6. Infective Endocarditis Flashcards
What is it?
• Potentially lethal infectious disease
• Affects ____ surface of heart
• May progress to ____ and ____
•Potentially lethal disease because inflammation of the heart is not a good thing to happen and could ____ to other distant sights to infect distal organs like the brain
•So if a bug leaves the area it can anywhere it wants including the ____
•Refresher of the heart
o Pointstolabelsontheheart
endocardial sepsis shock emoblize brain
Epidemiology • \_\_\_\_ per 100,000 person-years (general population) • Higher in \_\_\_\_ • 40,000 cases per year • High \_\_\_\_ rate • \_\_\_\_ > female • Trend towards \_\_\_\_ patients
o If patient has history of endocarditis then that patient warrants a ____
o The number is not big but that is a relatively common occurrence in patients that are at risk like ____, dialysis patients and the
older you get the more likely you are to get disease because ____ system is weaker
o Reads numbers
• Of these cases there is a lot that end up as mortality
§ Mortality can result from ____ that these patients undergo
o Over all there is a slight male predilection and now a days with ____ there is a trend towards a younger onset of this condition
3-7 elderly mortality male younger
prophylaxis HIV immune treatments drug abuse
Risk factors • \_\_\_\_ disease • Prosthetic valves • \_\_\_\_ disease • Hemodialysis • \_\_\_\_
o Rheumatic heart disease one of the most important because there is ____ to the heart that increases the risk for bacteria to exploit that in find a hole they can get into
o Prosthetic valves are ____ that can also serve as a reservoir
o Hemodialysis is a treatment whereby patient cant ____ own blood in kidneys they go several time a week go to machine
and the blood cleaned
o Lastly intravenous catheters for several reasons like ____ causes a site that can be susceptible to disease
rheumatic heart
valvular
intravenous
structural damage
artificial
clean
drug administration
• Far left is artificial valve (tricuspid valve) both he bicuspid and the tricuspid
• Showing pics of the infected valve and replacement
• Ex of the hemodialysis- undergoing this procedure because they cant clean their blood and it is artificially cleaned
and put back in the body
YAY!
Risk factors
• ____ drug users
• ____ per 100,000 person years (____ drug users)
• ____ disease
- Very important risk factor
- In this pop the number of cases sky rockets and in this specific pop it is 150-2000 which is very significant
- HIV with constant intravenous drug use there is also a risk of getting HIV, ____, and Hep B and there is now a route for the bacteria to get into the heart that occurs in the
intravenous 150-2000 IV HIV Hep C
Clinical variants
• Left-sided native-valve IE
• Most ____
- Left-sided prosthetic valve IE
- Most ____ form
- Right sided IE
- ____ users and ____ devices
- Healthcare-associated IE
- ____ (in hospital) and ____ (outpatient)
•Several clinical variants
o Depends where occurs in the heart and where occurs in geographic setting
o Most common is left sided native valve IE which is the ____ native valve that is the hearts native vale is the most common
• Next most common is the left sided prosthetic valve IE- valve replacement of the left side and can become the most severe form of the disease
§ Right side IE is the most common with drug users and when they inject into the ____ that is
where it goes first
• Healthcare associated IE that occurs in the hospital or outpatient setting and can be through ____ is a big ex
common severe IV-drug cardiovascular nosocomial non-nosocomial
bicuspid
blood stream
catheters
Pathogenesis - causative organisms • \_\_\_\_ species • Staphylococcus aureus • \_\_\_\_ species • Other microbes
•Not depending on location that pathogenesis is common to all types
•Only focusing on bacteria today, but know ____ and fungus can also do this
•The bacteria that most common cause this are
o Strep
o Staph
o Enterococcus-comes in through the ____ tract
oral streptococcus
enterococcus
viral
GI
Einstein Medical Center study
•In hospital setting there was patients were older and 50/50 in sex, and a quarter of all patient died in house
•____ is important because typically found in oral cavity and oral pharynx so found typically in the mouth •Questions? Inaudible
o There study was 50/50 male female but there is a slightly male predilection
strep viridans
Pathogenesis - Determinants of pathogen-host interaction
Pathogen
• ____ properties
• ____ production
• ____ production
Host
• ____ (mechanically injured or inflamed)
• Hemostatic mechanisms (hypercoagulable state)
• Host ____
• Gross anatomical abnormalities in the heart (valves, ____ material)
•What causes the bug to be pathogenic?
