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2020 CPR II Cardio Exam 1 > Lecture 1: Microbiology of the Cardiovascular System > Flashcards

Lecture 1: Microbiology of the Cardiovascular System Flashcards

1
Q

What are 6 differential diagnoses for Myocarditis?

A
  1. Acute MI
  2. Acute and/or chronic HF
  3. Atypical chest pain
  4. Pericarditis
  5. Cardiomyopathies
  6. Valvular disease
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2
Q

During PE/ausculation of patient with myocarditis what are 3 possible findings?

A
  1. Soft S3/S4 (impaired ventricular function)
  2. New murmur (2’ to valvular insufficiency - variable)
  3. Pericardial friction rub (if extension into pericardium)
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3
Q

With myocarditis the signs and sx’s will be similar to CHF of which part of h cardiac cycle?

What signs/sx’s?

A
  • Systolic CHF (decreased contractility)
  • Orthopnea, dyspnea on exertions, crackles, paroxysmal noctural dyspnea
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4
Q

Upon extra-workup for myocarditis utilizing an EKG what are you assessing for and what are the most common findings?

Which rhythm is most common?

A
  • A assess for arrhythmia (sinus TACHY most common)
  • Transient ST-T wave
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5
Q

What are 5 workups that should be considered to aid in your diangosis of myocarditis?

A
  1. EKG
  2. CXR
  3. Echocardiogram
  4. PCR - detection of viral genome
  5. Labs
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6
Q

What would an echocardiogram help you assess in a patients with suspected myocarditis?

A
  • Ventricular function and structure
  • Evaluation of ejection fraction, LV size, and wall abnormalities
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7
Q

Which 5 lab values would be helpful in the diagnosis of myocarditis?

A
  1. CBC (possible leukocytosis)
  2. Cardiac enzymes (likely ↑ 2’ to myocyte damage)
  3. BNP (signs/sx’s of HF)
  4. CPK (assesing muscle damage)
  5. ESR and CRP
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8
Q

Which invasive diagnostic study may aid in the definitive diagnosis of Myocarditis?

A

Endomyocardial biopsy

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9
Q

What are 3 possible complications of myocarditis?

A
  1. Dilated cardiomyopathy
  2. Myopericarditis
  3. Sudden cardiac death (20%)
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10
Q

Which 3 drug classes are feasible options for treating myocarditis?

A
  • Beta blockers
  • ACE-I
  • Diuretics
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11
Q

What are 3 things that need to be avoided or reduced in a patient with myocarditis?

A
  • NSAIDs and Alcohol
  • Exercise (restricted)
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12
Q

What are the 3 most common infectious etiologies of Myocarditis?

A
  • Coxsackie B
  • Trypanosoma cruzi
  • Trichinella spiralis
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13
Q

Which viral family does Coxsackie B virus belong to and what is it’s morphology?

A
  • Picornaviridae, Enterovirus
  • (+) ssRNA virus, small, naked, icosahedral
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14
Q

When is the peak incidence of Coxsackie B virus and it’s mode of transmission?

A
  • Summer and fall
  • Fecal-oral transmission
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15
Q

What are 4 clinical manifestations caused by Coxsackie B virus?

A
  • URI
  • Pleurodynia (Devil’s grip - severe intercostal pain and fever)
  • Myocarditis (most common infectious etiology)
  • Aseptic meningitis
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16
Q

Which parasitic cause of Myocarditis is described as a hemoflagellate (intracellular protozoa)?

A

Trypansoma cruzi

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17
Q

What are 2 diagnostic methods for Chagas disease (Trypanosoma cruzi)?

A
  • Peripheral smear for trypomastigotes
  • Xenodiagnosis
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18
Q

Signs/sx’s of acute phase Chagas Disease?

A
  • Chagoma, Romana sign
  • Fever, malaise, LAD
  • CV: myocarditis
  • CNS: severe meningoencephalitis (young pt’s)
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19
Q

What are the sign/sx’s of chronic Chagas Disease, both CV and GI?

