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Cardiovascular II > Cardiac infections > Flashcards

Cardiac infections Flashcards

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1
Q

Invasion and multiplication of microorganisms on the endocardial surface, within the endocardium, within the myocardium, and/or on the prosthetic material within the cardiac structure

A

Infective endocarditis

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2
Q

Causes of bacteremia potentially leading to infective endocarditis

A

Oro-dental extraction/surgery
Respiratory tract intubation/scope
GI tract scope/biopsy
Urinary tract scope/surgery
IVDU
AV fistula

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3
Q

Potential pathogens in infective endocarditis related to indwelling catheter, AV fistula, or hemodialysis

A

S aureus
S epidermidis –> coagulase negative

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4
Q

Potential pathogens in infective endocarditis related to dental procedure

A

Strep viridans
HACEK

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5
Q

Potential pathogens in infective endocarditis related to GI procedure

A

Enterococcus species
Strep gallotycius/bovis

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6
Q

Potential pathogens in infective endocarditis related to urinary tract procedure

A

Enterococcus species

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7
Q

Potential pathogens in infective endocarditis related to IVDU

A

S aureus
Pseudomonas
Candida

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8
Q

Virulence factors of Strep viridans that contribute to infective endocarditis

A

Dextran
FimA –> surface adhesins

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9
Q

Virulence factors of S epidermidis that contribute to infective endocarditis

A

Glycocalyx and slime layer –> adhesion

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10
Q

Common pathogens in prosthetic valve endocarditis within 2 mos of surgery

A

Strep epidermidis
S aureus
Gram negative aerobic bacilli
Candida

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11
Q

Common pathogens in prosthetic valve endocarditis that develops >2 mos after surgery

A

S epidermidis
Strep viridans
HACEK

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12
Q

Constitutional symptoms of infective endocarditis

A

Fever, chills, rigors
Malaise
Weight loss
Night sweats
Myalgias

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13
Q

Cardiac symptoms of infective endocarditis

A

New or changing murmur
Arrhythmia (heart block)
HF (valve insufficiency)

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14
Q

Major modified duke’s criteria for diagnosing infective endocarditis

A

2 positive blood cultures
Positive echocardiogram
New valvular regurgitation

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15
Q

Minor modified duke’s criteria for diagnosing infective endocarditis

A

Predisposing heart condition of IVDU
Fever
Vascular phenomenon
Immunologic phenomenon
Microbiological evidence of positive blood culture not meeting criteria

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16
Q

Amount of Duke’s criteria needed for diagnosis of infective endocarditis

A

2 major OR 1 major and 3 minor OR 5 minor

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17
Q

Bacteria that can contaminate blood cultures

A

Staph epidermidis

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18
Q

When to suspect endocarditis when
blood culture is negative

A

Recent antibiotic therapy or consider non-bacterial endocarditis

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19
Q

Gram positive cocci in chains. Alpha hemolysis on blood agar with greenish discoloration. Catalase negative. Optochin resistant. Resistant to bile.

A

Strep viridans

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20
Q

Gram positive cocci in pairs and short chains, with acute angles. Usually non-hemolytic and catalase negative. Grows in 6.5% NaCl and tolerates 40% bile. Hydrolyzes esculin.

A

Enterococcus species –> fecalis and faecium

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21
Q

Gram positive cocci in clusters. Beta hemolysis of blood agar with golden colonies. Coagulase and catalase positive.

A

S aureus

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22
Q

Gram positive cocci in clusters. Beta hemolysis of blood agar with golden colonies. Coagulase negative and catalase positive.

A

S epidermidis

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23
Q

HACEK –> slow/difficult to culture

A

Hemphilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella

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24
Q

Group of bacteria that are all gram negative baccilli/coccobacilli and part of normal oro-dental flora. All are fastidious and may be missed on routine blood cultures.

