Infectious and Valve Disease Flashcards Preview

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Flashcards in Infectious and Valve Disease Deck (26)
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Valvular stenosis and valvular regurgitation and what are their different types

Stenosis is the thickening of the valve or the failure of the valve to open completely whereas regurgitation is the failure of the valve to close completely

Valvular insufficiency is also regurgitations

Can be pure, like it can be either stenosis or insufficiency or it can be isolated or combined which basically means it involves more than one valves


Different mitral valve and aortic valve diseases and their associated reasons

Mitral valve stenosis - the only reason for that is rheumatic fever

Mitral valve regurgitation has several causes - one of the cause is mitral valve prolapse which is fairly common in women

Aortic stenosis - rheumatic heart disease and you can also have calcification


Calcific stenosis - this valve is fused due to the white Ca deposits, this is the tricuspid valve


Bicuspid or mitral valve - Calcific Stenosis


Calcific Stenosis


Facts about mitral valve prolapse

1. 20% among women, fairly common.

2. Myxamatous degeneration

3. Echo can find it, there is a chance of sudden death due to valve not closing properly causing arrythmias

Remember this is part of the mitral valve regurgitation


Acute Rheumatic Fever

1. It mainly happens in children, following a pharyngeal infection which causes the inflammation of the valve of the heart leading to their defective function

2. It is due to autoimmune disease due to streptococcus pyogenes antigens - molecular mimicry


What is the name of the criteria for Rheumatic fever

It is called the Jones criteria, it consist of mythralgia, acute phase reactants and fever


What are the symptoms of Rheumatic fever

1. There are distinct foci of fibrinoid necrosis of lymphocytes and macrophages which are called the ASCHOFF BODIES. Aschoff bodies are the defining symptoms of rheumatic fever, it is found in all layers of the heart.

2. Non specific arthritis - migratory arthritis

3. Erythema Maginatum - subcutaneous nodules of aschoff bodies 


Chronic inflammation of the valves in rheumatic fever, usually mitral valve is affected the most but aortic valve can also be affected. 


What are the pathophysiological changes that take place in the heart in ARF

1. Fibrous adhesions can cause fusion of the leaflets of the mitral valve

2. Shortening, thickening and fusion of chordae tendenae

3. Dilation of left atrium that can cause arrythmias

4. Thrombosis of the left atrium

5. Bacterial endocarditis


What is the end results of rheumatic fever

It leads to Rheumatic Heart Disease (RHD), this mainy happens due to mitral stenosis, blood is gonna get backed up in the lungs:

1. Pulmonary congestion and edema

2. Right ventricle hypertrophy and right side heart failure

3. Hemorrhage and infarction

4. Hyperplasia of the pulmonary arterioles


Mitral valve stenosis, its called the fish mouth


Aortic valve stenosis, fusion fo the aortic valve leaflets due to RF or RHD


Endocarditis and what is the pathological criteria

Acute or Sub acute bacterial endocarditis, SABE or ABE. He listed a whole range of risk factors:

RHD is one of them

Pathological criteria is microorganisms in the blood and histological evidence of endocarditis in vegetation or in intracardiac abscess


What is the clinical criteria for endocarditis

Major: 1. Positive blood culture

2. Evidence in on echocardiogram

3. New valvular regurgitation

Minor: IV drug use, fever, Janeway lesions,Osler nodes and Roth spots


Contaminants of blood cultures

These contaminants are there when you puncture the skin to take blood samples and these microorganisms enter the blood sample from the top surface of the punctured skin 

Staph spp, Bacillus spp, Coryneabacterium spp and Propionoibacterium spp

Contaminants = misinformation


What are some of the other causes for contaminants in blood sample

1. Povidone-iodine solution can be contaminated which is used to sterilize the skin

2. Residents of med students dont wait for the iodine to dry on the skin - most common cause, have to wait 60 s!

3. Collection vials can be contaminated

4. Drawing culture from indwelling catheter, sample from another site should also be collected


What is an effective way to get avoid the contaminants when getting blood sample

Take samples from 2 different poisitions in the body and follow proper procedure (wait for the iodine to dry out)


What pathogen is the leading cause of endocarditis

Staphylococcus aureus, it is a very pathogenic microorganism, it can even infect a normal valve, usually a valve has to be defective to get infected, it is called aureus (gold) cuz it appears yellow on the blood culutre plate.

It leads to large vegetations that almost always cause murmurs


Staph aureus caused endocarditis, it can be seen that it has eaten through the valve


Staph aureus can break off from the valve and travel downstream, causing infection


What are HACEK

Just need to remember that cultures for these organisms have to be held for longer than 30 days, need to talk to ID to get approval for that


What are the cardiac complications of Infectious Endocarditis

Perforation of ventricular septum and valvular insufficiency and/or stenosis

Supurative pericarditis

Dehiscene of an artificial valve since the pus causes the sutures to break

There are embolic complications as well


Non Bacterila Thrombotic Endocarditis

This is a procoagulative state, which can cause precipitation of fibrin causing coagulation in the heart, the vegetations formed are small. 

The most common cause for this are pregnancy and cancer. Cancer is more common. Complications of this disease include embolic infarcts in the brain, kidney, liver and other parts of the body


Comparison of endocarditis, where is it located in different disease

The last one is lupus, where is it located on the underneath side of the valve