A
  • CV: dilated cardiomyopathy, arrhythmias
  • Megalcolon and achalasia
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20
Q

What type of helminth is Trichinella spiralis**?

A

Invasive nematode

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21
Q

How is Trichinella spiralis transmitted?

A

Ingestions of cysts from raw pork (boars OR even horses)

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22
Q

Explain the life cyle of Trichinella spiralis upon ingestion of cysts, where do larvae mature and disseminate?

A
  • Develop in gut –> mate –> larvae disseminate hematogenously
  • Penetrate muscle tissue: skeletal, heart, and brain
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23
Q

What are the signs/sx’s Trichinella spiralis based on location in the body?

A
  • Abdominal pain, diarrhea, fever (small intestines)
  • Muscle aches (muscle invasion)
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24
Q

Periorbital edema, myositis, and eosinophilia should make you consider the diagnosis of which organism?

A

Trichinella spiralis

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25
What are diagnostic techniques utilized for *Trichinella Spiralis?*
- **Serologic** (ELISA, etc.) - **Latex agglutination** - **CPK** levels - **Muscle biopsy**
26
Extension of myocarditis into the pericardium is termed what?
Myopericarditis
27
What are the common presenting signs/sx's of Pericarditis?
- Chest pain that is **sharp**, often positional and pleuritic in nature - Often **relieved** by **leaning forwards** - Fever - Palpitations
28
What are the common PE findings associated with Pericarditis?
- **Friction rub** upon auscultation - Rapid or irregular pulse
29
What is the **hallmark** EKG findings and in what leads for **Pericarditis**?
DIFFUSE **ST elevations** w/ **RECIPROCAL dpressions** in leads **aVR** and **V1** w/ **PR depression**
30
Majority of CXRs with pericarditis show minimal abnormalities, what is the exception? What characteristic findings?
- **Pericardial effusion** \>250 mL --\> **symmetrically** enlarged cardiac silhoutte - "**Water bottle sign"**
31
Which imaging modality should be used in pericarditis to assess for pericardial effusion and/or tamponade, as it is more sensitive than CXR.
**Transthoracic** **Echocardiogram**
32
What would be a PE finding in pt with suspected Pericarditis that would warrant blood cultures?
Temp \>38°C
33
What labs would be useful for diagnosing Pericarditis?
- Cardiac enzymes (**serial**) - CBC w/ diff - ESR - CRP - Blood cultures if temp \>38°C
34
What is a possible complication of Pericarditis and how is it treated?
- **Cardiac Tamponade** - Tx w/ **pericardiocentesis** \*Counsel about activity restrictions\*
35
Which drugs should be utilized in Pericarditis due to **viral** etiology? What is **contraindicated**?
- **High dose ASPIRIN** **x3/day** (ibuprofen, Indomethacin are options too) AND - **Colchicine** - **ANTICOAGULANTS** ARE **CONTRAINDICATED!!!!**
36
Which infectious agent **most often** causes **serous** pericarditis and which most often causes **causeous** pericarditis?
- **Coxsackie B** = **serous** pericarditis - **Mycobacterium tuberculosis** = **caseous** pericarditis
37
What is distinct morphology of Mycobacterium Tuberculosis? Oxygen dependency and facultative intracellular in what?
- **Acid fast bacillus** (weakly G +) - **Obligate** aerobes - **Facultative intracellular** in **Macrophages**
38
Due to the mycolic acid cell wall composition Mycobacterium tuberculosis is **highly resistant** to what?
Desiccation (drying out) including NaOH
39
The virulence of Mycobacterium Tuberculosis is related to what factors?
