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CVPR > CVPR Week 9: Acquired Heart disease > Flashcards

CVPR Week 9: Acquired Heart disease Flashcards

1
Q

Objectives

A
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2
Q

Rheumatic fever description

A
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3
Q

Rheumatic heart disease

A

damage to the valves secondary to ARF can become a chronic condition leading to congestive heart failure, strokes, endocarditis and death

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4
Q

ARF AKA

A

Acute Rheumatic fever

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5
Q

Rheumatic fever and heart disease

A

significant public health concerns around the world and despite decreasing incidence there is still a significant disease burden especially in developing nations

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6
Q

Describe the epidemiology of rheumatic fever and rheumatic heart disease

A

significant public health concerns around the world and despite decreasing incidence there is still a significant disease burden especially in developing nations

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7
Q

Describe the epidemiology of rheumatic fever and rheumatic heart disease

A
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8
Q

Acute rheumatic fever pathogenesis

A

a consequence of anti-strep antibodies cross-reacting with group A carbohydrate (human heart valves, M-protein (heart-muscle), protoplast membrane (sarcolemma)

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9
Q

Acute rheumatic fever clinical presentation

A
  • 30% subclinical
  • presentation 1-3 weeks post strep
  • case fatality rate is 2-3 %
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10
Q

Rheumatic fever/Rheumatic heart disease age of onset

A

Group A Streptococcus (GAS) pharyngitis occurs most commonly between 5-15 years of age

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11
Q

Rheumatic fever/Rheumatic heart disease precipitating infection

A

GAS pharyngitis and not skin infections (impetigo)

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12
Q

Rheumatic fever/Rheumatic heart disease strains

A

Strains that cause RF & RHD are based on type of M-protein

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13
Q

Why does RF & RHD occur in response to an infection?

A
  • Because streptococcal antigens mimic normal human tissue antigens (molecular mimicry)
  • so this leads to abnormal autoimmune humoral and cellular responses
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14
Q

Describe the immune response in RF/RHD

A

Rheumatogenic strains/encapsulated mucoid M strains are resistant to phagocytosis so they are particularly immunogenic and produce antibodies against epitopes

similar epitopes in sarcolemmal membranes and valve glycoproteins

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15
Q

Describe the path to RF/RHD

A
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16
Q

Dx of Acute Rheumatic Fever

A

Jones criteria

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17
Q

Jones Criteria Dx what

A

Acute Rheumatic fever

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18
Q

Describe the Jones criteria for Dx

A

2 major criteria or 1 major and 2 minor criteria - PLUS

  • preceding documented strep infection by throat culture or antibody (antistreptolysin (ASO titer) or Antideoxyribonuclease B titer (anti-DNase B titer)
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19
Q

What are the major criteria of the Jones Criteria

A
  • Polyarthritis
  • Carditis
  • Chorea
  • Subcutaneous nodules
  • Erythema Marginatum
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20
Q

What are the minor criteria of the Jones Criteria

A
  • Arthralgia
  • Prolonged PR interval on ECG
  • Fever
  • Elevated acute phase reactants
  • History of rheumatic fever
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21
Q

What are the skin findings in RF

A
  • Erythemia marginatum
  • subcutaneous nodules
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22
Q

Describe erythema marginatum

A
  • <5% of RF patients
  • Bright pink, serpiginous borders and central clearing
  • Non-pruritic, non-painful and blanch with pressure
  • located on trunk or proximal extremities
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23
Q

Describe subcutaneous nodules

A
  • 0-10% of RF cases (not pathognomic)
  • 0.5 - 2.0 cm round, firm, movable, non-tender nodules
  • Usually occur over extensor, surfaces of joints, scalp or spinous processes of back
  • last 1-2 weeks
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24
Q

What is Sydenham Chorea?

A

involuntary purposeless movements, muscular incoordination/weakness and emotional lability

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25
Q

How often does Syndenham chorea occure in RF?

A

10-30% of cases of RF

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26
Q

Why does Sydenham Chorea occur

A

occur due to inflammation in basal ganglia, cerebral cortex and cerebellum

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27
Q

Latency period of RF with chorea

A

longer latency period from GAS infection (acute phase-reactants and antibodies often not elevated)

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28
Q

How long does Sydenham Chorea last

A

lasts anywhere from 1-2 weeks to 2-3 years

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29
Q

What % of group A beta haemolytic streptococcal infection progress to develop acute rheumatic fever

A

0.3 - 30% of untreated develop acute rheumatic fever

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30
Q

Prevalence of Carditis in acute rheumatic fever

A

30-70% of cases

Severe carditis and heart failure occurs in 13-64% of RF cases

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31
Q

Carditis onset in RF

A

most often occurs within 2 weeks of acute illness

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32
Q

What is pancarditis?

A

is the inflammation of the entire heart: the epicardium, the myocardium and the endocardium.

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33
Q

What is endocarditis?

A

is an infection of the endocardium, which is the inner lining of your heart chambers and heart valves.Endocarditis generally occurs when bacteria, fungi or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart

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34
Q

What is myocarditis?

A

is an inflammation of the heart muscle (myocardium). Myocarditis can affect your heart muscle and your heart’s electrical system, reducing your heart’s ability to pump and causing rapid or abnormal heart rhythms (arrhythmias)

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35
Q

What is pericarditis?

A

refers to inflammation of the pericardium, two thin layers of a sac-like tissue that surround the heart, hold it in place and help it work. A small amount of fluid keeps the layers separate so that there’s no friction between them.

