Infections of the Heart

Question 1

A systemic immune process that is a sequela of β-hemolytic streptococcal infection of the pharynx (Group A strep)

Inflammatory condition – primarily involves heart, skin, and connective
tissue

Answer 1

Rheumatic Fever

Question 2

Rheumatic fever is most common among what age range?

Answer 2

5-15 years of age

Question 3

Rheumatic fever directly related to what?

Answer 3

immune response

Question 4

Jones Major Criteria: CANCER

List the components

Answer 4

C – carditis
A – arthritis
N – nodules
C – chorea
E – erythema marginatum
R – rheumatic fever

Question 5

Mid-diastolic murmur at apex that can be associated with carditis

Answer 5

Carey-Coombs murmur

Question 6

What is the least common jones major criteria seen?

Answer 6

Sydenham’s Chorea

Question 7

Sudden, aimless, irregular movements especially of the face, tongue, and upper extremities

Answer 7

Sydenham’s Chorea

Question 8

What rash characteristic of rheumatic fever?

Answer 8

Erythema Marginatum

Question 9

Describe the rash Erythema Marginatum

Answer 9

Rapidly enlarging macules that assume the shape of rings or crescents with clear centers

Vary greatly in size

Trunk/proximal extremities (never on the face)

Non-pruritic, non-indurated, blanches on pressure

Transient/persistent

Question 10

For the Jones Major Criteria, what is acceptable criterion for
polyarthritis?

Answer 10

Two or more joints

≥ 2 minor manifestations (Fever, ESR, etc)

High titer of streptococcal antibody

Question 11

What are the characteristics of subcutaneous nodules in Jones major criteria?

Answer 11

Pea sized (0.5-2cm)

Painless

Firm

Mobile

Rarely seen – when present (in children), are usually associated with severe carditis

Over bony prominences

Persist for days or weeks, often recurrent

Question 12

Jones Minor Criteria – CAFÉ PAL

List the components

Answer 12

C – CRP increased
A – arthralgia
F – fever
E – ESR increased

P – prolonged PR interval
A – already had RF o rRHD
L - leukocytosis

Question 13

Jones Criteria

Answer 13

2 major
or
1 major + 2 minor

Question 14

Streptococcal antibody titers

Answer 14

ASO (antistreptolysin O)
Anti-DNase B
AH (antihyaluronidase)
ASTZ (antistreptozyme)

Question 15

Acute rheumatic fever can be prevented if antibiotics are given
within how many days of symptom onset?

Answer 15

9

Question 16

In acute rheumatic fever, strict bedrest is required until what criteria is met?

Answer 16

Temperature returns to normal without the use of antipyretic medications

ESR normalizes

Resting heart rate returns to normal

EKG returned to baseline

Question 17

In acute rheumatic fever, significant symptomatic valvular heart disease occurs in what percentage of cases?

Answer 17

<10%

Question 18

In acute rheumatic fever, what significant symptomatic valvular heart disease is most common to occur?

Answer 18

Mitral Stenosis

Question 19

What is the target INR for a mechanical valve?

Answer 19

INR of 2.5-3.5

Question 20

Infection of endocardial surface of the heart, including the cardiac valves, can lead to extensive tissue damage and often fatal

Answer 20

Endocarditis

Question 21

“vegetation” on a heart valve

Answer 21

Endocarditis

Question 22

This infection can result in a 100% mortality if not recognized and treated correctly

Answer 22

Endocarditis

Question 23

Native valve endocarditis accounts for what percentage of cases?

Answer 23

60-80%

Question 24

In endocarditis, rank the of valves in order of frequency of infection

Answer 24

mitral – aortic – tricuspid – pulmonic

Question 25

In endocarditis, which side of the heart is affected most cases?

Answer 25

left involvement

Question 26

What type of organisms account for approximately 90% of cases in endocarditis?

Answer 26

Gram positive

Question 27

In endocarditis, for a native valve what is the most common pathogen seen?

Answer 27

Staph Aureus

Question 28

In endocarditis, infections tend to attack which type of valves?

Answer 28

prosthetic

Question 29

In endocarditis, for a prosthetic valve what is the most common pathogen seen?

Answer 29

Staphylococcus epidermidis,

Question 30

IV drug uses have high propensity for endocarditis of right-sided valves, especiallywhich valve?

Answer 30

tricuspid

Question 31

IV drug uses have high propensity for endocarditis of right-sided valves, which is the the most common pathogen in these cases?

Answer 31

Staphylococcus aureus

Question 32

What are the risk factors for endocarditis?

Answer 32

IV drug use Prosthetic heart valves Structural heart disease Prior endocarditis

Question 33

What is the organism in Subacute Bacterial Endocarditis?

Answer 33

Viridans streptococci

Question 34

What is the organism in Acute Bacterial Endocarditis?

Answer 34

Staphylococcus aureus

Question 35

In endocarditis, what is the most common complication/cause of death?

Answer 35

Heart failure

Question 36

Systemic emboli from endocarditis most commonly affects which organs?

Answer 36

Spleen and kidney most common

Question 37

List the unique peripheral stigmata that can be seen in cases of endocarditis

Answer 37

Splinter hemorrhages Janeway lesions Osler nodes Roth spots

Question 38

What is the imaging gold standard for workup in endocarditis cases?

Answer 38

Echo