Cardiovascular system infections

Question 1

What is transient bacteremia?

Answer 1

self-resolving in patients with no underlying illness, immune deficiency or turbulent cardiac blood flow

Question 2

What type of bacteremia is characterized by “direct inoculation of the blood stream; nosocomial or IV drug user”

Answer 2

Primary bacteremia

Question 3

What is secondary bacteremia?

Answer 3

microorganism causing infection at another site incase the bloodstream and disseminate via the circulation to other body areas (hematogenous spread)

Question 4

What is sepsis?

Answer 4

life-threatening organ dysfunction due to a dysregulated host response to infection

Question 5

What does SOFA measure?

Answer 5

respiratory, hepatic, cardiovascular, renal , CNS, and platelet dysfunction

Question 6

What is the endocardium?

Answer 6

thin lining inside the chambers of the heart

Question 7

What is the muscle tissue of the heart called?

Answer 7

the myocardium

Question 8

What is the pericardium?

Answer 8

The thin double layered sac that encloses the heart

Question 9

In Canada people who develop endocarditis it is usually caused by _

Answer 9

bacteria

Question 10

Myocarditis and pericarditis are typically aligned with _ infections

Answer 10

viral

Question 11

What is rheumatic fever?

Answer 11

A rare complication of streptococcal pharyngitis infections, autoimmune reaction lasting about 3 months

Question 12

What population is most commonly affected by rheumatic fever?

Answer 12

children between 5-15 and adults in developing countries, as well as in indigenous northern regions

Question 13

What are the four types of possible autoimmune reactions that can result from rheumatic fever?

Answer 13

• carditis
• polyarthritis
• erythema marginatum
• chorea

Question 14

How is rheumatic fever treated?

Answer 14

anti-inflammatories, diuretics, bed rest

Question 15

What is the method of continued prevention for someone with no residual heart disease?

Answer 15

penicillin (IM), once monthly for a minimum of 10 years or until 25 (because at that point the likelihood of developing strep is low)

Question 16

What is the method of continued prevention for someone with residual heart disease?

Answer 16

penicillin (IM), once monthly until 40-45 years old, but often continued for life (because body has proven it cannot handle it)

Question 17

Why are patients with a rheumatic heart valve at an increased risk of complications associated with bacteremia?

Answer 17

Increased risk due to the turbulent blood flow at the site of the damaged valve (can cause erosions and damage to the endocardium, can then lead to the ability for platelets and fibrin to bind, making it easy for bacteria to adhere)

Question 18

Minor fibrin and platelet deposition can occur on the low pressure side of the damaged valve causing_

Answer 18

non-bacterial thrombotic endocarditis (NBTE)

Question 19

What is endocarditis?

Answer 19

infection and inflammation of the endocardium; commonly affects the heart valves - mitral and aortic (especially in IV drug users)

Question 20

What type of endocarditis is associated with non-virulent bacteria such as viridans streptococci?

Answer 20

subacute endocarditis

Question 21

What is the differentiating symptom between subacute and acute endocarditis?

Answer 21

sepsis in acute endocarditis

Question 22

What are peripheral manifestations of endocarditis?

Answer 22

splinter hemorrhages, Osler’s nodes, conjunctival petechiae, Roth’s spots, Janeway lesions

Question 23

What are the risk factors of abnormal valves mainly associated with subacute infective endocarditis?

Answer 23

prosthetic valve, mitral valve prolapse, rheumatic valve, congenitally abnormal valve

Question 24

In the case of developing endocarditis in the hospital from a central venous catheter, what heart valve would most be affected?

Answer 24

tricuspid valve

Question 25

What is the Duke Criteria for diagnosis of endocarditis?

Answer 25

Definitive IE: 2 major OR 1 major and 3 minor OR 5 minor

Question 26

What are two of the major criteria for endocarditis diagnosis?

