other heart ds Flashcards
Rheumatic Heart Disease definition + frequency of valve locations
Definition:
- Systemic IMMUNE process that is a sequelae of group A beta hemolytic steptococcal infection of pharynx
- presents with perivascular granulomatous reaction w/ vasculitis (WBCs/granulomas form around the vessels and the vessels are inflammed)
- GABHS doesn’t directly infect valves but causes an immune activation that leads to an autoimmune response in the valves
Locations:
- Mitral Valve (MC): 75-80%
- Aortic Valve: 30%
- Tricuspid/Pulmonary: 5%
Rheumatic Heart Disease presentation
MC:
- 5-15 yrs old
- immigrant population; uncommon in US
- 2-3 post infections typical
Rheumatic Heart Disease dx
Jones Criteria Diagnosis must meet:
- Two Major
- One Major and Two Minor
- Subclinical on Echocardiogram
lower threshold in high risk populations:
- main difference is just arthritis
Major + Minor Criteria for Rheumatic Heart Ds
Low Risk Populations- Standard Population
Major: JONES
Joint involvement - polyarthritis ONLY
O= heart MyOcarditis
Nodules (Subcutaneous)
Erythema Marginatum
Sydenham Chorea
(CAFE P)
Minor:
- CRP >3.0 (Elevated)
- POLYArthralgia *
- Fever (>38.5) *
- ESR > 60 *
- Prolonged PR Interval
Major + Minor Criteria for Rheumatic Heart Ds
Moderate- High Risk Population
Major: JONES
Joint involvement: MONOARTHRITIS!* and polyarthralia***
O= heart MyOcarditis
Nodules (Subcutaneous)
Erythema Marginatum
Sydenham CHOREA
Minor: “CAFE P”
- CRP >3.0 (Elevated)
- MONOArthralgia *
- Fever (>38.0) *
- ESR > 30 *
- Prolonged PR Interval
Chronic RHD has rigidity and deformity of the valve cusps … what can occur?
Fusion of commissures or shortening/ fusion of chordae tendinea
Evolves from acute inflammatory part of rheumatic fever -> lasting damage to the heart valves Can lead to:
- VALVULAR stenosis: narrowing of the valve opening
- REGURGITATION: leak blood flow back into the valve
Treatment + prevention of Rheumatic Heart Disease
Bedrest until stable
Salicylates (Aspirin)
- Fever reduction
- Joint pain reduction
PCN IM *
Prednisone: Joint symptom relief
Prevention:
- Early treatment of GABHS: Penicillin
- prevent recurrence by discarding toothbrush after RHD
Prognosis:
- Mortality 1-2%
- 30% of this population of children can die within 10 years - after 10 years: 2/3 will have detectable valvular abnormalities
endocarditis organisms: acute, vs subacute
Acute Endocarditis: Most severe/Septic
- Staphylococcus aureus ** IV drug users
-Streptococcus pneumoniae
-Streptococcus pyogenes
-Neisseria gonorrhoeae
Subacute Endocarditis: Less severe + slower onset
- Streptococcus bovis: associated with colon cancer
- Streptococcus viridans: associated with dental procedure + pts with hx of valvular disease
- Staphylococcus epidermidis: associated with prosthetic valves
-Candida albicans: IV drug users
Bacterial Endocarditis
Definition
Bacterial or fungal infection of the valvular or endocardial surface of the heart
- Bacteria in blood stream colonizes valve surface -> could form emboli and travel hemotogenously thorughout the body
- MCC: STAPH AUREUS -> rapid progression with destructive infection; bad aseptic technique in hospital pts, IV drug use
Most common cause of Bacterial Endocarditis and pathology
MC cause: Underlying valvular disease (REGURGITATION > stenotic)
- Valvular abnormalities create turbulent blood flow = disrupts endothelial surface = conducive for attachment & colonization (nidus for attachment)