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36
Q

Describe acute rheumatic carditis

A
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37
Q

Clinical features of acute rheumatic fever with carditis

A
  • New or changing murmur
  • or Silent carditis
  • Tachycardia out of proportion to fever
  • congestive heart failure
  • Pericarditis
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38
Q

Heart murmurs of acute rheumatic fever with carditis

A
  • Apical holosystolic murmur, high-pitched, blowing, with radiation to the axilla - Acute mitral regurgitation
  • Apical diastolic murmur - relative mitral stenosis due to large volume of regurgitant flow
  • Soft crescendo-decrescendo murmur of aortic insufficiency - acute aortic insufficiency
  • Silent carditis - which is only detected on echo imaging
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39
Q

How is silent carditis detected?

A

detected only on echo imaging

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40
Q

What are the features of congestive heart failure?

A
  • increased JVD
  • Crackles
  • Hepatomegaly
  • Crackles
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41
Q

Features of pericarditis

A

pericardial friction rub

muffled heart sounds

paradoxical pulse (exaggerated fall in the pulse on inspiration)

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42
Q

Rheumatic heart disease valves effected

A
  • most commonly involves the mitral and then the aortic valve
  • but all 4 valves can be affected
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43
Q

What is this?

A

bread and butter fibrinous pericarditis

44
Q

What is this?

A

McCallum plaques-vegetations on the mitral valve

45
Q

What is this?

A

Aschoff bodies and Anitchkows cells-macrophages seen in the sarcomere

46
Q

Describe echocardiographic Dx of rheumatic carditis

47
Q

Describe the clinical course of development of symptoms in RHD

48
Q

Describe Tx of acute streptococcal pharyngitis and primary prevention of rheumatic fever

49
Q

Describe antibiotic therapy of rheumatic fever and pharyngitis

A

Primary (treating GABHS pharyngitis) penicillin, clindamycin

secondary prevention (in someone with a previous history of RF)

50
Q

Describe anti-inflammatory therapy of rheumatic fever and pharyngitis

A

aspirin or naproxen +/- steroids depending on severity

51
Q

Rheumatic fever prophylaxis

52
Q

Kawasaki Disease age of onset

53
Q

Kawasaki disease description

A
  • acute self-limited vasculitis of childhood
  • affects medium-sized blood vessels
  • generalized systemic vasculitis - involves blood vessels throughout the body
  • coronary arteries are always involved in autopsy cases
54
Q

What is this?

55
Q

Diagnostic criteria of Kawasaki disease

56
Q

Clinical manifestation of Kawasaki disease

A

fever persisting at least 5 days without other source in association with at least 4 principle features

  • fever
  • strawberry tongue
  • red lips
  • cervical lymphadenopathy
  • superficial skin layers desquamate easily
  • Red soles & palms
  • peripheral edema
  • conjunctival redness
  • lethargy
  • irritability
  • cardiac complications in 5-20%
  • occasionally intermittent Collicky ABD pain associated with MI
  • Rash over trunk & perineal area
57
Q

What is this?

58
Q

What is this?

59
Q

What is this?

60
Q

What is this?

61
Q

What is this?

62
Q

What is this?

63
Q

KD DDx

64
Q

Incomplete/atypical Kawasaki disease

65
Q

Evaluation of suspected or incomplete/atypical KD

66
Q

Cardiac findings of KD

67
Q

Tx of KD

68
Q

Etiology of KD

69
Q

KD symptoms timeline

70
Q

Coronary artery involvement in KD

71
Q

Describe how the coronary arteries are affected in KD

72
Q

Describe coronary artery involvement of KD

73
Q

What do coronary artery aneurysms in KD

74
Q

What is this?

A

Coronary artery aneurysms

75
Q

What is this?

76
Q

What is this?

77
Q

Follow up for KD patients

78
Q

What is infectious endocarditis?

A

inflammation of the endocardial surface of the heart

typically involves heart valves and adjacent structures

79
Q

Who gets infectious endocarditis?

80
Q

Pathogenesis of infectious endocarditis

81
Q

Etiology of infectious endocarditis

A
  • S. aureus and Virdans strep: 90%
  • Gram negative organisms 2.5%
  • Enterococcus
  • Fungi
82
Q

Dx of infectious endocarditis

A

Clinical/blood cultures are most important

  • New murmur & positive blood cultures

Echocardiography has poor sensitivity

  • cannot use to rule out endocarditis
  • very helpful in deciding who needs emergent surgery
83
Q

Echo for Dx of infectious endocarditis

A

poor sensitivity so cannot use it to rule out endocarditis

but

it is very helpful in deciding who needs emergency surgery

84
Q

Major diagnostic criteria for infectious endocarditis

85
Q

Minor diagnostic criteria for infectious endocarditis

86
Q

What are the Duke major criteria for infectious endocarditis

A

2 positive blood cultures

positive ECHO

new regurgitant murmur

87
Q

What are the Duke minor criteria for infectious endocarditis

A
  • predisposing condition
  • fever
  • immunologic signs
  • one positive blood culture
  • positive ECHO not meeting major criteria
88
Q

What is this?

89
Q

What is this?

90
Q

What is this?

91
Q

Classification of the likelihood of a patient having infectious endocarditis

92
Q

What is this?

93
Q

What is this?

94
Q

What is this?

95
Q

Tx of infectious endocarditis

96
Q

Prophylaxis of infectious endocarditis

97
Q

Common lesions not requiring infectious endocarditis prophylaxis

98
Q

AHA guidelines for infectious endocarditis prophylaxis

99
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CVPR (93 decks)

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