Infection And Inflammaiton In The Heart

Question 1

Is a non-infectious form of endocarditis common in SLE

Answer 1

Libman-Sacks Endocarditis (LSE)

Question 2

A significant percentage of patients with SLE have

Answer 2

Valve Abnormalities (28-74%)

Question 3

The number one valve affected in LSE is

Answer 3

Mitral (the aortic)

Question 4

Valve thickening is a common problem with

Answer 4

LSE

Question 5

An inflammatory infiltrate of the myocardium with necrosis and/or degeneration of adjacent myocytes

Answer 5

Myocarditis

Question 6

Manifests in an otherwise healthy person and can result in rapidly progressive heart failure and arrhythmia

Answer 6

Myocarditis

Question 7

Myocarditis is a cause of

Answer 7

SCD

Question 8

Characterized by chest pain and palpitations w/ ECG changes, ventricular arrhythmias, and life-threatening cardiogenic shock

Answer 8

Myocarditis

Question 9

We must exclude coronary artery disease and other non-inflammatory diseases from our differential for

Answer 9

Myocarditis

Question 10

What is a major bacterial species that can cause myocarditis?

Answer 10

Borrelia species

Question 11

Which protozoal agent can cause myocarditis?

Answer 11

Trypanosoma cruzi (Chagas disease)

Question 12

The most common cause of myocarditis in the US

Answer 12

Cardiotropic viruses (Enteroviruses, adenoviruses, parvo B19, and Influenza A)

Question 13

What are the 4 cardiotropic viruses that cause myocarditis?

Answer 13

Coxsackie B3, Adeno, Parvo B19, and Influenza A

Question 14

The A toxin of diphtheria targets

Answer 14

EF-2

Question 15

Can have systemic effects including the myocardium

Answer 15

A Toxin

Question 16

What a are the key phases of diphtheria

Answer 16

Pseudomembrane and “Bull Neck”

Question 17

Club-shaped, Gram (+) that are black on tinsdale agar w/ potassium telluride

Answer 17

Diphtheria

Question 18

A multi system illness caused by Borrelia burgdorferi

Answer 18

Lyme Disease

Question 19

Lyme spirochetes invade the tissues of the

Answer 19

Heart

Question 20

The most commonly recognized clinical feature of Lyme carditis is

Answer 20

Atrioventricular block (some form of heart block)

Question 21

The third most common parasitic infection in the world

Answer 21

Chagas Disease

Question 22

Myocardial involvement occurs in most individuals infected w/

Answer 22

Chagas’ disease

Question 23

Causes a chronic immune-mediated myocarditis that may progress to cardiac insufficiency in 10-20 years

Answer 23

Chagas Disease

Question 24

Characterized by mild and nonspecific symptoms which includes fever, malaise, hepatosplenomegaly, and atypical lymphocytosis

Answer 24

Acute Chagas

Question 25

Of the people w/ acute Chagas, 20-30% have progression to

Answer 25

Chronic Chagas’ Cardiomyopathy

Question 26

Highly arrhythmogenic and can progress to dilated cardiomyopathy w/ ventricular aneurysms

Answer 26

Chagas’ Cardiomyopathy

Question 27

Autoimmune disease that develops as a sequel a of Group A Beta-hemolytic streptococcal infection (GABHS)

Answer 27

Acute Rheumatic Fever

Question 28

Causes nonsuppurative inflammatory lesions of the heart, joints, and CNS

Answer 28

Acute Rheumatic Fever

Question 29

Anti-cardiac antibodies have been demonstrated w/

Answer 29

Rheumatic Fever

Question 30

80% of patients are children ages 5-15

Answer 30

Acute Rheumatic Fever

Question 31

What percentage of patients w/ GABHS pharyngitis develop acute Rheumatic fever

Answer 31

3%

Question 32

Presents 2-3 weeks after streptococcal infection, although many patients do not recall having an URI

Answer 32

Acute Rheumatic Fever

Question 33

Rheumatic fever causes a very painful symmetrical arthritis called

Answer 33

Migratory polyarthritis (35-75%)

Question 34

What are 4 things caused by rheumatic fever?

Answer 34

Migratory polyarthritis, pancarditis, syndenham chorea, and erythema marginatum

Question 35

Involuntary movement caused by RF

Answer 35

Syndenham Chorea

Question 36

The number one sign of rheumatic fever is

Answer 36

Polyarthritis

Question 37

Typically involves the knees, ankles, elbows, and wrists -Inflammation disappears w/in 2-4 weeks

Answer 37

Polyarthritis

Question 38

The ONLY manifestation of acute rheumatic fever w/ significant potential for long-term disability or death

Answer 38

Pan-carditis

Question 39

Can lead to development of new murmurs, signs of CHF, pericardial friction rub, and/or signs of pericardial effusion

Answer 39

Pan-carditis

Question 40

The number one lesion of pan-carditis is

Answer 40

Mitral Regurgitation

Question 41

With acute rheumatic fever, we see a characteristic feature of the myocardium called

Answer 41

Aschoff bodies

Question 42

Can be found in all layers of the heart -Caterpillar cells die to condense chromatin

Answer 42

Aschoff Bodies

Question 43

Pathognomonic for Rheumatic heart disease

Answer 43

Aschoff nodules

Question 44

In 70% of pan-carditis cases, the only valve affected is the

Answer 44

Mitral valve (25% mitral and aortic)

Question 45

The first sign of pan-carditis is

Answer 45

Mitral regurgitation

Question 46

Chronic pan-carditis from RF results in

Answer 46

“Fishmouth” Stenosis

Question 47

Leaflet thickening and commissary thickening and shortening -Thickening and fusion of the chordae tendoniae

Answer 47

Fishmouth Stenosis

Question 48

Neurological disorder characterized by emotional lability, personality change, muscular weakness, etc

Answer 48

Syndenham Chorea

Question 49

Patients are unable to maintain a clenched fist when attempting to grip the examiner’s hand

Answer 49

Syndenham Chorea

Question 50

Acute Rheumatic Fever DOES NOT cause

Answer 50

Stenosis

Question 51

Chronic Rheumatic Fever can then cause

Answer 51

Mitral Stenosis