Extra cardiac path (infectious endocarditis, rheumatic fever) Flashcards

1
Q

Define rheumatic fever

A

An inflammatory (T2HS) multisystem disorder that arises as a delayed complication of an URTI with beta haemolytic streptococci

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2
Q

What is the aetiology of rheumatic fever

A

Pharyngeal infection with Lancefield group A beta-haemolytic streptococci triggers rheumatic fever 2-4 weeks later
Pharyngeal infection with Lancefield group A beta-haemolytic streptococci triggers rheumatic fever 2-4weeks later

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3
Q

What criteria is used to diagnose rheumatic fever

A

Jones
2 major OR 1 major + 2 minor

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4
Q

What is the Jones criteria for rheumatic fever

A

Major:
Carditis
Arthritis
Sydenham’s chorea
Erythema migracans
Subcutaneous nodules

Fever
Raised ESR
Arthralgia
Prolonged PR
Previous rheumatic fever

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5
Q

What is the management for rheumatic fever

A
  1. Admit
  2. A-E assessment
  3. Abx
  4. long-term Abx - benzylpenicillin every 4 weeks until 21yo
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6
Q

What will be seen on histology for rheumatic fever

A

Aschoft bodies (small giant cell granulomas)
Antischkov myocytes (regenerating myocytes)

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7
Q

What are the types of endocarditis and what will be seen for each

A

Rheumatic heart disease: WARTY vegetations on valve leaflet
Infective endocarditis: large irregular masses on valve cusps, extends to the chordae tendinae
Non-bacterial thrombotic endocarditis: small, bland vegetation (throbmosis)
Libman sacks: small. sterile, platelet, rich vegetation

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8
Q

What are the causes of infective endocarditis

A

Dental: strep. viridans
IVDU: staph. aureus (usually causes R-sided IE)
Prosthetic: staph. epidermidis
Farmers: coxiella
Unpasteurised: Brucella

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9
Q

What are the signs and symptoms of infective endocarditis

A

Hands: Janeway lesions, osler’s nodes, splinter haemorrhages
Eyes: Roth spots
Haematuria (glomerular nephritis)
Splenomegaly
New onset fever
FLAWS symptoms

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10
Q

What criteria is used to diagnose infective endocarditis

A

Duke’s
2 major
1 major + 3 minor
5 minor

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11
Q

What is the Duke’s criteria for diagnosing infective endocarditis

A

Major
+ve culture for the typical organisms
2 +ve cultures 24h apart
Vegetations seen on echo
New-onset murmur

Minor
RFs of IE
S/S of IE
+ve blood culture that does not fit major criteria
Fever

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12
Q

What is the management for infective endocarditis

A

Abx for 6 weeks
Acute: flucloxacillin
Subacute: benzylpenicillin + gentamicin

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