Infections of Cardiovascular Flashcards
what is primary bacteremia?
direct inoculation of the blood stream (nosocomial, IV drug use)
what is secondary bacteremia?
microorganisms causing infection at another site (pneumonia) invade the blood stream and disseminate via the circulation to other body areas (hematogenous spread) - (ex. opportunistic)
what is transient bacteremia?
self resolving in people with NO underlying illnesses, immune deficiency or turbulent cardiac blood flow
what is bacteremia?
presence of bacteria in the bloodstream; may or not be clinically significant
what is sepsis?
life threatening organ dysfunction due to dysregulated host response to infection (body response to an infection injures its own tissues and organs)
what is septic shock?
subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality
what is the critical criteria for septic shock?
- sepsis
- hypotension requiring vasopressors to maintain mean arterial pressure (MAP) >65 mm Hg despite fluid restriction
- lactate > to 2 mmol/L
what are the characteristics of sepsis?
- infection (suspected or confirmed)
- acute, life threatening organ dysfunction as defined by a sepsis related organ failure assessment (SOFA) tool
(SOFA)= measures respiratory, hepatic, CV, renal, CNS and platelet dysfunction
what is the endocardium?
thin continuous lining inside the chambers of the heart, extends to cover the valves
what is the myocardium?
muscle tissue of the heart (middle layer)
what is the pericardium?
thin double-layered sac that encloses the heart
what is rheumatic fever?
autoimmune reaction
complication of streptococcal pharyngitis (strep) infections
what microbe causes rheumatic fever?
streptococcus pyogenase (group A streptococcus)
what people most commonly get rheumatic fever?
most are socioeconomicly disadvantaged, low/middle incomes countries (indigenous children an young peoples)
how long does rheumatic fever last for?
approx 3 months
what is the patho of rheumatic fever?
form of molecular mimicry; microorganisms with episodes similar to host self- antigens triggers autoimmune mediated tissue damage
who is erythema marginatum rarely observed in?
adults
who is chorea rarely observed in?
adults, observed in children
what is carditis?
- inflammation of heart valves (valvulitis), no infection
- acute valvulitis: valvular regurgitation, chronic valvulitis, valve stenosis
- typically effects left sided valves, with greater affinity for mitral valve
- HF symptoms develop with progressive heart valve damage
what is polyarthritis?
large joints, lasts approx 2-4 weeks
how can you prevent rheumatic fever?
prophylaxis with treatments antibiotics
how can you prevent rheumatic fever with NO residual HD?
benzathine penicillin G, IM q/4 weeks until age 21 or 10 years after last ARF, lifetime prophylaxis may be needed
how can you prevent rheumatic fever with residual HD?
benzathine penicillin G, q/4weeks until age 40 or 10 years after last ARF, lifetime prophylaxis may be needed
what is residual HD referred to as?
persistent valvular disease - referred to as rheumatic valve
is there a treatment/cure for acute rheumatic fever?
no, management
what drugs can help acute rheumatic fever to relieve inflammation and bed rest?
anti inflammatory drugs
- pharmacologic therapies used for HF (if symptomatic)
what procedure may be required for residual HD?
valvuloplasty and valve replacement
(percutaneous mitral balloon commissurotomy for mitral valve stenosis is the Tx of choice in those with a suitable valve)
clients with rheumatic heart valve are at an increased risk for complications associated with what?
bacteremia
why do transient cases of bacteremia become problematic?
bc the microbe has a new place to adhere (due to roughening of endocardium), increasing risk of infective endocarditis
the increased risk of bacteremia with rheumatic heart valve is associated with what?
turbulent blood flow at site of the damaged valve an resulting damage to the endocardium
minor fibrin and platelet deposition can occur on the low pressure side of the damaged valve and can lead to?
non bacterial thrombotic endocarditis (NBTE)
what are splinter hemorrhages?
linear lesions in the long axis of the distal third of the nail
what are janeway lesions?
painless macular lesions, commonly on palmer surfaces of hands and feet (septic emboli)
what are oslers nodes?
small painful nodular lesions commonly on pads of fingers and toes, mainly seen in cases of subacute endocarditis
what are Roth spots?
pale - centered retinal hemorrhages; fibrin and platelet aggregation in white center
what is acute endocarditis associated with?
highly virulent bacteria (staphylococcus aureus)
how do symptoms manifest in acute endocarditis?
develop quickly (days), high fever (38.9-40), chills, tachycardia
what is acute endocarditis?
new or changing heart murmu, peripheral manifestations
what is subacute endocarditis?
new or changing heart murmu, peripheral manifestations
how do symptoms manifest in subacute endocarditis?
develop slowly (weeks to months); mild fever, malaise/fatigue, weakness, myalgia, cough, headache, back or chest pain and wt loss