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CVPR > CVPR Week 9: Acquired Heart disease > Flashcards

CVPR Week 9: Acquired Heart disease Flashcards

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1
Q

Objectives

A
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2
Q

Rheumatic fever description

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3
Q

Rheumatic heart disease

A

damage to the valves secondary to ARF can become a chronic condition leading to congestive heart failure, strokes, endocarditis and death

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4
Q

ARF AKA

A

Acute Rheumatic fever

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5
Q

Rheumatic fever and heart disease

A

significant public health concerns around the world and despite decreasing incidence there is still a significant disease burden especially in developing nations

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6
Q

Describe the epidemiology of rheumatic fever and rheumatic heart disease

A

significant public health concerns around the world and despite decreasing incidence there is still a significant disease burden especially in developing nations

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7
Q

Describe the epidemiology of rheumatic fever and rheumatic heart disease

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8
Q

Acute rheumatic fever pathogenesis

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a consequence of anti-strep antibodies cross-reacting with group A carbohydrate (human heart valves, M-protein (heart-muscle), protoplast membrane (sarcolemma)

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9
Q

Acute rheumatic fever clinical presentation

A
  • 30% subclinical
  • presentation 1-3 weeks post strep
  • case fatality rate is 2-3 %
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10
Q

Rheumatic fever/Rheumatic heart disease age of onset

A

Group A Streptococcus (GAS) pharyngitis occurs most commonly between 5-15 years of age

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11
Q

Rheumatic fever/Rheumatic heart disease precipitating infection

A

GAS pharyngitis and not skin infections (impetigo)

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12
Q

Rheumatic fever/Rheumatic heart disease strains

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Strains that cause RF & RHD are based on type of M-protein

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13
Q

Why does RF & RHD occur in response to an infection?

A
  • Because streptococcal antigens mimic normal human tissue antigens (molecular mimicry)
  • so this leads to abnormal autoimmune humoral and cellular responses
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14
Q

Describe the immune response in RF/RHD

A

Rheumatogenic strains/encapsulated mucoid M strains are resistant to phagocytosis so they are particularly immunogenic and produce antibodies against epitopes

similar epitopes in sarcolemmal membranes and valve glycoproteins

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15
Q

Describe the path to RF/RHD

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16
Q

Dx of Acute Rheumatic Fever

A

Jones criteria

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17
Q

Jones Criteria Dx what

A

Acute Rheumatic fever

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18
Q

Describe the Jones criteria for Dx

A

2 major criteria or 1 major and 2 minor criteria - PLUS

  • preceding documented strep infection by throat culture or antibody (antistreptolysin (ASO titer) or Antideoxyribonuclease B titer (anti-DNase B titer)
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19
Q

What are the major criteria of the Jones Criteria

A
  • Polyarthritis
  • Carditis
  • Chorea
  • Subcutaneous nodules
  • Erythema Marginatum
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20
Q

What are the minor criteria of the Jones Criteria

A
  • Arthralgia
  • Prolonged PR interval on ECG
  • Fever
  • Elevated acute phase reactants
  • History of rheumatic fever
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21
Q

What are the skin findings in RF

A
  • Erythemia marginatum
  • subcutaneous nodules
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22
Q

Describe erythema marginatum

A
  • <5% of RF patients
  • Bright pink, serpiginous borders and central clearing
  • Non-pruritic, non-painful and blanch with pressure
  • located on trunk or proximal extremities
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23
Q

Describe subcutaneous nodules

A
  • 0-10% of RF cases (not pathognomic)
  • 0.5 - 2.0 cm round, firm, movable, non-tender nodules
  • Usually occur over extensor, surfaces of joints, scalp or spinous processes of back
  • last 1-2 weeks
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24
Q

What is Sydenham Chorea?

A

involuntary purposeless movements, muscular incoordination/weakness and emotional lability

