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Cardiovascular II > Cardiac infections > Flashcards

Cardiac infections Flashcards

1
Q

Invasion and multiplication of microorganisms on the endocardial surface, within the endocardium, within the myocardium, and/or on the prosthetic material within the cardiac structure

A

Infective endocarditis

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2
Q

Causes of bacteremia potentially leading to infective endocarditis

A

Oro-dental extraction/surgery
Respiratory tract intubation/scope
GI tract scope/biopsy
Urinary tract scope/surgery
IVDU
AV fistula

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3
Q

Potential pathogens in infective endocarditis related to indwelling catheter, AV fistula, or hemodialysis

A

S aureus
S epidermidis –> coagulase negative

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4
Q

Potential pathogens in infective endocarditis related to dental procedure

A

Strep viridans
HACEK

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5
Q

Potential pathogens in infective endocarditis related to GI procedure

A

Enterococcus species
Strep gallotycius/bovis

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6
Q

Potential pathogens in infective endocarditis related to urinary tract procedure

A

Enterococcus species

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7
Q

Potential pathogens in infective endocarditis related to IVDU

A

S aureus
Pseudomonas
Candida

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8
Q

Virulence factors of Strep viridans that contribute to infective endocarditis

A

Dextran
FimA –> surface adhesins

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9
Q

Virulence factors of S epidermidis that contribute to infective endocarditis

A

Glycocalyx and slime layer –> adhesion

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10
Q

Common pathogens in prosthetic valve endocarditis within 2 mos of surgery

A

Strep epidermidis
S aureus
Gram negative aerobic bacilli
Candida

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11
Q

Common pathogens in prosthetic valve endocarditis that develops >2 mos after surgery

A

S epidermidis
Strep viridans
HACEK

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12
Q

Constitutional symptoms of infective endocarditis

A

Fever, chills, rigors
Malaise
Weight loss
Night sweats
Myalgias

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13
Q

Cardiac symptoms of infective endocarditis

A

New or changing murmur
Arrhythmia (heart block)
HF (valve insufficiency)

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14
Q

Major modified duke’s criteria for diagnosing infective endocarditis

A

2 positive blood cultures
Positive echocardiogram
New valvular regurgitation

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15
Q

Minor modified duke’s criteria for diagnosing infective endocarditis

A

Predisposing heart condition of IVDU
Fever
Vascular phenomenon
Immunologic phenomenon
Microbiological evidence of positive blood culture not meeting criteria

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16
Q

Amount of Duke’s criteria needed for diagnosis of infective endocarditis

A

2 major OR 1 major and 3 minor OR 5 minor

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17
Q

Bacteria that can contaminate blood cultures

A

Staph epidermidis

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18
Q

When to suspect endocarditis when
blood culture is negative

A

Recent antibiotic therapy or consider non-bacterial endocarditis

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19
Q

Gram positive cocci in chains. Alpha hemolysis on blood agar with greenish discoloration. Catalase negative. Optochin resistant. Resistant to bile.

A

Strep viridans

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20
Q

Gram positive cocci in pairs and short chains, with acute angles. Usually non-hemolytic and catalase negative. Grows in 6.5% NaCl and tolerates 40% bile. Hydrolyzes esculin.

A

Enterococcus species –> fecalis and faecium

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21
Q

Gram positive cocci in clusters. Beta hemolysis of blood agar with golden colonies. Coagulase and catalase positive.

A

S aureus

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22
Q

Gram positive cocci in clusters. Beta hemolysis of blood agar with golden colonies. Coagulase negative and catalase positive.

A

S epidermidis

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23
Q

HACEK –> slow/difficult to culture

A

Hemphilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella

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24
Q

Group of bacteria that are all gram negative baccilli/coccobacilli and part of normal oro-dental flora. All are fastidious and may be missed on routine blood cultures.

A

HACEK bacterias

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25
Q

Gram negative rod that is strictly aerobic. Blue-green pigment produced on culture with a sweet/fruity odor. Oxidase positive.

A

Pseudomonas aeruginosa

26
Q

Duration of antibiotics in infective endocarditis

A

4-8 wks

27
Q

Conditions where prophylaxis for infective endocarditis is indicated

A

Valvular defects
Hx of endocarditis
Congenital heart disease
Prosthetic valve
Post cardiac surgery/transplant

28
Q

Prophylaxis for infective endocarditis

A

Antibiotic administered 30-60 min before dental, GI, urinary, or respiratory procedures, and I&D.

