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Y3- I & W > Heart disorders 2 > Flashcards

Heart disorders 2 Flashcards

Rheumatic heart disease Infective endocarditis Medications Cardiomyopathies, pericarditis, myocarditis

1
Q

what is acute rheumatic fever

A

acute immunologically mediated multi inflammatory disease which usually follows a group A beta haemolytic strep infection

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2
Q

what does acute rheumatic fever usually follow

A

a group A

beta haemolytic strep infection

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3
Q

what is acute rheumatic fever characterised by

A 
changes in the heart valves and heart tissue 
Blood vessels 
joints 
subcutaneous tissues 
and CNS
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4
Q

when can we see symptoms of acute rheumatic fever

A

10 days to 6 weeks post infection

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5
Q

what else is included in the pathogenesis of acute rheumatic fever

A

HS reaction combined antibody and T cell response

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6
Q

what are the antibodies against in acute rheumatic fever

A

the m proteins of streptococci but they cross react with the antigens on the heart

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7
Q

what is it called when we suffer from acute rheumatic fever in the heart

A

carditis

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8
Q

what is it called when we suffer from acute rheumatic fever in the pericardium

A

pericarditis

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9
Q

what is it called when we suffer from acute rheumatic fever in the myocardium

A

myocarditis

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10
Q

what is it called when we suffer from acute rheumatic fever in the endocardium

A

valvulitis

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11
Q

what is it called when the aschoff body is seen in all three layers of the heart

A

pancarditis

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12
Q

what is the aschoff body

A

it is a distinct lesion found int he heart which is compromised of macrophages plasma cells and t cells in RHD

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13
Q

when is the aschoff body seen

A

in acute rheumatic heart disease

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14
Q

what are the clinical features of acute rheumatic fever

A 
Migratory polyarthritis of joints 
○ Pancarditis 
○ Subcutaneous nodules 
○ Skin lesions 
Sydenham chorea- involuntary random movements
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15
Q

what is migratory polyarthritis

A

One large joint after another becomes painful and swollen for a period of days and then subsides spontaneously, leaving no residual disability.

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16
Q

how do we diagnose acute rheumatic fever

A

by the JONES CRITERIA

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17
Q

what does the jones criteria state

A

that they have two of the major manifestations
OR
one major and two minor manifestations

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18
Q

what do we definitely need for acute rheumatic fever

A

previous strep A infection

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19
Q

what is the definition of rheumatic heart disease

A

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

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20
Q

what can we develop from rheumatic heart disease

A 
Cardiac hypertrophy 
Dilation 
Heart failure 
Arrhythmias 
Thromboembolic complication due to trial dilation 
Infective endocarditis
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21
Q

what is the treatment for rheumatic heart disease

A

Surgical repair or prosthetic replacement of heart valves

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22
Q

what is the pathology for rheumatic heart disease

A

nodules called verrucae in areas of valve damage

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23
Q

what is usually the sole cause of mitral stenosis

A

rheumatic heart disease

24
Q

define endocarditis

A

inflammation of the endocardium of the heart

25
Q

what are the two main forms of endocarditis

A

infective endocarditis

non infective endocarditis

26
Q

what does non infective endocarditis involve

A

nonbacterial thromboembolic endocarditis

27
Q

define infective endocarditis

A

it is invasion of the heart valves or chamber by a microbe/bacteria/fungi

28
Q

what is the vegetations of infective endocarditis a mixture of

A

thrombotic debris
organisms
and they destroy underlying cardiac tissues

29
Q

what is the difference between acute and subacute infective endocarditis

A

acute infective endocarditis is very nasty and more destructive

30
Q

DESCRIBE ACUTE INFECTIVE endocarditis

A

can occur with infection of a previously normal heart valve

caused by highly virulent organisms

31
Q

what are the signs and symptoms of acute infective endocarditis

A

necrotising ulcerative lesions that perforate through the valve

32
Q

what is the treatment of acute infective endocarditis

A

difficult to treat with antibiotics but will need surgery

33
Q

describe subacute infective endocarditis

A

low virulence bacteria than acute

insidious deformed valves

34
Q

treatment for subacute infective endocarditis

A

antibiotics

35
Q

what is needed for infective endocarditis

A

organisms present in the blood stream to cause infection
OR
cardiac vascular abnormality leading to abnormal flow leading to adherence or growth of organisms

36
Q

risk factors for infective endocarditis

A

pros heart valves
IVDU IV drug use
younger age group usually males
polymicrobial infective endocarditis

37
Q

what in creases the mortality for infective endocarditis

A

Right sided cardiac involvement in more than 60% of cases

Mortality rate is 4x higher for pure left sided vs pure right sided

38
Q

high risk factors for IE is

A

prior ep of endocarditis
pros heart valve
complex congenital heart defects

39
Q

moderate risk of IE

A

PATENT ductus arteriosus
septal defects
hypertrophic cardiomyopathy

40
Q

how does bacteria get into the blood

A 
IVDU 
wounds 
strep viridans in the mouth
strep aureus on the skin 
coagulase negative staphylocci- Heart valves
41
Q

which group of bacteria can be a cause of infective endocarditis

A

the HACEK GROUP

42
Q

what bacteria are part of the HACEK group

A 
haemophilus 
aggribacteur 
cardiobacterium 
eikenella 
kingella
43
Q

what can also be a cause of IE in 5-10% of cases

A

culture negative IE

44
Q

which organisms fail to grow in nromal blood cultures

A

coxiella
chlamydia
bartonella
legionella

45
Q

what are clinical features of infective endocarditis

A 
fever
chills
weakness 
loss of weight/flu like 
new heart murmur
46
Q

how do we diagnose infective endocarditis

A

duke criteria

47
Q

what are clinical manifestations of infective endocarditis

A

janeway lesions
osler nodes
roth spots

48
Q

what do janeway lesions look like

A

erythymatous spots on hands/soles

49
Q

what to osler nodes look like

A

subcutaneous nodes in the pulp of digits

50
Q

what do roth spots look like

A

retinal haemorrhages in the eye

51
Q

what pneumonic can we use to look at clinical manifestations of IE

A

FROM JANE

52
Q

WHAT does from jane stand for

A

fever
roth spots
osler nodes
murmurs

janeway lesions
anaemia
nail haemorrhage
emboli

53
Q

what is the treatment for infective endocarditis

A

but of a pain but we can use

broad spectrum antibiotic such as penicillin for 4-6 weeks

54
Q

what are the nice guidelines for infective endocarditis

A

Antibacterial prophylaxis and chlorhexidine mouthwash are not recommended for the prevention of endocarditis in pt undergoing dental procedures

better to have high OH standard

55
Q

who does non infective endocarditis affect

A

occurs in debilitated patients

can be a part of trousseau syndrome

Y3- I & W (21 decks)

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