Heart Disorders 2 Flashcards

1
Q

What is Acute Rheumatic Fever?

A

an acute, immunologically mediated, multi-system inflammatory disease

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2
Q

what is rheumatic heart disease?

A

valvular disease resulting from chronic valve damage as a result of acute rheumatic fever

aka rheumatic valve disease

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3
Q

what is the difference between rheumatic fever and rheumatic heart disease

A

rheumatic fever is an inflammatory disease

rheumatic heart disease is a result of rheumatic fever, leading to chronic valve damage

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4
Q

aetiology of rheumatic fever

A

commonly from group A streptococcal pharyngitis

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5
Q

pathogenesis of rheumatic fever

A
  • a hypersensitive response - antibody and T cell
  • antibody response against M proteins of streptococci
  • CD4 + T cells specific to streptococcal peptides
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6
Q

what are the key clinical features of rheumatic fever (5)

A
  • migratory polyarthritis of the large joints
  • pancarditis
  • skin lesions
  • subcutaneous nodules
  • CNS - cause Sydenham chorea = involuntary movements
  • 10 days-6 weeks post infection
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7
Q

what is migratory polyarthiritis?

A

one large joint becomes painful and swollen for a period of days then subsides
- happens to another large joint
- repeats

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8
Q

what is Pancarditis or acute rheumatic carditis?

A

affecting all three layers of the heart
- can cause cardiac dilation or heart failure

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9
Q

what is acute rheumatic carditis? what is affected?

A

when acute rheumatic fever affects the heart

  • can affect the three layers of the heart
    = pericardium
    = myocardium
    = endocardium
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10
Q

what are the 3 layers of the heart.

A

pericardium
myocardium
endocardium

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11
Q

with the 3 layers of the heart, what can be a result of acute rheumatic carditis?

A

pericardium = pericarditis

myocardium = myocarditis

endocardium = endocarditis

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12
Q

what is a characteristic feature of myocarditis?

A

Aschoff bodies - clumps of macrophages recruited into the area of muscle damage due to autoimmune response

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13
Q

where can Aschoff bodies be found?

A

in all three cell layers of the heart
= pancarditis

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14
Q

what is the diagnostic criteria of rheumatic fever

A

using the Jones Criteria
- must have evidence of group A strep infection

patient symptoms
- 2 of the major criteria or
- one major and 2 minor

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15
Q

what comes under major diagnostic criteria for acute rheumatic fever? (5)

A

carditis
polyarthritis
chorea - abnormal movements
erythema marginatum
subcutaneous nodules

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16
Q

what comes under minor diagnostic criteria for acute rheumatic fever? (5)

A

fever
arthralgia
previous rheumatic fever or rheumatic heart disease
acute phase reactions
prolonged PR interval

17
Q

pathogenesis of rheumatic heart disease (6)

A
  • cardiac hypertrophy
  • cardiac dilation
  • heart failure
  • arrhythmias
  • veruccae aka vegetations
  • mitral stenosis
18
Q

what is mitral stenosis?

A

narrowing of the mitral valve, found on the left side

19
Q

what is the most likely cause of mitral stenosis?

A

rheumatic heart disease

20
Q

what are veruccae? - rheumatic heart disease

A

nodules found in areas of valve damage

21
Q

what valves are involved in rheumatic heart disease?

A

mostly only mitral valve
25% aortic valve - usually wear and tear
tricuspid/pulomonary valves are uncommon

22
Q

what are the key clinical features of rheumatic heart disease (2)

A

-permanent and cumulative valve damage
- mitral stenosis - looking like a fish mouth or buttonhole

23
Q

what is the diagnostic criteria of rheumatic heart disease

A

relies on the Jones Criteria

24
Q

what is endocarditis? how does it usually present?

A

inflammation of the endocardium
- usually get vegetation lesions on the valve

25
what are the 2 forms of endocarditis?
infective endocarditis non-infective endocarditis
26
define infective endocarditis
a clinically serious infection - a microbe colonises or invades the heart valves or heart chamber
27
what are the two types of infective endocarditis?
acute infective endocarditis = the worse one sub-acute infective endocarditis
28
what is the cause and 3 effects of acute infective endocarditis?
highly virulent organism necrotising, ulcerative, destructive lesions
29
how is acute infective endocarditis treated?
its difficult to cure - antibiotics and surgery - death is frequent
30
what is the cause of subacute infective endocarditis? how it is treated?
lower virulent organisms less destructive cured with long-term antibiotics
31
what are the risk factors for infective endocarditis? 4 high risk factors 5 mid risks 1 low risk
high risk - artificial heart valves - prior episodes - complex cardiac defects - surgically constructed shunts mod risk - septal defects - hypertrophic cardiomyopathy - valvular dysfunction - MVP with mitral regurgitation low risk - innocent murmur - organisms in bloodstream = infection - cardiac vascular abnormalities = abnormal flow = promotes adherence and growth - rheumatic heart disease - damages the valves, disrupts blood flow
32
what is polymicrobial infective endocarditis? what is a common risk factor and pathogenesis?
infection due to multiple organisms predominant risk factor = IV drug use 1/3 die
33
what are the clinical features for infective endocarditis?
can be more than one valve bulky, crumbles away vegetation can erode and lead to access = ring abscess can embolise and be septic - contain large numbers of virulent organisms fever non-specific symptoms - loss of weight murmurs - from new valvular defect or pre-existing abnormality
34
how is infective endocarditis diagnosed?
Duke Criteria
35
what is the pathogenesis of infective endocarditis?
any route of bacteria into blood - dental abnormalities - wounds - IV needles - streptococcus viridans from the mouth - staph aureus from the skin - coagulase-negative staphlococci - usually heart valve - HACEK group - all commensals in oral cavity = unusual
36
what does it mean that endocarditis is culture negative?
you cannot isolate the causative agent
37
what can be the complications/features of infective endocarditis? FROM JANE
F - fever - Roth Spots - retinal haemorrhage in the eye - Osler's Nodes - subcutaneous nodules in the pulp of digits M - murmurs - Janeway Lesions - erythematous or haemorrhage non-tender lesions on palms or soles - Anaemia - Nail splinter haemorrhgaes - Emboli (septic)
38
what is the treatment for infective endocarditis?
high concentration of IV antibiotics 4-6 weeks
39
what are the clinical guidelines for treating patients with all above conditions?
there is no clear association with dental procedures - brushing has more risk than procedures - antibacterial prophylaxis and chlorhexidine mouthwash are not recommended - maintain high standard of hygiene -report any unexplained illness after dental treatment, should be investigated promptly