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Cardiovascular Module > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

Endocarditis definition

A

Inflammation of the endocardium

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2
Q

Most frequently involved structure of the endocardium in endocarditis

A

Valves

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3
Q

Valvular endocardium characteristics

A

Vegetations projecting from endocardial surface where there is damage or inflammation

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4
Q

2 main Classification of endocarditis

A

Infective

non effective

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5
Q

Types of infective endocarditis

A

Fungal
bacterial
viral
rickettsial

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6
Q

Types of non-infective endocarditis

A

Rheumatic
verrucous or Libman sacks
nonbacterial thrombotic

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7
Q

Infective endocarditis definition

A

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

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8
Q

Two types of infective endocarditis

A

Acute

subacute

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9
Q

Acute Infective endocarditis

A

Highly virulent organism (like staph aureus )

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

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10
Q

Subacute infective endocarditis

A

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

Insidious and slow progress

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11
Q

Host factors Predisposing to Infective endocarditis

A 
Neutropenia 
immunodeficiency
 therapeutic immunosuppression 
diabetes mellitus 
alcoholism
 intravenous drug abuse
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12
Q

Origin of causative organism in infective endocarditis

A

From the normal floraOf body surfaces and getting into the bloodstream

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13
Q

Main pathogen in non immunocompromised individual with infective endocarditis

A

Virulent organism like staphylococcus aureus

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14
Q

Main pathogen in infective under colitis in patients with prosthetic valves

A

Coagulas négative Staph albus

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15
Q

Main pathogen in infective endocarditis s of intravenous drug addicts

A

Gram negative bacteria in Salinas like staph aureus

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16
Q

Commonest fungal close of infective endocarditis

A

Candida

17
Q

Infective endocarditis pathogenesis

A

Bacteremia
followed by adherence to valves
proliferation

18
Q

Some bacteremia causes in infective endocarditis

A

Dental procedures (strep viridans)

Skin sepsis, wound infections, lung infection (staph)

Urogenital instrumentation intestinal surgery ( enterococcus )

Drug addicts IV contamination

19
Q

Infective endocarditis morphology

A

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

20
Q

Which organism tend to cause larger vegetations

A

Fungi

21
Q

Microscopic morphology of infective endocarditis

A

Superficial layer with platelets, packed fibrin and organisms

Inflammation and vascularisation under cusp
Macrophages
Small giant cells

22
Q

When do you see

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

A

In healing of a vegetation after antibiotic treatment

23
Q

Fungal endocarditis micro morphology please

A

Inflammation

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

24
Q

Type Infective endocarditis sequelae

A

Cardiac complications
Embolic complications
immuno logical complications

25
Q

Cardiac complications of infective endocarditis

A

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

26
Q

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

A

Due to friable nature of the vegetations, exposure to high pressure flow, cusp movement

Can lead to infarct or metastatic infection

27
Q

Main organs at risk of emboli after left sided lesions

A

Spleen and kidney 50% of cases

Cerebral 20% of cases

28
Q

Right sided lesions can lead to

A

Pulmonary complications like abscess and pneumonia

29
Q

Immunological complications

A

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

30
Q

Clinical presentation of infective endocarditis

A

Fever, weight loss , malaise, splenomegaly due to bacteremia

Finger clubbing (shamroths sign)

31
Q

Cure rates of infection endocarditis

A

50% 290% with medical therapy

32
Q

When is prognosis poor in infective endocarditis

A

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

33
Q

Causes of death in infective endocarditis

A 
Persistence infection 
congestive heart failure 
embolism to major organs 
rupture of mycotic aneurysm of cerebral arteries
 renal failure
34
Q

Most common association of non bacterial thrombotic endocarditis

A

Underlying malignancy especially mucin secreting adenocarcinoma

35
Q

Vegetations in non infective endocarditis

A

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

36
Q

Libman sacks endocarditis

A

Endocarditis of SLE

Cardiac manifestation of SLE on less than 50% of patients

37
Q

Microscopic vegetation libman sacks

A

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

38
Q

Is embolic phenomenon characteristic of Libman sacks

A

No

Cardiovascular Module (21 decks)

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