Typically amoxicillin or ampicillin

29
Q

Antibiotics used for infective endocarditis prophylaxis in those with penicillin allergy

A

Azithromycin
Clindamycin

30
Q

Latent period between GAS pharyngitis and acute rheumatic fever

A

1-3 wks

31
Q

Main hypersensitivity reaction type in acute rheumatic fever

A

Type II hypersensitivity

32
Q

Major JONES criteria for diagnosis of acute rheumatic fever

A

Erythema marginatum
Carditis
Skin nodules
Migratory polyarthritis

33
Q

Number of major and/or minor JONES criteria required for diagnosis of acute rheumatic fever

A

2 major OR 1 major and 2 minor

34
Q

Minor JONES criteria for diagnosis of acute rheumatic fever

A

Fever
Arthralgia
Raised ESR
Raised CRP
Prolonged PR interval
Hx of rheumatic fever or rheumatic heart disease

35
Q

Positive ssRNA non-enveloped viruses spread via feco-oral route that can cause viral myocarditis

A

Coxsackie
Enterovirus
ECHOvirus

36
Q

Risk factors for development of viral myocarditis

A

Children - severe
20-40 yo
Long-term steroid of NSAID use
Alcohol
Nutritional deficiencies

37
Q

Pathogenesis of acute phase of viral myocarditis

A

IFN-alpha, IFN-beta, NK cells and other inflammatory cytokines destroy infected myocytes. Non-infected myocytes survive. Spontaneous resolution.

38
Q

Pathogenesis of subacute phase of viral myocarditis

A

CD8 cells stimulate cytokine production. B cells recruited and lymphocytic infiltration. Results in myocardiocyte inflammation

39
Q

Pathogenesis of chronic phase of viral myocarditis.

A

Fibrotic replacement of dead myocardiocytes or viral persistance/inflammation. Results in cardiac remodeling leading to dilated cardiomyopathy and CHF.

40
Q

Clinical features of viral myocarditis

A

CP
Fever
Rash
Fatigue
Myalgia
Respiratory and/or GI upset

41
Q

ECG findings in viral myocarditis

A

Non-specific ST segments elevations and T wave changes

42
Q

Chronic manifestations of viral myocarditis

A

Dilated cardiomyopathy
CHF

43
Q

Morphological forms of Trypanosoma cruzi in the body

A

Amastigote –> in tissue
Trypomastigote –> in circulation

44
Q

Chagoma

A

Swelling that forms at site of infection/bite in Chagas disease

45
Q

Romana’s sign

A

Chagoma of eyelid

46
Q

ECG changes in Chagas disease dilated cardiomyopathy

A

Arrhythmias
Complete right bundle branch block

47
Q

Cardiac complications of Chagas disease

A

Dilated cardiomyopathy
Cardiomegaly
Apical LV aneurysm

48
Q

Causal agent in Lyme disease

A

Borrelia burgdorferi

49
Q

Signs and symptoms of stage 1, early localized, Lyme disease

A

Erythema migrans
Flu-like symptoms

50
Q

Erythema migrans

A

Bulls-eye rash seen in early Lyme disease

51
Q

Signs and symptoms of stage 2, early disseminated, Lyme disease

A

Secondary lesions
Carditis
3rd degree complete AV block
Bell’s palsy
Migratory myalgias and/or transient arthritis

52
Q

Signs and symptoms of stage 3, late disseminated, Lyme disease

A

Chronic arthritis
Encephalopathy

53
Q

Bacteriophage encoded virulence factor that inhibits eukaryotic protein synthesis by inhibiting elongation factor 2. Affects respiratory tract epithelium, myocardium, and CNS.

A

Diphtheria toxin

54
Q

Clinical manifestation of diphtheria toxin

A

Arrhythmias
Circulatory collapse

55
Q

Symptoms of infectious pericarditis

A

Fever (viral)
Sharp, pleuritic, substernal CP that radiates to shoulder/neck
Intense pain when supine relieved when upright

56
Q

Clinical signs of infectious pericarditis

A

Pericardial friction rub
Pericardial effusion –> muffled heart sounds

57
Q

ECG changes in acute pericarditis

A

Widespread concave ST segment elevation
Widespread PR segment depression
Reduced QRS amplitude –> pericardial effusion

58
Q

Complication of infectious pericarditis

A

Cardiac tamponade

59
Q

Pathogenesis of syphilitic heart disease

A

Obliterative endarteritis (vasculitis) and vasa vasorum which weakens the aortic root wall

60
Q

Result of weakening of the aortic root wall in syphilitic heart disease

A

Aortic dilation and aneurysm
Aortic valve regurgitation

61
Q
A

Cardiovascular II (29 decks)

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