- Facultative intracellular - **Sulafatides** - **Cord factor** - **Surface protein** can cause delayed hypersensitivity and cell mediated immune rxn - **Wax D**
40
Which 2 stains can be used for Mycobacterium Tuberculosis and the appearance of the organism with each?
- **Acid Fast** (Ziehl-Neelsen, Kinyon) = **"red rods****"** - **Auramin-rhodamine stain** = **fluorescent apple green color**
41
Although, the main manifestation of mycobacteirum tuberculosis is pulmonary TB, how can it cause caseating pericarditis?
**Direct lymphatic** or **hematogenous diseemination**
42
Infective endocarditis (IE) starts with what?
Bacteremia
43
What are the constitutional sx's associated with Infective Endocarditis (IE)?
- **Fever, chills** - Weight loss - **New/worsening** murmur - Fatigue - **Arthralgia** and **myalgia**
44
How do the signs and sx's of Acute IE differ from Subacute IE?
- **Acute** = _RAPID_ progrssion of sx's and cardiac damage --\> **high fever, chills, weakness SOB, pleuritic chest pain** - **Subacute** = _INDOLENT_ course w/ **low grade fever**, weight loss over time, fatigue, arthralgia/myalgia
45
What are 5 possible complications of Infective Endocarditis (IE)?
- Congestive heart failure - Abscess formation - Hematogenous spread - Embolism - Systemic immune rxn --\> **death**
46
Which side of the heart and valves are most often affected in acute vs. subacute IE?
- **Acute** **IE**: R side \> L side --\> Tricuspid \> aortic, especially w/ *S. aureus* - **Subacute IE**: L side \> R side --\> Mitral or aortic valve
47
What are the diagnostic studies (imaging)/labs indicated for Infective Endocarditis? Why is a UA indicated?
- **Blood culture** **x3** (**ALWAYS prior** to Abx) - **CBC w/ diff** + **CMP** + **ESR** and **CRP** - **EKG** and **CXR** and **Transesophageal echocardiogram (US)** - **UA** (assess for hematuria)
48
Using the DUKE criteria for diagnosis of IE, what are the 4 **major** criteria?
- **Blood culture** positive for IE - Evidence of **endocardial** involvement - **Echocardiogram** positive for IE - **New** valvular regurgitation (worsening or changing or preexisting murmur NOT sufficient)
49
Using the DUKE criteria for diagnosis of IE, microorganisms consistent with IE from persistently (+) blood cultures is defined as what?
- **At least 2** positive blood cultures of blood samples draw **\>12 hr** apart OR - **All of three** or a **majority of ≥4** seprate cultures of blood (w/ first and last sample drawn at least 1 hr apart)
50
Transesophageal echocardiogram (TEE) is recommended in pt's under what 3 conditions?
- Pt's with **prosthetic valves** - Rated at least "possible IE" by clinical criteria - Complicated IE (paravalvular abscess)
51
What are the 6 minor criteria as defined by the DUKE criterias for diagnosis of IE?
- **Predisposition**, predisposing heart condition of **IV drug use** - **Fever**, temp **\>38°C** - **Vascular phenomena** - **Immunologic phenomena** - **Microbiological evidence** - **Echocardiographic** minor criteria eliminated
52
Which microbiological evidence is considered **minor** using the DUKE criteria for IE?
- Positive blood culture but does NOT meet a major criterion - **Serological** evidence of acute infection w/ organisms inconsistent w/ IE
53
Using the DUKE criteria for diagnosis of IE how many major, minor, or combination needs to be met for **definitive diagnosis**?
- **2 major criteria** OR - **1 major** and **3 minor criteria** OR - **5 minor criteria**
54
What are the risk factors/considered high risk pt's for Infective Endocarditis (including age, sex, and underlying conditions)?
- **Age** \>60 and **M\>F** - **Poor dentition** - **IV drug abuse** - Structural, congenital or valvular HD - **Prosthetic valve** replacement - **Rheumatic heart disease**
