Endocarditis

Question 1

Endocarditis definition

Answer 1

Inflammation of the endocardium

Question 2

Most frequently involved structure of the endocardium in endocarditis

Answer 2

Valves

Question 3

Valvular endocardium characteristics

Answer 3

Vegetations projecting from endocardial surface where there is damage or inflammation

Question 4

2 main Classification of endocarditis

Answer 4

Infective

non effective

Question 5

Types of infective endocarditis

Answer 5

Fungal
bacterial
viral
rickettsial

Question 6

Types of non-infective endocarditis

Answer 6

Rheumatic
verrucous or Libman sacks
nonbacterial thrombotic

Question 7

Infective endocarditis definition

Answer 7

Invasion and colonization of heart valves

mural endocardium or a congenital defect with Microbiologic agents

Formation of masses of thrombus or vegetation laden with the organism

Question 8

Two types of infective endocarditis

Answer 8

Acute

subacute

Question 9

Acute Infective endocarditis

Answer 9

Highly virulent organism (like staph aureus )

develops on normal valves progresses rapidly to death within days to weeks

Question 10

Subacute infective endocarditis

Answer 10

Organism of low virulence (like strep viridans)
develop on previously abnormal valves

Insidious and slow progress

Question 11

Host factors Predisposing to Infective endocarditis

Answer 11

Neutropenia 
immunodeficiency
 therapeutic immunosuppression 
diabetes mellitus 
alcoholism
 intravenous drug abuse

Question 12

Origin of causative organism in infective endocarditis

Answer 12

From the normal floraOf body surfaces and getting into the bloodstream

Question 13

Main pathogen in non immunocompromised individual with infective endocarditis

Answer 13

Virulent organism like staphylococcus aureus

Question 14

Main pathogen in infective under colitis in patients with prosthetic valves

Answer 14

Coagulas négative Staph albus

Question 15

Main pathogen in infective endocarditis s of intravenous drug addicts

Answer 15

Gram negative bacteria in Salinas like staph aureus

Question 16

Commonest fungal close of infective endocarditis

Answer 16

Candida

Question 17

Infective endocarditis pathogenesis

Answer 17

Bacteremia
followed by adherence to valves
proliferation

Question 18

Some bacteremia causes in infective endocarditis

Answer 18

Dental procedures (strep viridans)

Skin sepsis, wound infections, lung infection (staph)

Urogenital instrumentation intestinal surgery ( enterococcus )

Drug addicts IV contamination

Question 19

Infective endocarditis morphology

Answer 19

Presence of vegetation (Single or multiple, sessile or polypoidal or cauliflower like lass ,cauliflower like Mass , varying size?

May spreads especially in the left atrium

Question 20

Which organism tend to cause larger vegetations

Answer 20

Fungi

Question 21

Microscopic morphology of infective endocarditis

Answer 21

Superficial layer with platelets, packed fibrin and organisms

Inflammation and vascularisation under cusp
Macrophages
Small giant cells

Question 22

When do you see

Granulation tissue with fibrosis , hyalinization, calcification, endothelialization of vegetation

Answer 22

In healing of a vegetation after antibiotic treatment

Question 23

Fungal endocarditis micro morphology please

Answer 23

Inflammation

granulomatous or Acute and chronic non-specific inflammation with or without suppuration

Question 24

Type Infective endocarditis sequelae

Answer 24

Cardiac complications
Embolic complications
immuno logical complications

Question 25

Cardiac complications of infective endocarditis

Answer 25

Valvular incompetence (heart murmur ) - perforation or cusps or rupture of chordae tendinae heart failure - acute volume overload due to increased regurgitation intramyocardial emboli (platelets mostly ) intramyocardial abscesses ( if emboli composed of viable organisms) myocarditis (inflammatory cells ) Tiny foci of necrosis ( braht wachter bodies and low grade vasculitis ) Myocardial ring abscesses (can lead to perforation of aorta ) Suppurative pericarditis

Question 26

Embolic complications due to … and can lead to .. or

Answer 26

Due to friable nature of the vegetations, exposure to high pressure flow, cusp movement Can lead to infarct or metastatic infection

Question 27

Main organs at risk of emboli after left sided lesions

Answer 27

Spleen and kidney 50% of cases Cerebral 20% of cases

Question 28

Right sided lesions can lead to

Answer 28

Pulmonary complications like abscess and pneumonia

Question 29

Immunological complications

Answer 29

Oslers nodes - small red tender nodules on hands and feet Subungual splinter hemorrhages (linear hemorrhage beneath tip of nails ) Purpura due to vasculitis Arthritis , glomerulonephritis Janeway lesions

Question 30

Clinical presentation of infective endocarditis

Answer 30

Fever, weight loss , malaise, splenomegaly due to bacteremia Finger clubbing (shamroths sign)

Question 31

Cure rates of infection endocarditis

Answer 31

50% 290% with medical therapy

Question 32

When is prognosis poor in infective endocarditis

Answer 32

When infection due to virulent strains when patient has prosthetic valve infection when patients has for complication cardiac failure

Question 33

Causes of death in infective endocarditis

Answer 33

``` Persistence infection congestive heart failure embolism to major organs rupture of mycotic aneurysm of cerebral arteries renal failure ```

Question 34

Most common association of non bacterial thrombotic endocarditis

Answer 34

Underlying malignancy especially mucin secreting adenocarcinoma

Question 35

Vegetations in non infective endocarditis

Answer 35

Non destructive Small sterile masses of fibrin on valve leaflets Thrombus with no inflammation Valve ulceration or perforation

Question 36

Libman sacks endocarditis

Answer 36

Endocarditis of SLE | Cardiac manifestation of SLE on less than 50% of patients

Question 37

Microscopic vegetation libman sacks

Answer 37

Finely granular Fibrinous eosinophilic material with haematoxyphilic bodies Valvulitis and fibrinoid necrosis

Question 38

Is embolic phenomenon characteristic of Libman sacks

Answer 38

No