Infections of Heart

Question 1

Diagnostic Criteria for Bac Endocarditis

Answer 1

• Any pathological signs (microbe in vegetation or abscess, histology)
• OR 2 major OR 1 major 3 minor OR 5 minor
  • Major - blood culture, echo, new regurgitation
  • Minor- fever, classic lesions, abnormal valve, single unusual blood culture

Question 2

6 Common Complications from Endocarditis Embolism

Answer 2

• Splinter hemorrhages (in fingernails)
• January lesions - non-painful
• Osler nodes - painful, red, on fingers and toes
• Roth’s spots - retina
• Kidney abscesses
• Brain infarcts

Question 3

2 Pathology Signs of Rheumatic Myocarditis

Answer 3

• Aschoff body (t cells, plasma cells, activated macrophages)
• Anitschkow cells w/in bodies (multi-nucleated, activated macrophages, “caterpillar cells”)

Question 4

Viral Myocarditis (causes and features)

Answer 4

• Poss Causes - Coxsackie, adenoviruses, flu
• Clinical Features - viral illness symptoms, arrhythmia or palpitations, dyspnea, pre-cordial discomfort (inflammation over chest area); elevated CK-MB and troponins
• CAN RAPIDLY LEAD TO HEART FAIL AND DEATH
• Gross Pathology - pale, floppy myocardium
• Histo - LYMPHOCYTES

Question 5

Eosinophilic Myocarditis

Answer 5

• Causes - drug reaction or parasite

- Ex) Chagas - trypanosoma cruzi (“kissing bug”) —> immune-mediated myocarditis

Question 6

Giant Cell Myocarditis

Answer 6

• Particularly aggressive/quick death

- Mixed infiltrate w/ giant cells and extensive myocte necrosis

Question 7

What are the 3 major complications of pericarditis?

Answer 7

Cardiac Tamponade/fluid collection (immediate pericardiocentesis) & Cardiac Arrhythmia

Chronically - restrictive pericarditis as scarring occurs

Question 8

Beck’s Triad

Answer 8

• Inc jugular venous distension (high atrial P)
• Hypotension (low CO)
• Muffled heart sounds (fluid dec sounds)

Question 9

4 Types of Pericarditis

Answer 9

1- Serous

    - Clear fluid or straw-colored; high protein exudate
    - Caused by SLE, rheumatic fever, viral infection

2- Fibrinous

    - Yellow or white stringy exudate b/c rich in fibrin
    - Caused by Dressler’s Syndrome (acute MI or recent heart surgery) or uremia due to renal failure

3- Purulent

    - Thick yellow pus
    - Caused by infection

4- Hemorrhagic

    - Bloody inflammatory effusion
    - Caused by chronic TB, tumor invading pericardium (2 Ts) or bacterial infection