infectious & rheumatic heart disese Flashcards by m .

What is the definition of rheumatic fever?

Infection with Group A Streptococcus Pyogens (GAS) → autoimmune reaction

Develops 2-3 weeks after the onset of sore throat

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What chronic condition is associated with rheumatic fever?

Rheumatic heart disease, characterized by chronic valvular abnormalities, mostly mitral stenosis (MS)

Incidence has fallen dramatically in industrialized countries

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What pathological findings are seen in the heart during rheumatic fever that are indicative of an autoimmune reaction?

Aschoff’s bodies

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What is the major diagnostic criteria of rheumatic fever?

J❤️nes

Joints: Polyarthritis of large joints; fleeting
Involves multiple joints, typically large ones

Cardiac: murmurs (mitral regurgitation or aortic regurgitation), congestive heart failure, pericarditis (pericardial rub)

Subcutaneous Nodules: over tendons/ joints/ bony prominences

Erythema marginatum: transient pink coalescent rings on trunk

Sydenham’s chorea: involvement of the central nervous system
Results in involuntary movements

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What are the minor criteria for diagnosing rheumatic fever?

Fever
Elevated ESR or CRP or leukocytosis
Prior history of rheumatic fever or rheumatic heart disease
Prolonged PR interval on ECG
Arthralgia

Minor criteria are less specific than major criteria

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What is required for a diagnosis of rheumatic fever?

2 major criteria OR 1 major and 2 minor + throat culture growing GAS OR elevated anti-streptolysin O titers

Diagnostic criteria must be met for confirmation

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What is the recommended treatment for rheumatic fever?

Complete bed rest (especially for those with carditis)
High-dose aspirin (to control arthritis, fever, and other acute symptoms)
Penicillin (to eradicate residual streptococcal infection)
Treatment monitored with CRP
Prednisolone if cardiac involvement
Treat valvular pathology

Management is crucial to prevent complications

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What is the preventive measure for streptococcal pharyngitis?

Penicillin (erythromycin if allergic)

Prevention of rheumatic fever through treatment of infections

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What is the duration of prevention for rheumatic fever with carditis and residual heart disease? (persistence valvular disease)

10 years or until age 40, whichever is longer

Duration is based on the risk of recurrence

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What is the duration of prevention for rheumatic fever with carditis but no residual heart disease? (no persistence valvular disease)

10 years or until age 21, whichever is longer

Less duration compared to those with residual heart disease

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What is the duration of prevention for rheumatic fever without carditis?

5 years or until age 21, whichever is longer

Shortest duration of prevention

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What is the definition of infective endocarditis?

Infection of the endocardium or the vascular endothelium of the heart

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What are the two types of infective endocarditis?

Acute: Mostly by S. aureus, normal valve, fatal in <6 weeks if untreated
Subacute: More common, Streptococcus viridians or Enterococcus, damaged valve, takes >6 weeks to cause death

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What organism is commonly associated with infective endocarditis in a native healthy valve?

Staph. aureus

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Which organism is associated with infective endocarditis in a native diseased valve?

Strept. viridians

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What is the common organism causing early onset prosthetic valve infective endocarditis?
(< 60 days of surgery)

Staph. epidermidis (acquired in perioperative period)

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What organism is responsible for late onset prosthetic valve infective endocarditis?
(> 60 days of surgery)

Streptococci (follows bacteremia)

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Which organisms are commonly found in infective endocarditis among IV drug users?

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S. aureus mostly
Enterococci
Streptococci
Fungi (Candida)
Gram -ve rods (Pseudomonas)

usually are right-sided valves

What are the culture negative organisms associated with infective endocarditis?

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Coxiella burnetti
Bartonella
Chlamydia
Legionella

What are some constitutional symptoms of infective endocarditis?

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Fever
Weight loss
Anemia
Slight splenomegaly (important finding)

What rule must be followed when a new heart murmur is present with fever?

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Must rule out infective endocarditis

What causes heart failure and murmurs in infective endocarditis?

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Valve destruction due to vegetations made up of fibrin, platelets, and infectious organisms

What are Janeway lesions?

