CVS Week 9 Flashcards
(28 cards)
Define endocarditis and list its key risk factors.
Definition: Inflammation of the endocardium, primarily heart valves. Risk Factors: Pre-existing valvular disease, prosthetic valves, IV drug use, congenital heart disease, indwelling catheters, immunocompromise.
Enumerate the main etiologic agents of Infective Endocarditis (IE).
Bacteria: Staphylococcus aureus (IVDU, prosthetic valves), Viridans group streptococci (native valves, dental), Enterococci, HACEK group. Fungi: Less common.
Describe the pathogenesis of Infective Endocarditis (IE).
- Endothelial damage (e.g., turbulent flow). 2. Sterile platelet-fibrin thrombus (NBTE) forms. 3. Bacteremia; bacteria adhere to NBTE. 4. Bacterial proliferation forms vegetations. 5. Vegetations grow, causing valve destruction, embolization, or persistent infection.
Discuss the key clinical manifestations of Infective Endocarditis (IE).
Common: Fever, new/changing heart murmur. Nonspecific: Fatigue, malaise, weight loss. Embolic: Stroke, splenic/renal infarcts, pulmonary emboli (right-sided IE). Immunologic: Osler nodes (tender), Janeway lesions (non-tender), Roth spots (retinal), glomerulonephritis.
Enumerate common etiologic agents of myocarditis.
Viral (most common): Coxsackievirus B, adenovirus, parvovirus B19, influenza, enteroviruses, HIV. Other: Bacterial, fungal, parasitic (Chagas), autoimmune (SLE, sarcoidosis), toxins/drugs (alcohol, cocaine).
Describe the pathogenesis of viral myocarditis.
- Direct viral infection of cardiomyocytes. 2. Immune-mediated damage (cross-reactivity). 3. Myocyte necrosis & inflammation. 4. Impaired cardiac function.
Discuss the clinical manifestations of myocarditis.
Variable: Asymptomatic to severe heart failure/sudden death. Prodrome: Flu-like symptoms (fever, myalgia, fatigue). Cardiac: Chest pain (mimics MI), dyspnea, palpitations, syncope, heart failure symptoms (edema, orthopnea), arrhythmias.
Define acute pericarditis and list its common causes.
Definition: Inflammation of the pericardium (heart sac). Causes: Viral (most common), bacterial, autoimmune (SLE, Dressler’s), uremia, neoplastic, trauma/surgery, idiopathic.
Discuss the clinical manifestations of acute pericarditis.
Chest Pain: Pleuritic (sharp, stabbing), relieved by leaning forward, worse with inspiration/lying flat. Auscultation: Pericardial friction rub (scratchy, triphasic). Other: Fever, dyspnea.
Compare the chest pain, ECG, and specific auscultation findings for Acute Pericarditis, Pulmonary Embolism (PE), and Myocardial Infarction (MI).
Pericarditis: Pleuritic pain (relieved by leaning forward), widespread concave ST↑, PR↓, friction rub. PE: Sudden pleuritic pain, S1Q3T3/tachycardia, normal/crackles. MI: Crushing substernal pain (radiates), localized convex ST↑/Q waves, S3/S4/new murmur.
Define Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD).
ARF: Acute inflammatory disease after Group A Strep infection (pharyngitis), affecting heart, joints, brain, skin. RHD: Chronic heart damage (valves) resulting from one or more ARF episodes.
Discuss the etiology and pathogenesis of Rheumatic Fever (RF).
Etiology: Autoimmune reaction to Group A Streptococcus pyogenes (GAS) pharyngeal infection. Pathogenesis: “Molecular mimicry” - antibodies to GAS M proteins cross-react with human tissues (heart, joints, brain), causing inflammation and damage.
Describe the morphological features of acute RF and RHD, and their clinical manifestations.
Acute RF Morphology: Pancarditis (Aschoff bodies, valvulitis/verrucae), migratory polyarthritis, erythema marginatum, Sydenham chorea, subcutaneous nodules. RHD Morphology: Chronic valve damage (fibrosis, thickening, calcification), leading to stenosis/regurgitation (mitral most common). Clinical (ARF): Arthritis, carditis (murmurs, HF), chorea, erythema marginatum, subcutaneous nodules. Clinical (RHD): Symptoms of chronic valve dysfunction (dyspnea, fatigue, palpitations, HF) years later.
Discuss the origin and morphological features of cardiac myxoma.
Origin: Most common primary benign heart tumor in adults; from multipotent mesenchymal cells. Location: >80% in left atrium (often pedunculated, near foramen ovale). Morphology: Gelatinous, soft, lobulated, glistening.
Describe the clinical features and diagnosis of cardiac myxoma.
Clinical: Cardiac: “Ball-valve” obstruction (positional syncope, dyspnea), variable murmur, HF symptoms. Embolic: Stroke, splenic/renal infarcts. Constitutional: Fever, malaise, weight loss (cytokine release). Diagnosis: Echocardiography (definitive), Cardiac MRI/CT.
Discuss the treatment, prognosis, and familial aspects of cardiac myxoma (Carney Complex).
Treatment: Surgical excision (definitive). Prognosis: Excellent if completely resected; recurrence possible. Familial Myxomas: Multiple, recur more. Carney Complex: Autosomal dominant syndrome with cardiac myxomas (multiple), skin myxomas, lentigines, endocrine tumors (e.g., Cushing syndrome).
What are the key investigations and diagnostic findings for endocarditis?
Investigations: Blood cultures (multiple sets), Echocardiography (TEE more sensitive than TTE), elevated ESR/CRP. Diagnostic Findings: Vegetations on echo, positive blood cultures. Criteria: Duke Criteria (major/minor).
Outline the management of Infective Endocarditis (IE).
Medical: Prolonged IV antibiotics (4-6 weeks), tailored to organism. Surgical: Indicated for severe valve dysfunction, intractable infection, large emboli risk, heart failure. Monitoring: Regular blood cultures, echo, clinical assessment.
Discuss the major complications and prognosis of Infective Endocarditis (IE).
Complications: Heart failure (valve damage), systemic embolism (stroke), perivalvular abscess, renal failure. Prognosis: Variable; high mortality if untreated or with severe complications.
What are the key investigations for myocarditis, and what are the Dallas Criteria?
Investigations: ECG (non-specific), cardiac biomarkers (↑ troponin), Echocardiography, Cardiac MRI (sensitive for inflammation), Endomyocardial Biopsy (gold standard). Dallas Criteria (Biopsy): “Myocardial inflammatory infiltrate with associated myocyte necrosis not typical of ischemic damage.”
Outline the management of myocarditis.
Supportive: Rest, monitor, treat heart failure (diuretics, ACEi, beta-blockers). Specific: Immunosuppression (for autoimmune, not viral). Arrhythmias: Manage as needed. Avoid: NSAIDs, alcohol.
Discuss the complications and prognosis of myocarditis.
Complications: Dilated cardiomyopathy, arrhythmias (sudden cardiac death), acute/chronic heart failure. Prognosis: Variable; many resolve, some progress to chronic HF or require transplant.
What are the key investigations and diagnostic findings for pericarditis?
Investigations: ECG (widespread ST↑, PR↓), Echocardiography (effusion, tamponade), Chest X-ray (cardiomegaly), elevated ESR/CRP.
Outline the management of pericarditis.
Pain Relief: NSAIDs (first-line). Recurrence Prevention: Colchicine (often added to NSAIDs). Refractory/Specific: Corticosteroids (avoid initially). Underlying Cause: Treat as needed.
