Pathoma - Endocarditis, Cardiomyopathy, Cardiac tumors

Question 1

What is the most common cause of endocarditis

Answer 1

Strep Viridans

Question 2

What type of valves does Strep Viridans effect and how badly?

Answer 2

It is low-virulence

Affects previously damaged valves with small vegetations that do not destroy the valve (subacute endocarditis)

Question 3

What type of patients does Staph Aureus cause endocarditis in

Answer 3

IV drug users

Question 4

What valve is most often affected by Staph Aureus endocarditis

Answer 4

Tricuspid valve

Question 5

What type of valves does Staph epidermidis endocarditis effect?

Answer 5

Prosthetic valves

Question 6

What is the association with Strep bovis endocarditis?

Answer 6

Patients with underlying colorectal carcinoma

Question 7

What are the HACEK organisms and how does endocarditis present?

Answer 7

H - Haemophilus
A - Actinobacillus
C - Cardiobacterium
E - Eikenella
K - Kingella

Will have endocarditis with NEGATIVE blood culture

Question 8

What are some of the clinical features of endocarditis?

Answer 8

Fever
Murmur (due to vegetations)
Embolization of septic vegetations
Anemia of chronic disease

Question 9

What are some of the presentations of embolization of septic vegetations?

Answer 9

Janeway lesion - erythematous, non tender lesion on palms and soles

Osler nodes - tender lesions on fingers and toes

Splinter hemorrhages

Roth spots in the retina

Question 10

What are the lab findings of anemia of chronic disease (Hb, MCV, ferritin, TIBC, serum iron, % saturation)

Answer 10

Low Hb
Low MCB
High ferritin
Low TIBC
Low serum iron
Low % saturation

Question 11

What are the associated causes of nonbacterial thrombotic endocarditis

Answer 11

Hypercoagulable state

Underlying adenocarcinoma

Question 12

What is Libman-Sacks endocarditis

Answer 12

Associated with SLE

Vegetations on both surface and undersurface of mitral valve

Question 13

Dilated cardiomyopathy leads to what type of heart dysfunction

Answer 13

Systolic dysfunction

May lead to biventricular CHF

Question 14

What is the most common cause of hypertrophic cardiomyopathy

Answer 14

Genetic mutation in sarcomere protein (usually autosomal dominant)

Question 15

Complication of hypertrophic cardiomyopathy

Answer 15

Decreased cardiac output (due to decreased ventricular filling)

Sudden death due to arrhythmias (common cause of sudden death in young athletes)

Syncope with exercise (hypertrophy of the ventricular septum can lead to functional aortic stenosis)

Question 16

Causes of restrictive cardiomyopathy (decreased compliance/filling)

Answer 16

Amyloidosis, sarcoidosis, endocardial fibroelastosis, Loeffler syndrome

Question 17

What is endocardial fibroelastosis

Answer 17

Dense layer of fibrosis within the endocardium (usually in children)

Question 18

What is Loeffler syndrome

Answer 18

Eosinophilic infiltrate with inflammation results in fibrosis of the endo-myocardium

Question 19

EKG findings of restrictive cardiomyopathy

Answer 19

low voltage EKG with diminished QRS amplitude

Question 20

What is the most common primary cardiac tumor

Answer 20

Myxoma (benign mesenchymal tumor)

Question 21

Most common location and presentation of cardiac myxoma

Answer 21

Pedunculated mass within the LA

Causes syncope due to obstruction of the mitral valve

Question 22

Most common primary cardiac tumor in children and what is its association

Answer 22

Rhabdomyoma (benign hamartoma of cardiac muscle)

Associated with tuberous sclerosis

Question 23

Where do metastatic tumors from the heart come from?

Answer 23

Lungs, breast, melanoma, lymphoma