- Having rheumatic valves, bicuspid aortic valve, sclerotic valves, hypertrophic subaortic stenosis, congenital disorders, mitral valve prolapse
noninfectious causes of Bacterial Endocarditis
Autoimmune-like response
Libman-Sacks Endocarditis
- From hx of systemic lupus erythematosus
- Commonly mitral or aortic valve involvement
Marantic Endocarditis:
- From metastatic cancer, poor prognosis
Bacterial Endocarditis sx
Sx: “FROM JANE - P”
Fever, FLANK pain (renal)
Roth Spots
Osler Node
Murmur: new or louder*
Janeway Lesions
Arthralgia/arthritis
Nail-Bed Hemorrhage: SPLINTER HEMORRHAGE*
Emboli: Stroke, Systemic emboli, Renal emboli*
PETICHIAE
Endocarditis Work up most common order valves
MITRAL MC
aortic
tricuspid
pulmonic
Bacterial Endocarditis dx
Duke Criteria:
- 2 Major Criteria
- 1 Major & 3 Minor Criteria
- 5 Minor Criteria
“BE First VIP Man”
Major: “BE”
- 1) Blood Culture: 2 separate positive blood cultures with microorganisms typical for endocardits
-2) Endocardial involvement:
2.1 Echocardioraphic evidence: see vegetation, abscess, dehisence of prosthetic valve
2.2) New Valvular Regurgitation
Minor: “First VIP Man”
- Fever
- Vascular phenomenon: arterial emboli, pulmonic infarct, intracranial conjunctival hemmorhage, janeway lesion
- Immunological Phenomena: (glomerunephritis, olser nodes, roth spots, RF)
- Predisposition heart condition or IV drug use
- Microbiological evidence (+ blood culture, serologic evidence of active infx)
Possible complications of Bacterial Endocarditis
“AM SHAPES”
-Aneurysms
-MI
-Septic PE/lung abscess
-HF
-Arrhythmia
-Perivalvular abscess
-Embolism: spleen or kidneuy
-Stroke
Imaging/ labs for Bacterial Endocarditis
Imaging:
-TEE
Labs:
- Blood Cultures
- Three sets at least 1 hr apart before starting antibiotics
Prevention of Bacterial Endocarditis
Antibiotic prophylaxis with predisposing congenital or valvular abnormalities having:
-DENTAL PROCEDURES
-RESPIRATORY OPERATIONS
- OPERATIONS OF INFECTED SKIN/MUSCOSKELETAL TISSUE
Prophylaxis:
- PCN
- clindamycin if allergic
Myocarditis
Definition primary vs secondary
Inflammation of the muscle wall of the heart
Primary:
- Acute viral infection or post viral immune response
Secondary:
- Due to non-viral causes = medications, chemicals, inflammatory diseases, radiation, cocaine, chemotherapy
Bacterial Endocarditis Medical tx
Medical Management:
- Treat infectious cause: IV Antibiotics or Antifungal
- pts with no prosthetic valve: empiric antibiotic tx
- Anticoagulant tx to prevent emboli
Bacterial Endocarditis surgical tx - when is it indicated
Surgical Management:
- Surgical Valve Replacement
Indication for surgery:
- HF
- refractory to medical management
- abscess formation
- conduction disturbance: arrhythmias
Myocarditis Signs and Symptoms
Heart failure (R or L sided)
Shock
Pericardial Friction Rub *
Dyspnea
Chest pain
Tachycardia
Heart Gallop: S3 or S4
ST changes on EKG
Myocarditis tx
Aggressive support for shock
Treat for heart function:
- ACEi
- Beta Blocker
Treat underlying systemic disorder:
- infection
- inflammatory ds
Avoid causative agent if secondary: medication, chemo, cocaine, etc
Myocarditis dx
Echo
Cardiac MRI to show infiltration
Endomyocardial Biopsy
Acute Pericarditis
definition
Definition:
- Inflammation of pericardium -> could lead to pericardial EFFUSION
- movement = friction between pericardium layer - chest pain that feels better when sitting up
- Usually lasts less than 2 weeks
