Cardiovascular - Endocarditis + Myocarditis

Question 1

Primary infectious endocarditis

Answer 1

primary infectious heart disease

microorganisms invade valvular endothelium and cause proliferative or erosive lesions

Question 2

2 valves commonly affected by animals with infective endocarditis?

Answer 2

mitral and aortic

Question 3

vegetative lesions

Answer 3

platelets, fibrin, microorganisms and inflammatory cells - she bacteria internalized by endothelium (walled off) and are not well accessible to immune system or treatments

Question 4

Structural changes to the valve from the infection typically lead to severe valvular _______ that often develops acutely.

Answer 4

regurgitation

Question 5

T/F: the clinical signs associated with infective endocarditis are localized to the heart

Answer 5

false, causes systemic disease so can see fever, anorexia and lethargy

Question 6

Which of the following is FALSE regarding infective endocarditis?
A) can be caused by pyoderma
B) likelihood of getting it is increased if an animal has sub aortic stenosis
C) most common presenting complaint is lameness
D) is not accompanied with a heart murmur

Answer 6

D - most dogs do present with a heart murmur

Question 7

Clinical syndromes associated with infective endocarditis

Answer 7

Immune mediated disease - mass antibody formation leads to immunocomplexes + deposition in organs, poly arthritis and glomerulonephritis most common
CHF + arrhythmias - valve damage = mitral/aortic regurgitation, CHF develops in 75% cases
Thromboembolic disease - kidneys, spleen, myocardium, brain, lungs

Question 8

Signalment of animals with infective endocarditis

Answer 8

middle aged to older dogs, male, medium to large breeds

German shepherds, golden retriever, Labrador retriever

Question 9

Clinical signs of infective endocarditis

Answer 9

Most common presenting sign - lameness
also - lethargy, hyporexia, tachypnea, cough, dyspnea, weakness, fever
may have recent history of infection

Question 10

You are conducting a follow up appointment on a dog that recently had a pyometra. You notice that the dog is showing signs of lameness. You auscultate and hear a systolic murmur. Considering the history and clinical presentation, what is your likely diagnosis?

Answer 10

mitral valve infective endocarditis

Question 11

Which bacteria that causes infective endocarditis does not cause a fever and why?

Answer 11

Bartonella - hides from immune system so won’t see fever

Question 12

T/F: animals with infective endocarditis rarely present with a fever

Answer 12

False, they commonly do

Question 13

murmur heard with mitral infective endocarditis?

Answer 13

left apical systolic

Question 14

murmur heard with aortic infective endocarditis?

Answer 14

left basilar diastolic

Question 15

T/F: arrhythmias are common with infective endocarditis

Answer 15

true

Question 16

what arrhythmias are seen with infective endocarditis

Answer 16

ventricular and/or supra ventricular premature beats or tachycardia, 3rd degree AV block

Question 17

Common CBC abnormalities of infective endocarditis

Answer 17

leukocytosis, neutrophilia, monocytosis, thrombocytopenia, mild anemia

Question 18

biochemical abnormalities of infective endocarditis

Answer 18

hypoalbuminemia, azotemia, elevated liver enzymes, proteinuria, hematuria, pyuria, hemoglobinuria, bacteria

Question 19

Aside from albumin, what other protein may be lost in urine due to glomerular disease?

Answer 19

antithrombin 3

- this aids in clot breakdown so patient will be prothrombotic

Question 20

T/F: urine culture should be performed in IE patients

Answer 20

True

Question 21

When should you obtain a diagnostic blood test for infective endocarditis?
A) 3 days after antibiotic treatment
B) Blood tests are not used to diagnose infective endocarditis
C) Prior to antithrombotic therapy
D) none of the above

Answer 21

C - should be taken prior to antibiotic therapy

Question 22

Which is FALSE regarding blood cultures to diagnose infective endocarditis?
A) 3-4 samples should be collected and submitted for aerobic and anaerobic culture
B) different venous sites should be used
C) it is an aseptic procedure
D) all samples should be taken at the same time

Answer 22

D - they should be taken 30mins to 1h apart

Question 23

Diagnostic testing options for infective endocarditis

Answer 23

blood cultures, thoracic rads, echocardiogram, ECG if arrhythmia auscultated

Question 24

T/F: vegetative lesions are visible on an echocardiogram

Answer 24

True - appear as a blob on the valve

Question 25

Mainstay of therapy for infective endocarditis
A) Fluid therapy
B) euthanasia
C) long term bactericidal
D) diuretics

Answer 25

C - usually a betalactam +/- amino glycoside or enrofloxacin

Question 26

If CHF present in infective endocarditis, should you treat it?

Answer 26

yes

Question 27

Prognosis of infective endocarditis

Answer 27

valve damage often permanent even after infection is resolved
dogs with aortic IE usually have grave prognosis

Question 28

How can you prevent infective endocarditis?

Answer 28

dogs with congenital heart disease (especially sub aortic stenosis) should receive periprocedural antibiotics (B-lactam, cephalosporin)

Question 29

Define myocarditis

Answer 29

myocardial inflammation in the absence of schema resulting in myocyte damage and cardiac dysfunction

Question 30

Most common cause of myocarditis

Answer 30

infectious causes

Question 31

T/F: there is a very specific clinical presentation of myocarditis

Answer 31

false, non-specific

Question 32

Clinical signs of myocarditis

Answer 32

fever, lethargy, hyporexia, resp signs, syncope, muscle pain, diarrhea

Question 33

PE findings seen in myocarditis

Answer 33

arrhythmia, murmur,, abnormal lung sounds, fever, lymphadenopathy

Question 34

What is commonly seen on a myocarditis ECG?

Answer 34

ventricular premature complexes

Question 35

What biomarker test is useful to hep confirm diagnosis of myocarditis?

Answer 35

cardiac troponin I - leaked from damaged/necrotic cardiomyoctes into circulation

Question 36

Treatment of myocarditis

Answer 36

anti-arrhythmic drugs and supportive care

treat underlying cause

Question 37

Important cause of myocarditis in Texas and Southern USA

Answer 37

Chagas Disease, trypanosome cruzi
Acute - lethargy, generalized lymphadenopathy, paleo, hepatosplenomegaly, sudden death
Chronic - progressive R sided cardiac dysfunction and CHF
Dx - serology, trapomastigotes on blood smear
Tx - clinical signs