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CardioPulmonary Vascular Disease > Infective Carditis > Flashcards

Infective Carditis Flashcards

1
Q

What is a major distinction that can be made b/t Staphy A. & S. epi.?

A

S. Aureus is coagulase positive; S. Epidermidis is coagulase negative

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2
Q

But wait!!!! Streptococcus is also catalase negative.

A

Well, Strep is also hemolytic

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3
Q

What strain of Strep is alpha-hemolytic?

A

S. viridans

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4
Q

What Strep strain is beta-hemolytic?

A

S. pyogenes- Strep A

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5
Q

S. bovis should be implicated if pt. has what?

A

a GI neoplasm

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6
Q

S. mutans & S. mitis should be considered in pts. w a h/o what?

A

very poor dentition

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7
Q

What are the 2 most common enterococci assoc. w/ infective endocarditis?

A

E. faecalis, E. faecium

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8
Q

What labs would you order to rule out enterococcus-induced IEC?

A

bile-esculin test (if solution turns black then it is a + test); most enterococci are also gamma-hemolytic

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9
Q

Fungal IEC is incredibly rare, but what are the 2 most common assoc. w/ IEC?

A

Candida & Aspergillus

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10
Q

What are common atypical pathogens assoc. w/ IEC?

A

mycobacteria TB; Chlamydia

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11
Q

List out the HACEK acronym?

A

H: Haemophilus
A: actinobacillus
C: cardiobacterium
E: eikenella
K: kingella

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12
Q

Describe the morphology of HACEK bacteria

A

pleomorphic gram-neg. rods

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13
Q

You are a lab technician and you notice that the agar plate from an IEC pt. is corroded & emits a bleach-like odor; what pathogen is it?

A

Eikenella

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14
Q

What additional components must be added to the agar for haemophilus to grow?

A

factor X & V

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15
Q

you notice yellow granules on a trypticase soy broth agar; what pathogen is it?

A

actinobacillus

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16
Q

culture media must be supplemented with what for nutritionally variant strep. to grow?

A

pyridoxal

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17
Q

Corynebacteria would be moved to the top of your DDx if pt. had a history of what?

A

IV drug use; alcohol abusers; structural heart disease

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18
Q

what kind of medium is needed for corynebacteria?

A

loeffler’s medium

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19
Q

If pt. has symptoms of IEC and a recent h/o food poisoning, what would be the most suspected pathogen?

A

listeria monocytogenes

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20
Q

What kind of stain would you order if mycobacterium was suspected?

A

mycobacteria are acid-fast +

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21
Q

Your pt. works with rare exotic birds and is presenting w/ signs of IEC. What pathogen would you suspect and what stain would you order?

A

chlamydia; Giemsa/Wright stain

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22
Q

Dextran production causes what insults?

A

thrombotic & adhesive vegetation

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23
Q

what bacterial protein facilitates adherence?

A

Fim A.: increases binding capability to host fibronectin

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24
Q

infective endocarditis is assoc. w/ what systemic issues?

A

peripheral emboli & glomerulonephritis

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25
Q

onset of ARF typically occurs how long after URI?

A

3 weeks

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26
Q

Describe the pathophysiology of ARF.

A

Type II hypersensitivity; molecular mimicry of Abs targeting M protein also recognize human cardiac tissue; Cascade effects: Abs bind to endothelial cells to recruit lymphocytes that will lyse the cells; cell lysis release peptides that activate cross-reactive T-cells to amplify the damage

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27
Q

Infective Endocarditis will in most cases always reveal what for the cardio PE?

A

Mitral valve regurgitation

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28
Q

Infective Myocarditis can cause what conducting effect?

A

PR-interval prolongation

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29
Q

Infective Pericarditis is indicative of what PE findings?

A

friction rub, chest pain

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30
Q

What histological findings indicate infective myocarditis?

A

aschoff bodies & anitschkow cells

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31
Q

What would by your stereotypical drug regimen for ARF?

A

Bacteria: penicillin or amoxicillin; NSAIDs for arthralgias; inflammation: glucocorticoids; in server cases, carbamazepine or sodium valproate

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32
Q

What do you need to know about chronic RHD?

A

mechanism: repeated exposures to strep. A.; leads to valvular stenosis; usually presents 10-20 yrs. after initial infection

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33
Q

What is the most common culprit of bacterial vasculitis?

A

rickettsia rickettsii

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34
Q

What are the different characteristics of RMSF?

A

transmitted by dog ticks; small, gram - coccobacilli, stained w/ GIEMSA; bacteria replicates in vascular endothelial cells

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35
Q

How does the RMSF skin changes manifest?