55
If pt with IE goes into cardiogenic shock, what is the treatment?
Surgery ASAP
56
After obtaining blood cultures in pt with **acute/toxic IE**, you should start emperic Abx utilizing what 2 Abx?
**Vancomycin** +/- **Gentamicin**
57
It may not be necessary to initiate empiric Abx for which type of IE and can be best to wait for culture and sensitivites to target a specific organim?
SUBACUTE
58
Pt's considered high risk for IE can be given prophylactic Abx prior to dental or respiratory procedures, what is given if they are **able to take PO** medication?
Amoxicillin
59
Pt's considered high risk for IE can be given prophylactic Abx prior to dental or respiratory procedures, what are 3 options if they are **unable to take PO** and **need IV?**
**Ampicillin** or **Cefazolin** or **Ceftriaxone**
60
Pt's considered high risk for IE can be given prophylactic Abx prior to dental or respiratory procedures, what are 4 options if they are **allergic to penicillin (PCN)?**
**Desensitize** v. **Cephalexin** v. **Clindamycin** v. **Azithromycin**
61
What are the 4 most common infectious agents causing IE?
- *S. aureus* - *S. epidermidis* - *S. viridans* - Enterococcus (Group D strep)
62
What are the 4 **rare** etiologic agents that can cause of IE?
- HACEK group - *Coxiella burnetti* - *Brucella sp.* - *S. agalactiae*
63
A single positive blood culture for which agent is considered as meeting a **major** criteria when using DUKE for the dx of IE?
*Coxiella burnetti*
64
What is the morphology and major characteristics of *S. aureus?*
- **Gram (+) cocci**, clusters - **Coagulase** AND **catalase (+)** - Facultative anaerobe
65
*S. aureus*is a normal component of which flora and colonizes where in humans?
- Normal flora on **skin** (can breach) - Colonizes the **nasopharynx**
66
A gram stain taken from a pt with Infective Endocarditis is shown, what organism is this most consistent with?
*S. aureus =* Gram (+) cocci in clusters
67
Which 5 virulence factors of *S. aureus* allow for host cell **evasion?** Function of each.
- **Protein A:** prevents opsonization by binding Fc of IgG - **Coagulase**: forms fibrin clot around organism - **Catalase**: breaks down H2O2 - **Hemolysins**: destroy RBC - **Leukocydins**: destroy WBC
68
Which 3 virulence factors allow for **invasion** of tissue and bloodstream by ***S. aureus**?*
- **Hyaluronidase**: breaks down CT - **Staphylokinase**: lyses formed clots - **Lipase**: breaks down fat
69
What are the 3 toxin mediated manifestations caused by *S. aureus?*
- Food poisoning - Scalded Skin Syndrome (SSS) - Toxic Shock Syndrome
70
What are local manifestations of the skin and respiratory tract caused by *S. aureus?*
- **Skin**: impetigo, cellulitis, folliculitis, furuncles, carbuncles - **Respiratory**: pneumonia (**cavitary**)
71
What are the 4 systemic manifestations caused by *S. aureus?*
- **Acute** endocarditis (Tricuspid valve) - Meningitis - Osteomyelitis (#1 cause in adults AND children) - Septic arthritis
72
What are the signs/sx's of acute endocarditis caused by *S. aureus?*
- **Fever** and **chills** and **night sweats** - **Fatigue**, **dyspnea** - **CHF**
73
For systemic disease caused by *S. aureus* what is an exception choice of Abx? For MSSA?
- **Vancomycin** is exceptional choice - For **MSSA** use **Nafcillin**
74
What is the morphology of *Streptococcus viridan*s and major characteristics (O2 dependence, catalase, optochin..)?
- **Gram (+) cocci** in CHAINS - **α-hemolytic** (green zone) + catalase **negative** + Optochin **resistant** - Facultative anaerobe
75
*S. viridans* is a normal inhabitant of where?
Normal **oral flora**, nasopharynx, and GI tract
76
Which virulence factor of *S. viridans* allows for binding to heart valves?
