Infection And Inflammaiton In The Heart Flashcards
Is a non-infectious form of endocarditis common in SLE
Libman-Sacks Endocarditis (LSE)
A significant percentage of patients with SLE have
Valve Abnormalities (28-74%)
The number one valve affected in LSE is
Mitral (the aortic)
Valve thickening is a common problem with
LSE
An inflammatory infiltrate of the myocardium with necrosis and/or degeneration of adjacent myocytes
Myocarditis
Manifests in an otherwise healthy person and can result in rapidly progressive heart failure and arrhythmia
Myocarditis
Myocarditis is a cause of
SCD
Characterized by chest pain and palpitations w/ ECG changes, ventricular arrhythmias, and life-threatening cardiogenic shock
Myocarditis
We must exclude coronary artery disease and other non-inflammatory diseases from our differential for
Myocarditis
What is a major bacterial species that can cause myocarditis?
Borrelia species
Which protozoal agent can cause myocarditis?
Trypanosoma cruzi (Chagas disease)
The most common cause of myocarditis in the US
Cardiotropic viruses (Enteroviruses, adenoviruses, parvo B19, and Influenza A)
What are the 4 cardiotropic viruses that cause myocarditis?
Coxsackie B3, Adeno, Parvo B19, and Influenza A
The A toxin of diphtheria targets
EF-2
Can have systemic effects including the myocardium
A Toxin
What a are the key phases of diphtheria
Pseudomembrane and “Bull Neck”
Club-shaped, Gram (+) that are black on tinsdale agar w/ potassium telluride
Diphtheria
A multi system illness caused by Borrelia burgdorferi
Lyme Disease
Lyme spirochetes invade the tissues of the
Heart
The most commonly recognized clinical feature of Lyme carditis is
Atrioventricular block (some form of heart block)
The third most common parasitic infection in the world
Chagas Disease
Myocardial involvement occurs in most individuals infected w/
Chagas’ disease
Causes a chronic immune-mediated myocarditis that may progress to cardiac insufficiency in 10-20 years
Chagas Disease
Characterized by mild and nonspecific symptoms which includes fever, malaise, hepatosplenomegaly, and atypical lymphocytosis
Acute Chagas
Of the people w/ acute Chagas, 20-30% have progression to
Chronic Chagas’ Cardiomyopathy
Highly arrhythmogenic and can progress to dilated cardiomyopathy w/ ventricular aneurysms
Chagas’ Cardiomyopathy
Autoimmune disease that develops as a sequel a of Group A Beta-hemolytic streptococcal infection (GABHS)
Acute Rheumatic Fever
Causes nonsuppurative inflammatory lesions of the heart, joints, and CNS
Acute Rheumatic Fever
Anti-cardiac antibodies have been demonstrated w/
Rheumatic Fever
80% of patients are children ages 5-15
Acute Rheumatic Fever
What percentage of patients w/ GABHS pharyngitis develop acute Rheumatic fever
3%
Presents 2-3 weeks after streptococcal infection, although many patients do not recall having an URI
Acute Rheumatic Fever
Rheumatic fever causes a very painful symmetrical arthritis called
Migratory polyarthritis (35-75%)
What are 4 things caused by rheumatic fever?
Migratory polyarthritis, pancarditis, syndenham chorea, and erythema marginatum
Involuntary movement caused by RF
Syndenham Chorea
The number one sign of rheumatic fever is
Polyarthritis
Typically involves the knees, ankles, elbows, and wrists
-Inflammation disappears w/in 2-4 weeks
Polyarthritis
The ONLY manifestation of acute rheumatic fever w/ significant potential for long-term disability or death
Pan-carditis
Can lead to development of new murmurs, signs of CHF, pericardial friction rub, and/or signs of pericardial effusion
Pan-carditis
The number one lesion of pan-carditis is
Mitral Regurgitation
With acute rheumatic fever, we see a characteristic feature of the myocardium called
Aschoff bodies
Can be found in all layers of the heart
-Caterpillar cells die to condense chromatin
Aschoff Bodies
Pathognomonic for Rheumatic heart disease
Aschoff nodules
In 70% of pan-carditis cases, the only valve affected is the
Mitral valve (25% mitral and aortic)
The first sign of pan-carditis is
Mitral regurgitation
Chronic pan-carditis from RF results in
“Fishmouth” Stenosis
Leaflet thickening and commissary thickening and shortening
-Thickening and fusion of the chordae tendoniae
Fishmouth Stenosis
Neurological disorder characterized by emotional lability, personality change, muscular weakness, etc
Syndenham Chorea
Patients are unable to maintain a clenched fist when attempting to grip the examiner’s hand
Syndenham Chorea
Acute Rheumatic Fever DOES NOT cause
Stenosis
Chronic Rheumatic Fever can then cause
Mitral Stenosis
