Rheumatic Heart Disease & Complications Flashcards
What is a pancarditis?
Inflammation of all three layers of the heart
What pathology is an example of a pancarditis?
Acute rheumatic heart disease
What is the etiologic agent of rheumatic fever/heart disease?
Group A beta-hemolytic streptococcus pyogenes
What plays a pivotal role in the manifestation of rheumatic heart disease?
Molecular mimicry
How does rheumatic heart disease manifest?
Untreated systemic streptococcus pyogenes infection causes the body to make antibodies against streptococcus that also attack your own tissues
What cells are present in myocarditis caused by rheumatic heart disease?
Anitchkow cells, lymphocytes, and macrophages
What is an Aschoff body?
Focal granuloma of chronic inflammation seen in rheumatic heart disease
What pathology is an Aschoff body associated with?
Rheumatic heart disease
What are anitchkow cells?
Giant cells of rheumatic heart disease
What pathology are anitchkow cells seen in?
Rheumatic heart disease
What is characteristic of the nuclei of anitchkow cells?
Caterpillar shaped nuclei
Caterpillar shaped nuclei are associated with what cells and pathology?
Anitchkow cells and rheumatic heart disease
What type of exudate is present in pericarditis?
Fibrinous exudate
Valves are made of _________________?
Endocardium
What side valves are most often injured in endocarditis?
Left
What causes verrucae on the valves of the heart?
Endocarditis
What are verrucae?
Wart like masses present on valve commissure in infectious endocarditis
What exudate is present at the valves in endocarditis?
Fibrinous exudate
Where on the valve does infectious/verrucous endocarditis occur?
Valve commissure
What layer of heart inflammation persists from acute to chronic rheumatic heart disease?
Endocarditis
What criteria is used to diagnose rheumatic heart disease?
Jones criteria
What major criteria are signs of rheumatic heart disease involving the heart?
Pericardial friction rub
Cardiomegaly
pericarditis
Congestive heart failure
What major criteria is a sign of rheumatic heart disease involving joints?
Polyarthritis
What major criteria is a sign of rheumatic heart disease involving the nervous system?
Chorea
What major criteria is a sign of rheumatic heart disease involving the skin?
Erythema marginatum and subcutaneous nodules
What is erythema marginatum and what pathology is it a major criteria for?
Large pink rings on the torso and limbs for a rheumatic heart disease diagnosis
What minor criteria may help lead to a rheumatic heart disease diagnosis?
Previous history of rheumatic fever
Arthralgia or fever
Increased erythrocyte sedimentation rate
Positive C-reactive protein
What valve is most commonly and severely affected in chronic rheumatic heart disease?
Mitral valve
What valve is second most commonly affected in chronic rheumatic heart disease?
Aortic valve
Pectinate muscles are a characteristic of (Ventricles/Atria)?
Atria
Where will an embolus from the mitral valve embolize to?
Systemic circulation
What pathology presents with a diastolic murmur at the 5th ICS on the left?
Mitral stenosis
Patient presents to your office with a raspy voice and a rosy red rash across the cheeks and nose. Auscultation shows a diastolic murmur at the 5th ICS on the left. An ANA panel is performed and the results are negative. What is the likely diagnosis?
Mitral stenosis
What facial feature is indicative of mitral stenosis?
Mitral facies (pinkish-purple patches on the cheeks
What two bacteria can cause infective bacterial endocarditis?
Staphylococcus and streptococcus
What is the most common predisposing factor for bacterial endocarditis in children?
Congenital cardiac malformations
What are the most common predisposing factors for bacterial endocarditis in adults?
Mitral valve prolapse and congenital heart disease
If a patient has a streptococcus Viridans or mutans infection that has gone systemic, what may occur?
Subacute bacterial endocarditis
IV drug users are at increased risk of developing endocarditis (TRUE/FALSE)?
TRUE
Patient presents with a low grade fever. Ophthalmic exam shows small spotting in the retina and palpation reveals painful red spots on the patients palms. The patient reported having a bad pharyngitis infection about a year ago. What is the likely diagnosis?
Infective endocarditis
Myocarditis is diagnosed if it is the only heart layer currently affected (TRUE/FALSE)?
TRUE
What is the main etiologic agent of myocarditis?
Virus (Coxsackievirus)
Male patient age 32 presents with a fever. The patient has a history of HIV. Lymphocytes are slightly increased and enzymes are normal. Pain is centered just around the left chest with no radiation. What is a likely diagnosis?
Myocarditis
What can predispose an individual to a mitral valve prolapse?
Familial
Hereditary collagen diseases (Marfan’s, Ehler-Danlos, Osteogenesis Imperfecta)
What heart pathology presents with both a systolic ejection murmur and a diastolic murmur?
Aortic stenosis
What two murmurs are audible in a patient with aortic stenosis?
Systolic ejection murmur and diastolic murmur
(2nd ICS on the R)
What is the characteristic appearance of valvular stenosis?
Fish-mouth valves
How does mitral valve prolapse predispose valves to vegetation?
Increased turbulence at the valve commissure leads to endocarditis
What are septic emboli?
Emboli with infective material such as bacteria
Where can septic emboli from bacterial endocarditis spread to?
Retina
Nail beds
Skin of palms and soles of feet
What pathology can cause septic emboli?
Bacterial endocarditis
What is a septic emboli to the eye called?
Roth spot
What is a janeway lesion?
Non-painful septic emboli to the palms of the hands or soles of the feet
What is a Osler node?
Painful septic emboli to the palms of the hands or soles of the feet
