Flashcards in Cardiovascular disease 3 Deck (65)
What is endocarditis and what is its clinical features?
Inflammation of heart endocardium. Prototypical lesion = vegetation on valves
What are the two types of endocarditis?
Infective - clinically important!!
What is infective endocarditis?
Colonisation/invasion of heart valves/chamber endocardium by microbes
What is vegetation?
Thrombotic debris/organism which destroys/invades underlying cardiac tissue
Can invade prosthetic valves too!
What are most endocarditis infections caused by?
What is the difference between acute vs subacute?
- high virulent
- necrotising, ulcerative and destructive
- difficult to cure with antibiotics - surgery
- less virulent
- Less destructive - insidious infection
- Cured with antibiotics
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
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
What are the clinical features of infective endocarditis?
Fever (most consistent)
Unspecific - flu/weight loss
Murmur - 90% left sided IE
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
What predisposes individuals to non-infective endocarditis?
-Debilitation e.g. cancer patient
-Hyper coagulated state
-Endocardium trauma e.g. indwelling catheter/central line
What are the characteristics of the vegetation in non bacterial thrombotic endocarditis (NBTE)
- Systemic emboli
What disease is non-infective endocarditis associated with?
What valves are affected by non-infective 'Libman Sacks endocarditis'?
Tricuspid and mitral
What is the characteristics of the vegetation of infective endocarditis?
Friable, bulky, destructive, more than one valve (virulent organisms)
What are the characteristics of the vegetation of non bacterial thrombotic endocarditis?
Small, sit on cusps of valves only, not invasive/inflammatory
What are the characteristics of the vegetation of non infective endocarditis Libman-sacks?
Small, AV valves on chordae, valvular endocardium or mural endocardium
What is Rheumatic fever and what organism is it caused by?
Acute immunological mediated multistage disease (AUTOIMMUNE DISEASE)
- following group A strep pharyngitis
What is a distinctive feature of Rheumatic fever?
What is it called when an infection infects all 3 layers?
What are the vegetations of rheumatic fever called?
What valve is classically infected by rheumatic fever? What type of stenosis does it this called?
Mitral valve -Virtually ONLY cause of mitral stenosis
What type of condition is RF?
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
How is rheumatic fever diagnosed?
What can rheumatic fever cause in the long term?
-Left atrial dilatation
-Right ventricular hypertrophy
-Mitral thrombi - embolism?
What is pericarditis?
Inflammation of outside layer of heart, pericardium
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)
What is the difference between acute and chronic pericarditis?
Acute - inflammatory
Chronic - adhesive