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Flashcards in Cardiovascular disease 3 Deck (65)
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1

What is endocarditis and what is its clinical features?

Inflammation of heart endocardium. Prototypical lesion = vegetation on valves

2

What are the two types of endocarditis?

Infective - clinically important!!

Non-infective

3

What is infective endocarditis?

Colonisation/invasion of heart valves/chamber endocardium by microbes

4

What is vegetation?

Thrombotic debris/organism which destroys/invades underlying cardiac tissue

Can invade prosthetic valves too!

5

What are most endocarditis infections caused by?

Bacterial

6

What is the difference between acute vs subacute?

Acute
- nastyyyy
- high virulent
- necrotising, ulcerative and destructive
- difficult to cure with antibiotics - surgery

Subacute
- less virulent
- Less destructive - insidious infection
- Cured with antibiotics

7

How is endocarditis caused?

Can occur in healthy heart but mainly with valvular/cardiac abnormalities...

- rheumatic fever
- MV prolapse
- Valvular stenosis
- congenital defects
- prosthetic valves

8

What are the three main bacteria that cause endocarditis?

S viridans (from mouth)** in native but damaged/abnormal valves

S Areus (from skin) esp IVDU

Staph epidermis commonly infect prosthetic valves

9

What are the clinical features of infective endocarditis?

Fever (most consistent)
Unspecific - flu/weight loss
Murmur - 90% left sided IE

10

What are the clinical signs of IE?

F - fever
R - Roth spots
O - Oslers Nodes
M - Murmurs

J - Janeway lesions
A - anaemia
N - nail (splinter) haemorrhage
E - Emboli

11

What predisposes individuals to non-infective endocarditis?

-Debilitation e.g. cancer patient
-Hyper coagulated state
-Endocardium trauma e.g. indwelling catheter/central line

12

What are the characteristics of the vegetation in non bacterial thrombotic endocarditis (NBTE)

-Small (1-5mm)
-Not destructive
- Sterile
- Non-invasive/inflammatory
- Systemic emboli

13

What disease is non-infective endocarditis associated with?

SLE (lupus)

14

What valves are affected by non-infective 'Libman Sacks endocarditis'?

Tricuspid and mitral

15

What is the characteristics of the vegetation of infective endocarditis?

Friable, bulky, destructive, more than one valve (virulent organisms)

16

What are the characteristics of the vegetation of non bacterial thrombotic endocarditis?

Small, sit on cusps of valves only, not invasive/inflammatory

17

What are the characteristics of the vegetation of non infective endocarditis Libman-sacks?

Small, AV valves on chordae, valvular endocardium or mural endocardium

18

What is Rheumatic fever and what organism is it caused by?

Acute immunological mediated multistage disease (AUTOIMMUNE DISEASE)
- following group A strep pharyngitis

19

What is a distinctive feature of Rheumatic fever?

Aschoff bodies

20

What is it called when an infection infects all 3 layers?

Pancarditis

21

What are the vegetations of rheumatic fever called?

Veruccae

22

What valve is classically infected by rheumatic fever? What type of stenosis does it this called?

Mitral valve -Virtually ONLY cause of mitral stenosis

Fish mouth

23

What type of condition is RF?

Autoimmune condition

24

What happens with RF (the steps)

Antibodies produced against Strep A pharyngitis cross link with self antigens of the heart

CD4 cell against strep A pharyngitis react with proteins of heart - produce cytokines - macrophages - aschoff bodies

25

How is rheumatic fever diagnosed?

Jones criteria

26

What can rheumatic fever cause in the long term?

-Left atrial dilatation
-Right ventricular hypertrophy
-Mitral thrombi - embolism?

27

What is pericarditis?

Inflammation of outside layer of heart, pericardium

28

What are the causes of pericarditis?

Infection - virus (COXSACKIE B - if in doubt..), bacteria, fungi, parasites

Immunological - SLE, RF, Dresslers syndrome (late post MI), post-cariotomy

Others - trauma, radiation, post MI (early)

29

What is the difference between acute and chronic pericarditis?

Acute - inflammatory

Chronic - adhesive

30

What are the characteristics of serous pericarditis and what usually causes it?

Inflammation with serous fluid accumulation

Usually non infective aetiology but can be caused by..

Virus (coxsackie) rare
Immunological
Other

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