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Painless vascular phenomena associated with infective endocarditis

What are some examples of metastatic abscesses in infective endocarditis?

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Brain
Kidney
Spleen
Lungs (if right-sided)

what occurs with immune complex deposition?

- splinter hemorrhages (in nail beds) - roth’s spots (in retina) - osler’s nodes (painful) - arthralgia - glomerulonephritis with microscopic hematuria

What results with embolization of vegetations?

- janeway lesions (painless vascular phenomena) - metastatic abscesses (brain, kidney, spleen, lungs)

What are some investigations used to diagnose infective endocarditis?

* Blood cultures (3 sets taken over 24 hours) - taken before antibiotics are started * Serological tests for unusual organisms * CBC: normocytic normochromic anemia, leukocytosis, raised ESR * Echocardiography: Transthoracic and Transesophageal * CXR: Heart failure or evidence of embolization * ECG: MI or conduction defects * Urinalysis: hematuria * Raised serum Ig and low complement

What is the significance of taking blood cultures before starting antibiotics?

To ensure accurate identification of the causative organism

True or False: Transesophageal echocardiography is less sensitive than transthoracic echocardiography in the case of prosthetic valves.

False

Fill in the blank: The presence of _______ indicates a potential embolization to the coronary arteries.

What is the typical anemia seen in infective endocarditis?

Normocytic normochromic anemia

What is raised in serum due to immune complex deposition in infective endocarditis?

Raised serum Ig and low complement

What is required for a definite diagnosis of infective endocarditis according to the Modified Duke Criteria?

2 Major Criteria OR 1 Major and 3 Minor OR 5 Minor OR direct evidence of infective endocarditis ## Footnote Direct evidence includes vegetation histology or culture.

What is required for a possible endocarditis diagnosis?

1 Major and 1 Minor OR 3 Minor

What are the Major criteria for diagnosing infective endocarditis?

* 2 positive blood cultures for an organism known to cause IE * Persistent bacteremia (2 +ve 12 hours apart or 3 of 4 +ve drawn over 1 hour) * ECHO evidence (oscillating mass on valve, abscess, new valvular regurgitation, partial dehiscence of prosthetic valve)

What are the Minor criteria for diagnosing infective endocarditis?

* Predisposing factor (cardiac lesion, IV drug use) * Fever > 38°C * Evidence of emboli or vasculitis * Immunological features (Osler node, nephritis) * Echo of uncertain significance * Serology for Q fever or Chlamydial infection * Single +ve blood culture of uncertain etiology

What is the initial treatment protocol for infective endocarditis?

IV bactericidal Antibiotics for 2 weeks, then oral for 2-4 weeks.

What are the empirical antibiotics used for treating infective endocarditis?

Benzylpenicillin + gentamicin if staphylococci are suspected then vancomycin + gentamicin.

What are the indications for acute valve replacement in infective endocarditis cases?

* Severe heart failure * Worsening renal failure * Extensive damage to the valve * Prosthetic valve

Is prophylaxis indicated for patients diagnosed with infective endocarditis?

NOT INDICATED for patients when they are diagnosed.

What conditions require prophylaxis in patients with infective endocarditis? And what drug is used

When the patient has BOTH a qualifying cardiac indication AND a qualifying procedure. Amoxicillin. If allergic to penicillin, give Clindamycin or azithromycin.

What are the cardiac indications for prophylaxis in infective endocarditis?

* Prosthetic heart valve * History of infective endocarditis * Transplanted heart with valvular disease * Unrepaired cyanotic congenital heart disease * Repaired congenital heart disease with prosthetic material within the first 6 months after procedure * Repaired CHD with residual defects at the site of a prosthetic patch or device

What types of procedures require prophylaxis for infective endocarditis?

* Dental procedures involving manipulation of gingival tissue or periapical region * Invasive respiratory tract procedures involving incision or biopsy of respiratory mucosa * Surgical procedures involving infected skin or musculoskeletal tissue

Is prophylaxis required for genitourinary or gastrointestinal tract procedures in infective endocarditis?

No prophylaxis is required.

infectious & rheumatic heart disese Flashcards

(44 cards)