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25
How often does Syndenham chorea occure in RF?
10-30% of cases of RF
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Why does Sydenham Chorea occur
occur due to inflammation in basal ganglia, cerebral cortex and cerebellum
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Latency period of RF with chorea
longer latency period from GAS infection (acute phase-reactants and antibodies often not elevated)
28
How long does Sydenham Chorea last
lasts anywhere from 1-2 weeks to 2-3 years
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What % of group A beta haemolytic streptococcal infection progress to develop acute rheumatic fever
0.3 - 30% of untreated develop acute rheumatic fever
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Prevalence of Carditis in acute rheumatic fever
30-70% of cases Severe carditis and heart failure occurs in 13-64% of RF cases
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Carditis onset in RF
most often occurs within 2 weeks of acute illness
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What is pancarditis?
is the inflammation of the entire heart: the epicardium, the myocardium and the endocardium.
33
What is endocarditis?
is an infection of the endocardium, which is the inner lining of your heart chambers and heart valves.Endocarditis generally occurs when bacteria, fungi or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart
34
What is myocarditis?
is an inflammation of the heart muscle (myocardium). Myocarditis can affect your heart muscle and your heart's electrical system, reducing your heart's ability to pump and causing rapid or abnormal heart rhythms (arrhythmias)
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What is pericarditis?
refers to inflammation of the pericardium, two thin layers of a sac-like tissue that surround the heart, hold it in place and help it work. A small amount of fluid keeps the layers separate so that there's no friction between them.
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Describe acute rheumatic carditis
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Clinical features of acute rheumatic fever with carditis
* New or changing murmur * or Silent carditis * Tachycardia out of proportion to fever * congestive heart failure * Pericarditis
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Heart murmurs of acute rheumatic fever with carditis
* Apical holosystolic murmur, high-pitched, blowing, with radiation to the axilla - Acute mitral regurgitation * Apical diastolic murmur - relative mitral stenosis due to large volume of regurgitant flow * Soft crescendo-decrescendo murmur of aortic insufficiency - acute aortic insufficiency * Silent carditis - which is only detected on echo imaging
39
How is silent carditis detected?
detected only on echo imaging
40
What are the features of congestive heart failure?
* increased JVD * Crackles * Hepatomegaly * Crackles
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Features of pericarditis
pericardial friction rub muffled heart sounds paradoxical pulse (exaggerated fall in the pulse on inspiration)
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Rheumatic heart disease valves effected
* most commonly involves the mitral and then the aortic valve * but all 4 valves can be affected
43
What is this?
bread and butter fibrinous pericarditis
44
What is this?
McCallum plaques-vegetations on the mitral valve
45
What is this?
Aschoff bodies and Anitchkows cells-macrophages seen in the sarcomere
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Describe echocardiographic Dx of rheumatic carditis
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Describe the clinical course of development of symptoms in RHD
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Describe Tx of acute streptococcal pharyngitis and primary prevention of rheumatic fever
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Describe antibiotic therapy of rheumatic fever and pharyngitis
Primary (treating GABHS pharyngitis) penicillin, clindamycin secondary prevention (in someone with a previous history of RF)
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Describe anti-inflammatory therapy of rheumatic fever and pharyngitis
aspirin or naproxen +/- steroids depending on severity
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Rheumatic fever prophylaxis
52
Kawasaki Disease age of onset
childhood
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Kawasaki disease description
* acute self-limited vasculitis of childhood * affects medium-sized blood vessels * generalized systemic vasculitis - involves blood vessels throughout the body * coronary arteries are always involved in autopsy cases
54
What is this?
55
Diagnostic criteria of Kawasaki disease
56
Clinical manifestation of Kawasaki disease
fever persisting at least 5 days without other source in association with at least 4 principle features * fever * strawberry tongue * red lips * cervical lymphadenopathy * superficial skin layers desquamate easily * Red soles & palms * peripheral edema * conjunctival redness * lethargy * irritability * cardiac complications in 5-20% * occasionally intermittent Collicky ABD pain associated with MI * Rash over trunk & perineal area
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What is this?
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What is this?
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What is this?
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What is this?
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What is this?
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What is this?
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KD DDx
64
Incomplete/atypical Kawasaki disease
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Evaluation of suspected or incomplete/atypical KD
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Cardiac findings of KD
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Tx of KD
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Etiology of KD
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KD symptoms timeline
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Coronary artery involvement in KD
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Describe how the coronary arteries are affected in KD
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Describe coronary artery involvement of KD
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What do coronary artery aneurysms in KD
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What is this?
Coronary artery aneurysms
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What is this?
76
What is this?
77
Follow up for KD patients
78
What is infectious endocarditis?
inflammation of the endocardial surface of the heart typically involves heart valves and adjacent structures
79
Who gets infectious endocarditis?
80
Pathogenesis of infectious endocarditis
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Etiology of infectious endocarditis
* S. aureus and Virdans strep: 90% * Gram negative organisms 2.5% * Enterococcus * Fungi
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Dx of infectious endocarditis
Clinical/blood cultures are most important * New murmur & positive blood cultures Echocardiography has poor sensitivity * cannot use to rule out endocarditis * very helpful in deciding who needs emergent surgery
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Echo for Dx of infectious endocarditis
poor sensitivity so cannot use it to rule out endocarditis but it is very helpful in deciding who needs emergency surgery
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Major diagnostic criteria for infectious endocarditis
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Minor diagnostic criteria for infectious endocarditis
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What are the Duke major criteria for infectious endocarditis
2 positive blood cultures positive ECHO new regurgitant murmur
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What are the Duke minor criteria for infectious endocarditis
* predisposing condition * fever * immunologic signs * one positive blood culture * positive ECHO not meeting major criteria
88
What is this?
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What is this?
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What is this?
91
Classification of the likelihood of a patient having infectious endocarditis
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What is this?
93
What is this?
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What is this?
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Tx of infectious endocarditis
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Prophylaxis of infectious endocarditis
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Common lesions not requiring infectious endocarditis prophylaxis
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AHA guidelines for infectious endocarditis prophylaxis
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