Bacterial Endocarditis (SBE)
- 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
Acute Bacterial EndocarditisABE
- Develops in the course of intense bacteremia
- Produces necrotizing, valvular lesions with chance of perforation of the valve
ABE
- Faster growing
- High fevers, sweats, septic patient
- Must get blood cultures before giving patient abx
- Staph aureus destroys/erodes mitral valve
ABE
- Slower, less virulent disease
- Caused by organisms of less virulence (Strep viridans, mutans, mitis, sangui, intermedius)
- Can cause infection in previously ABNORMAL heart valves
Subacute Bacterial Endocarditis (SBE)
SBE takes a longer/slower course than ABE
How long is the course of SBE?
Weeks to months
- Lesions are less destructive
- shows evidence of healing
- Patients recover after appropriate abx therapy
SBE
Which type of endocarditis involved “normal valves?”
ABE
What are the 5 “pre-existing causes” for endocarditis?
- Artifical (prosthetic) valves *donated/mechanical*
- Congenital defects (ASD or VSD)
- Degenerative calcified valvular stenosis
- Bicuspid aortic valves
- Myxomatous mitral valve (mitral valve prolapse) = floppy
“alpha - hemolytic”
St. viridans, which causes SBE
Which organism causes the majority of prosthetic valve endocarditis?
- Staph epidermidis (on our skin, IV drug users)
- Staph aureus
Which other 3 organisms are less common causes of infective endocarditis?
- Enterococci
- Gram negative bacteria
- Fungi
In 10% of cases, why can’t we identify the organism responsible for Infective Endocarditis?
Prior abx therapy
Over 95% of endocarditis affects which valve?
Mitral Valve
An IV drug user will likely present with vegetations on which valve?
Tricuspid valve, pt is using main line in vein
What is the most consistent sign, present in almost all patients w/ Infective Endocarditis?
Fever
In ____, there is a quick onset of fever, chills, night sweats, and weakness.
ABE
The larger size of vegetations and/or leaflet destruction w/ Infective Endocarditis will lead to which 2 things?
- Murmur
- Embolization
In ___ the fever is usually low grade, along w/ fatigue and flu like sxs
SBE
What is the #1 complication of Endocarditis?***
Septic Emboli (1/3 of patients)
- 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
Complications of Endocarditis
- CHF due to valve destruction
- Ruptured chordae tendinae
- Myocardial muscle abscesses
- MI
Complications of Endocarditis
- What 4 things contribute to dx of Endocarditis?
- Which one is required for confirmation?
- Clinical presentation
- Complications
- US of vegetations
- blood culture (required)
(w/ repeated blood cultures, + cultures are obtained in 90% of cases)
- Bacteremia from cellulitis or phlebitis
- Drug contamination
Endocarditis in IV drug abusers (IVDA)
What are the 3 main organisms in patients w/ Endocarditis from IVDA?
- St. aureus (50 - 60%)
- Strept species
- Candida
(or any skin commensal)
The ____ valve is infected in over ___% of all drug addicts (IV) w/ signs/sxs of pulmonary emboli and abscesses leading to PNA.
- Tricuspid
- 50%