o The ____ itself and the ____ in which it is colonizing
surface
enzyme
toxin
vascular endothelium
immune system
device
pathogen
host
Pathogenesis
a. Microbes gain access to ____
b. Adherence of microbes to damaged valves via ____ (Non-bacterial thromboticendocarditis)
c. Some bugs can enter valve ____ to provoke additional tissue destruction
d. Proliferation of bugs promotes maturation of ____
e. Vegetations may embolize - ____ stroke
- cerebral hemorrhage
- ____ abscess
•Theory by which we go by for how the disease occurs
o Step by step
• If valve is damage that bug can then colonize the heart and the damaged tissue
§ During surgery you cant avoid some degree of damage and can result in a nonbacterial thrombotic endocarditis like if you scratch your skin and get a blood clot forming and you will get a scab and same thing applies in the heart then you will develop a clot or platelet plug and that is a ____ because there is inflammation of the heart tissue that is not bacterial yet, but because there are areas of the heart that have this roughed surface like clotting factors and there is a reservoir that the ____ can adhere to as passing in the blood stream
bloodstream platelet fibrin deposition endothelium vegetations ischemic brain
nonbacterial endocarditis
bacteria
Pathogenesis cont.
As the bacteria adheres they can invoke their own response that makes the ____ worse and as further propagates and more bacteria and PMN and cytokine and a negative cycle that results in vegetation that is a aggregate of bugs, bacterial byproducts, human protein and immune cells
§ Big collection of junk forming in the damaged area and as they further grow and propagate for these bugs to break off and enter ____ and go distally to other sites
• So at risk for embolization to the brain that causes ____ (when thrombus occludes the vessel you get ischemia and there is no O2 perfusion to the tissues ) in brain can also cause ____ hemorrhage and a brain abscess there are all life threating
inflammation
blood stream
ischemic stroke
cerebral
Pathogenesis – Mechanical injury to valve
- ____ thrombotic endocarditis
- Adherence of ____ during transient bacteremia - Monocytes release ____
- More ____ recruited and activated
- Endothelial cells may become infected and lysed by bacterial ____ and/or bacterial ____
•May occur ____ or ____
o Initially there is still a nonbacterial endocarditis for patients that undergo surgery and is ____ because done in sterile environment but there is a ____ surface that allows more bugs to adhere and as they adhere there is a viscous cycle that goes form a couple of blips there to a large area of involvement
non-bacterial microbes platelets toxins persistence
naturally
mechanically
sterile
roughed
Pathogenesis – Inflamed valve
- Activated endothelial cells express ____ which promotes ____ and adheres pathogen
- Bacteria are internalized, trigger endothelial cells to release ____ - causes ____, promotes inflammation and vegetation
- Infected endothelial cells ____ by bacterial products or bacteria persist ____
• As area becomes further inflamed can cause damage to the heart and risk of dislodgment into the ____
integrins fibronectin cytokines coagulation lysed intracellularly blood stream
Signs and symptoms of IE
____
Heart murmurs
____
Neurologic dysfunction
A - \_\_\_\_ (splinter) hemorrhages B- \_\_\_\_ spots - Retinal hemorrhages C- \_\_\_\_ nodes - Tender subcutaneous nodules on distal pads of fingers A, B and C due to \_\_\_\_ deposition D- \_\_\_\_ lesions – Painless \_\_\_\_ on palms and soles Caused by infected \_\_\_\_
•Results from this happening
o Can develop fever and this is a systemic infection and there is things like ____ that are secondary signs of symptoms but because a systemic infection and can contribute to them will see in this pop as well
o Damage to heart will cause heart murmur that is hearing the blood going through the heart where there is a ____ and can hear it
o They get ____ bleeding called Petechiae in the skin and oral cavity
o Brain complication if don’t cause death they will cause brain damage and neurological problems are symptoms of this and there is headaches, vestibular changes, ocular changes
fever petechiae subungual roth osler immune-complex janeway macules microemboli
malaise
blurb
pinpoint
These pics illustrated and reads the description on the side
• A these are subungual hemorrhages that are common occurrence
• B are Roth spots that are ____ in the retina
• C are the hands of patient that are Osler nodes that are hard structures on the finger pads typically that are the result of the
infection directly that are the ____ of deposition there and they represent an immune complex deposition within
the actual fingers
• D are Jane way lesions are macules on palms and soles of feet and are ____ in shape and are direct result of the ____,
usually darky in shape
petechiae
immune complex
irregular
organism