Extracellular dextran
77
What are 2 clinical manifestations caused by *S. viridans?*
- **Dental caries** - **Subacute endocarditis**
78
Which Abx is used for *S. viridans?*
Penicillin (PCN)
79
Which cause of infectious endocarditis is **novobicin sensitive**?
*Staphylococcus epidermidis* \*Sketchy = **naval** exposed and plumber is **sensitive**
80
What are morphological and major characteristics of Staphylococcus epidermidis (O2 dependence, coagulase/catalase)?
- **Gram (+) cocci** in **clusters** - **Coagulase** negative AND **catalase** positive - **Novobicin** sensitive - Facultative anaerobe
81
*Staphylococcus epidermidis* is a normal inhabitant of?
Normal flora of **skin**
82
What are the 2 virulence factors of *S. epidermidis* and which allows it specifically to adhere to prosthetic devices/indwelling catheters?
- **Adhesion polysaccharide** **capsule** --\> prosthetic's/catheters - **Biofilm** formation \*Gunk under sink, tubing under sink (cathether), plumber working on pipes (prosthetics)
83
Which *staphylococcus* is **coagulase negative** staph (CoNS)?
*S. epidermidis*
84
*Staphylococcus epidermidis* is extremely Abx resistant, so treat with which Abx?
Vancomycin
85
Vegetations of a prosthetic device, including knees and valves of the heart should make you think of what organism?
*S. epidermidis*
86
What are 2 systemic manifestations of *S. epidermidis?*
- **SUBacute** endocarditis - Infection and bacteremia in **neutropenic pt's** (susceptible)
87
What are the morphological and major characteristics of *Enterococcus faecalis* (Group D strep)? i.e., O2 dependence, catalase, and hemolytic nature
- **Gram (+) cocci** - Catalase **negative** - Facultative anaerobe - Variable hemolytic nature (alpha or gamma)
88
What is the virulence factor of *Enterococcus faecalis (Group D strep)*, allows it to bind what?
Extracellular **dextran** helps bind heart valves
89
What are 3 clinical manifestations caused by both *Enterococcus faecalis or Streptococcus bovis (Group D strep)?*
- **SUBacute** endocarditis - UTI's - Biliary tract infections
90
Forms of *Enterococcus faecalis* resistant to what Abx are on the rise?
Vancomycin
91
Which non-enterococci (group D strep) is associated with colon cancer and IBD?
*Streptococcus bovis*
92
What are the morphological and major characteristics of *Streptococcus bovis*? i.e., O2 dependence, catalase, hemolysis..
- **Gram (+) cocci** in **chains** - Catalase **negative** - Facultative anaerobe - Variable hemolytic nature (**α or γ**)
93
Which media can you grow the group D strep, *E. faecalis* and *S. bovis* on? What is one major difference.
- ***E. faecalis*** = **40% bile** AND **6.5% NaCl** or **blood agar** * - **S. bovis*** = **40% bile** and **Blood agar**
94
What are the morphological characteristics of the HACEK group of organisms?
**Gram (-)** group of **bacilli** + fastidious
95
Which agar can be used for the HACEK group of organisms?
Chocolate agar
96
The HACEK group of organism are a part of which normal flora?
Oral flora
97
Which type of *Haemophilus sp* is most likely to cause endocarditis?
*H. parainfluenzae*
98
*Haemophilus* *sp.* typically cannot grow up blood agar unless placed on same place as *S. aureus*, will show what type of growth? Why?
- **Stellate** growth - Due to **virulence factor** of *S. aureus*, hemolysins, which will lyse the RBC's
99
What is the morphology and major characteristics of *Coxiella burnetti?*
- **Gram (-)** and **pleomorphic** - **Aerobic** + **zoonotic** - Obligate intracellular
100
What is the mode of transmission for *Coxiella burnetti?*
**Aerosol** transmission

2020 CPR II Cardio Exam 1 (31 decks)

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