A

macules first appear on wrists & ankles and then spread to remainder of the extremities

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36
Q

What is the standard drug for treatment of RMSF?

A

doxycycline

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37
Q

What is the most common protozoan assoc. w/ Infective vasculitis?

A

Trypanosoma cruzi

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38
Q

Describe the etiology of Chagas Disease?

A

vector: reduviid bug (AKA kissing bug); trypomastigotes from the bug’s feces get introduced into a wound

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39
Q

Describe the clinical presentation of Chagas Disease?

A

Romana sign: unilateral painless periocular edema; Chagoma: focal lymphadenopathy at bite site; malise, fever, anorexia

40
Q

Chronic Chagas disease can cause what clinical manafestations?

A

arrhythmias, RBBB, DCM, megaesophagus, megacolon

41
Q

Chagas disease is most frequently found in which regions of the americas?

A

central & south america

42
Q

What stain would you order for suspected chagas disease?

A

Giemsa stain

43
Q

What are the drugs used to treat Chagas disease?

A

nifurtimox or benznidazole

44
Q

What are the physical exam findings of myocarditis?

A

S3; mitral/tricuspid murmurs

45
Q

Compare & contrast acute vs. fulminant myocarditis?

A

acute: 2-4 weeks after exposure, assoc. w/ DCM long-term complications; fulminant: usually within 2 weeks after exposure, assoc. w/ profound ventricular dysfunction, active inflammation & necrosis, sudden death syndrome or full recovery

46
Q

Compare & contrast the differences b/t chronic active vs. chronic persistent.

A

active: symptoms 2 weeks after exposure, moderate ventricular dysfunction with ongoing inflammation & fibrosis; Persistent: characteristic of the absence of ventricular dysfunction w/ foci of myocyte necrosis

47
Q

What long term complication is assoc. w/ chronic active myocarditis?

A

can develop into RCM 2-4 years after presentation

48
Q

What is the most common cause of infective myocarditis?

A

Viral: coxsackie B

49
Q

What are other viruses that can potentially cause infective myocarditis?

A

Parvovirus B-19; HIV, influenza, CMV, HHV-6; Hep. B.; enterovirus, rubella, polio

50
Q

What type of bacterial myocarditis is assoc. w/ an AV block?

A

borrelia burgdorferi (AKA Lyme carditis)

51
Q

What is the pathogenesis of diphtheriae induced myocarditis?

A

diphtheria toxin: subunit B binds to cells allowing subunit A to be released into the cytosol and inhibits EF2 (important for protein synthesis)

52
Q

What is the clinical presentation of chronic chagas disease?

A

cardiomegaly, megaesophagus, & megacolon

53
Q

composite a list of drugs that can cause Type 1 Hypersensitivity rxn. induced myocarditis?

A

ampicillin, thiazides, lithium

54
Q

What would you expect to find w/ light microscopy for suspected immune mediated myocarditis?

A

eosinophils

55
Q

Composite a list of direct cardiotoxins?

A

Anthracyclines (the “bicin”s); cocaine; alcohol; arsenic; cyclophosphamide; radiation; heavy metals

56
Q

Serous pericarditis is typically caused by what?

A

Irritation from infection of contagious tissues such as a URI; but not a direct infection of the pericardium itself

57
Q

What are common causes of serofibrinous pericarditis?

A

Acute MI; Dressler syndrome

58
Q

What is the definition of purulent/suppurative pericarditis?

A

active infection in the pericardial space that has be extended from neighboring infections

59
Q

What are the most common causes of hemorrhagic pericarditis?

A

TB; neoplasm

60
Q

Adhesive mediastinopericarditis affects which layer of the pericardium?

A

parietal layer

61
Q

What are the most common causes of mediatinopericarditis?

A

Post-infection, previous surgery, & radiation

62
Q

Constrictive pericarditis, unlike mediatino, is not assoc. w/ HCM or DCM; Why?

A

heart is encased in a dense, fibrocalcific scar and cannot adapt to increased systemic demands

63
Q

constrictive pericarditis mimics what other cardiopathy?

A

RCM

64
Q

What is the most common primary malignancy of cardiac tissue?

A

Angiosarcoma: Myxomas

65
Q

Describe the pathogenesis of myxomas?

A

linked to germline mutation of PRKAR1A (alpha regulatory subunit of cAMP-dependent protein kinase type1) this is a tumor suppressor gene (carney complex); derived from multipotent mesenchymal stem cells in the endocardium

66
Q

Describe the distinctive histological characteristics of myxomas?