A

HACEK bacterias

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25
Gram negative rod that is strictly aerobic. Blue-green pigment produced on culture with a sweet/fruity odor. Oxidase positive.
Pseudomonas aeruginosa
26
Duration of antibiotics in infective endocarditis
4-8 wks
27
Conditions where prophylaxis for infective endocarditis is indicated
Valvular defects Hx of endocarditis Congenital heart disease Prosthetic valve Post cardiac surgery/transplant
28
Prophylaxis for infective endocarditis
Antibiotic administered 30-60 min before dental, GI, urinary, or respiratory procedures, and I&D. Typically amoxicillin or ampicillin
29
Antibiotics used for infective endocarditis prophylaxis in those with penicillin allergy
Azithromycin Clindamycin
30
Latent period between GAS pharyngitis and acute rheumatic fever
1-3 wks
31
Main hypersensitivity reaction type in acute rheumatic fever
Type II hypersensitivity
32
Major JONES criteria for diagnosis of acute rheumatic fever
Erythema marginatum Carditis Skin nodules Migratory polyarthritis
33
Number of major and/or minor JONES criteria required for diagnosis of acute rheumatic fever
2 major OR 1 major and 2 minor
34
Minor JONES criteria for diagnosis of acute rheumatic fever
Fever Arthralgia Raised ESR Raised CRP Prolonged PR interval Hx of rheumatic fever or rheumatic heart disease
35
Positive ssRNA non-enveloped viruses spread via feco-oral route that can cause viral myocarditis
Coxsackie Enterovirus ECHOvirus
36
Risk factors for development of viral myocarditis
Children - severe 20-40 yo Long-term steroid of NSAID use Alcohol Nutritional deficiencies
37
Pathogenesis of acute phase of viral myocarditis
IFN-alpha, IFN-beta, NK cells and other inflammatory cytokines destroy infected myocytes. Non-infected myocytes survive. Spontaneous resolution.
38
Pathogenesis of subacute phase of viral myocarditis
CD8 cells stimulate cytokine production. B cells recruited and lymphocytic infiltration. Results in myocardiocyte inflammation
39
Pathogenesis of chronic phase of viral myocarditis.
Fibrotic replacement of dead myocardiocytes or viral persistance/inflammation. Results in cardiac remodeling leading to dilated cardiomyopathy and CHF.
40
Clinical features of viral myocarditis
CP Fever Rash Fatigue Myalgia Respiratory and/or GI upset
41
ECG findings in viral myocarditis
Non-specific ST segments elevations and T wave changes
42
Chronic manifestations of viral myocarditis
Dilated cardiomyopathy CHF
43
Morphological forms of Trypanosoma cruzi in the body
Amastigote --> in tissue Trypomastigote --> in circulation
44
Chagoma
Swelling that forms at site of infection/bite in Chagas disease
45
Romana's sign
Chagoma of eyelid
46
ECG changes in Chagas disease dilated cardiomyopathy
Arrhythmias Complete right bundle branch block
47
Cardiac complications of Chagas disease
Dilated cardiomyopathy Cardiomegaly Apical LV aneurysm
48
Causal agent in Lyme disease
Borrelia burgdorferi
49
Signs and symptoms of stage 1, early localized, Lyme disease
Erythema migrans Flu-like symptoms
50
Erythema migrans
Bulls-eye rash seen in early Lyme disease
51
Signs and symptoms of stage 2, early disseminated, Lyme disease
Secondary lesions Carditis 3rd degree complete AV block Bell's palsy Migratory myalgias and/or transient arthritis
52
Signs and symptoms of stage 3, late disseminated, Lyme disease
Chronic arthritis Encephalopathy
53
Bacteriophage encoded virulence factor that inhibits eukaryotic protein synthesis by inhibiting elongation factor 2. Affects respiratory tract epithelium, myocardium, and CNS.
Diphtheria toxin
54
Clinical manifestation of diphtheria toxin
Arrhythmias Circulatory collapse
55
Symptoms of infectious pericarditis
Fever (viral) Sharp, pleuritic, substernal CP that radiates to shoulder/neck Intense pain when supine relieved when upright
56
Clinical signs of infectious pericarditis
Pericardial friction rub Pericardial effusion --> muffled heart sounds
57
ECG changes in acute pericarditis
Widespread concave ST segment elevation Widespread PR segment depression Reduced QRS amplitude --> pericardial effusion
58
Complication of infectious pericarditis
Cardiac tamponade
59
Pathogenesis of syphilitic heart disease
Obliterative endarteritis (vasculitis) and vasa vasorum which weakens the aortic root wall
60
Result of weakening of the aortic root wall in syphilitic heart disease
Aortic dilation and aneurysm Aortic valve regurgitation
61

Cardiovascular II (29 decks)

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