Pathology: Endocarditis, Myocarditis and Pericarditis Flashcards
Why are about 10% of all infective endocarditis cases extremely difficult to treat?
Pericarditis
- Primary Pericarditis
- How common is it?
- What is it usually due to?
- Secondary Pericarditis
- What conditions is it usually secondary to?
- Where does pain radiate to?
- Are other structures usually involved?
- What is the most common systemic disorder associated with pericarditis?
Describe the mortality rates for infective endocarditis caused by
- Low-virulence organisms, eg, Streptococcus viridans or Streptococcus bovis
- Enterococci and S. aureus infections
- Aerobic gram-negative bacilli or fungi
Clinical Features of Infective Endocarditis
- What is the most consistent sign of infective endocarditis?
- What patient population would result in the absence of a fever?
- What manifestations would occur in this group of PTs instead?
- What patient population would result in the absence of a fever?
In viral myocarditis
- How do you ID pathogens?
- What is the reason for cardiac injury?
How can organisms even get into the body so that endocarditis can occur?
What are the histological features of Chagas myocarditis?
For infective endocarditis, what are the poor prognostic indicators?
- Septicemia
- Arrhythmias
- Suggesting extension to the underlying conduction system
- Systemic embolization
Non Infective Vegetations (Nonbacterial thrombotic endocarditis [NBTE])
- What is this disease characterized by?
- Do the lesions from this condition destroy the cardiac tissue?
- Describe the vegetations associated with NBTE?
Where do sterile platelet-fibrin deposits occur, and how do they relate to infective endocarditis?
Morphology of Infective Endocarditis
- What can occur because of the friable nature of the vegetations?
- Of acute and subacute endocarditis, which is associated with valvular destruction?
- This shows acute endocarditis on an aortic valve.
- Because this is the acute form and this heart is from an IV drug user, what organism would most likely cause it?
- What is odd about this aortic valve?
- What valve is associated with IV drug use and infective endocarditis?
- What is the arrow pointing to?
Tricuspid valve a frequent target in the setting of IV drug abuse.
Morphology of Infective Endocarditis
- What occurs in both acute and subacute forms?
- What valves are usually affected? How does IV drug use affect this?
- What is a ring abscess?
This shows Nonbacterial thrombotic endocarditis (NBTE) on a mitral valve.
- What is indicated at the arrows?
- What condition(s) are precursors to NBTE?
Morphology of Pericarditis
- In acute viral pericarditis or uremia,
- What does the exudate usually look like?
- In acute bacterial pericarditis,
- What does the exudate usually look like?
- What is noted about Tuberculous pericarditis?
- What does the exudate usually look like?
Clinical Features of Pericarditis
- What symptoms does Pericarditis classically manifests with?
- What can acute pericarditis cause when associated with significant fluid accumulation?
- What does Chronic constrictive pericarditis produce in terms of heart function?
Define the following
- Roth spots
- Janeway lesions
- Osler nodes
- Retinal hemorrhages (Roth spots)
- Painless palm or sole erythematous lesions (Janeway lesions)
- painful fingertip nodules (Osler nodes).
In NBTE, the local effect on the valve is usually benign. How then, does this condition become clinically significant?
Morphology of Myocarditis
- Microscopically, what is myocarditis characterized by? What is the most common microscopic feature of myocarditis?
- How does the myocardial injury heal?
Pericarditis
- What are the immediate hemodynamic complications associated with pericarditis?
- What can this eventually progress into?
This shows Infective endocarditis. What valve seems to be affected, and what are the arrows pointing to?
Pathogenesis of Myocarditis
- What viruses are usually associated with Myocarditis?
Acute endocarditis
- What does it refer to?
- What organisms are generally responsible for it?
- What kind of patient outcomes is it associated with?
This is Lymphocytic myocarditis. How can you tell?
Lymphocytic myocarditis, with edema and associated myocyte injury.
Pathogenesis of Infective Endocarditis
- What organism accounts for most infections that occur on damaged or deformed valves?
- What organism is associated with infective endocarditis in IV drug abusers?
- What makes the HACEK group, and where are they found in the body?
Clinical Features of Myocarditis
- Describe the broadness of the clinical features of Myocarditis
- What organism is responsible for Chagas disease?
- Where does this organism live?
- What happens to about 10% of people who have this disease?
- What can happen to patients 10 to 20 years after getting Chagas?
Describe the prognosis and adverse sequelae of Infective Endocarditis
Untreated IE is generally fatal.
- Infective Endocarditis is a microbial infection of the heart valves or the mural endocardium.
- What forms because of this infection, and what is it made of?
- What is usually destroyed in this condition?
- Why does the classification of subacute and acute endocarditis sometimes not make sense?
Clinical Features of Infective Endocarditis
- How does acute endocarditis manifest?
- When do murmors typically manifest?
- What happens when patients are not treated properly?
- How do you diagnosis this condition?
- What bacteria is responsible for Lyme disease?
- How often does this cause myocarditis? How is it treated?
- What other bacteria can cause myocarditis?
- What helminth can cause myocarditis?
This is a photomicrograph of an NBTE lesion
- What does the t and C stand for?
- What do you notice about any inflammation in this photo?
What host factors are associated with increased risk for infective endocarditis?
This is Chagas myocarditis. How can you tell?
What is at the arrow?
- What is Pericarditis due to malignancy often associated with?
- Describe how chronic pericarditis occurs
Pathogenesis of Infective Endocarditis
- Infective endocarditis can develop on previously normal valves, but cardiac abnormalities predispose to such infections. What abnormalities does this include?
- What accounts for 10-20% of all cases of IE?
How are acute and subacute endocarditis separated?
Subacute endocarditis
- What does it refer to?
- What organisms are generally responsible for it?
- What kind of patient outcomes is it associated with?