A

stellated fusiform; polygonal cells immersed in amorphous myxoid matrix

67
Q

What are cardiac fibromas composed of?

A

connective tissue & fibroblasts

68
Q

cardiac fibroma is assoc. with what syndrome?

A

nevoid basal-cell carcinoma syndrome (NBCCS)

69
Q

Describe the pathogenesis of NBCCS?

A

mutations in PTCH1 on ch.9 which is a tumor suppressor gene

70
Q

What other presentations are assoc. w/ NBCCS?

A

skeletal abnormalities & odontogenic keratocysts, basal cell carcinomas

71
Q

Papillary fibroelastoma is located where in the heart?

A

form on valves (sea anemone gross appearance)

72
Q

What complications are assoc. w/ papillary fibroelastoma?

A

cores can embolize and occlude coronary arteries leading to myocardial ischemia

73
Q

What is the most common primary cardiac tumor found in ped. pts.?

A

cardiac rhabdomyomas

74
Q

Describe the distinctive histological characteristics of cardiac rhabdomyomas.

A

cells look like they have a spider inside with fibrillar processes containing sarcomeres protruding from the center to the margins of the cell

75
Q

Cardiac rhabdomyomas can also be assoc. w/ hamartomas. Describe the pathogenesis of hamartomas.

A

assoc. w/ tuberous sclerosis caused by mutations in TSC1 &2

76
Q

what primary cardiac tumor is assoc. w/ the highest incidence of sudden death?

A

cystic tumors of the AV node in the triangle of Koch

77
Q

angiosarcomas are usually found in which regions of the heart?

A

right side

78
Q

What cancer is most likely to metastasize to the heart?

A

malignant melanoma

79
Q

What are the most commonly seen metastatic carcinomas of the heart?

A

lung, breast, GI, lymphomas/leukemias

80
Q

Compare and contrast the differences b/t acute & subacute infective endocarditis?

A

Acute: short incubation (<6 wks.), Staph A., high risk of septicemia & septicemic shock; Subacute: long incubation (>6 wks.), Strep. viridans, vegetation w/ granulomatous tissue that can fibrose or calcify

81
Q

Infective endocarditis caused by HACEK bacteria are most commonly seen in what group of pts.?

A

pediatric pts.

82
Q

Define marantic endocarditis.

A

non-bacterial thrombotic endocarditis; commonly found on undamaged valves; vegetations are small & sterile

83
Q

What are the most common causes of marantic endocarditis?

A

sepsis-induced DIC; pregnancy; venous catheters; carcinomas

84
Q

What is one distinction that can be made b/t NBTE & LSE?

A

NBTE vegetation only forms on one side of the valve leaflets whereas LSE grows on both sides

85
Q

What is typically seen on the results of a CBC for acute and subacute?

A

acute: leukocytosis; subacute: anemia

86
Q

RF is found in which type of infective endocarditis?

A

subacute; also decreased complements: C3, C4, & CH50; nephritic syndrome

87
Q

What can a CXR reveal for endocarditis?

A

Has an Embolus occured?

88
Q

V/Q scanning is good for assessing what type of cardiopathies?

A

right-sided endocarditis

89
Q

What can CT scans reveal about cardiopathies?

A

local abscesses, valvular abnormalities, & vegetations

90
Q

What can a cardiac catheterization assess?

A

degree of valvular damage

91
Q

If Cx come back negative, what would be the next best thing to order?

A

echocardiography

92
Q

What is the clinical criteria for diagnosis of infective endocarditis?

A

2 major criteria or 1 major & 3 minors or 5 minors

93
Q

What are the major criteria for infective endocarditis?

A

+ Cx (at least 2 that are drawn > 12 hrs. apart) or at least 3/4 + Cx with first and last Cx drawn 1 hr. apart; + ECG (defined as identifiable abscesses, a new dehiscence

94
Q

List the minor criteria for infective endocarditis?

A

predisposition (IV drug use or h/o HD); fever; Vascular: janeway lesions, micro emboli, roth spots, mycotic aneurysm, septic pulmonary infarcts, ICH; microbiological evidence and + ECG findings

95
Q

What serologic testing would you order if lyme carditis was suspected?

A

ELISA; if this is + then you would order a WB

96
Q

acute lateral wall infarction is usually assoc. w/ what virus?

A

Parvovirus B19

97
Q

TB pericarditis is assoc. w/ what?

A

elevated pericardial fluid adenosine deaminase; 50% of cases will develop constrictive pericarditis

CardioPulmonary Vascular Disease (7 decks)

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