Answer 26

- positive blood culture (2 separate but positive samples) | - evidence of endocardial involvement (hearring murmur or visual)

Question 27

What are the five minor criteria for endocarditis?

Answer 27

- predisposition - clinical symptoms - vascular phenomena - immunologic phenomena - positive blood culture not meeting major criteria

Question 28

What is the treatment protocol for endocarditis?

Answer 28

the appropriate antimicrobial therapy (bactericidal) administered parenterally (long duration, 4-6 weeks), valve replacement in severe cases, recurrent embolism or in cases of fungal endocarditis

Question 29

Which type of heart infection is most associated with pediatric cases?

Answer 29

myocarditis

Question 30

What does myocarditis look like in older adults?

Answer 30

it progresses slowly; progressive heart failure and dilated cardiomyopathy

Question 31

What does myocarditis look like in children?

Answer 31

acute symptoms - cardiogenic shock, acute heart failure and sudden death

Question 32

When causes pain to accompany myocarditis?

Answer 32

Pain is reported in those with concomitant pericarditis...if it is just the heart muscle there will be no sharp stabbing pain

Question 33

Inflammatory cardiomyopathy is most often associated with a _ infection of the myocardium and infiltration of cardiac muscle by _

Answer 33

viral; T-lymphocytes

Question 34

What else can cause myocarditis and pericarditis besides viruses?

Answer 34

medications

Question 35

What ensures full recovery from myocarditis?

Answer 35

early identification and treatment

Question 36

What is the treatment for myocarditis?

Answer 36

Same as for heart failure= ACE inhibitors, diuretics, beta blockers

Question 37

What do you want to avoid in the treatment of myocarditis?

Answer 37

NSAIDS - induced fluid retention (due to vasoconstriction of blood vessels in the kidney and resulting retention of sodium and potassium) makes the heart work harder

Question 38

What will occur if symptoms of myocarditis persist for more than 2 weeks to months?

Answer 38

permanent dilated cardiomyopathy (just like an 85 year old who has a heart attack), increase risk for heart attack and stroke

Question 39

What are the infectious causes of pericarditis?

Answer 39

viruses are the most causative pathogen, appears 2-3 weeks post "flu-like" illness (enteroviruses, influenza, HIV)

Question 40

What are some common symptoms of pericarditis?

Answer 40

sharp, stabbing chest pain caused by rubbing of two layers of the pericardium, pain worsens when lying down, with deep breaths, swallowing and coughing, sitting upright or forward relieves pain

Question 41

How can one differentiate the pain of a heart attack from pericarditis?

Answer 41

Pain improves from sitting upright or leaning forward, in a heart attack nothing will help the pain

Question 42

What are the three diagnostic findings of pericarditis?

Answer 42

- abnormal heart sounds (layers rubbing) - abnormal ECG (due to inflammation) - echocardiogram - appearance of fluid surrounding the heart

Question 43

T/F: you don't need the pericardium to live

Answer 43

True

Question 44

Persistent bacteremia is suggestive of _ infections such as endocarditis or _ infections

Answer 44

intravascular; catheter-related

Question 45

What are the 2 most common reasons for heart murmurs?

Answer 45

1. narrowing or leaking valves | 2. presence of abnormal passages through which blood flows in or near the heart

Question 46

What colour top blood collection tube is used for aerobic specimen?

Answer 46

green top

Question 47

What is the colour top of blood collection tube for anaerobic specimen?

Answer 47

orange top

Question 48

T/F: MRSA is not transmitted by the airborne route

Answer 48

true; contact route

Question 49

What is an indicator of bacterial growth in the bottle of blood specimens?

Answer 49

CO2 production in the bottom of the bottle where CO2 is able to diffuse down, there will also be a colour change

Question 50

What type of bacteria is catalase positive?

Answer 50

staphylococci (gram positive)

Question 51

What type of bacteria is catalase negative?

Answer 51

streptococci (gram negative)