Infective and Inflammatory Cardiac Disorders Flashcards
(236 cards)
1
Q
What is endocarditis?
A
An infection of the endocardial surface of the heart, most commonly involving the heart valves.
2
Q
What are the common causes of endocarditis?
A
Usually caused by bacteria, but can also result from fungal or other microbial infections.
3
Q
What are the two main classifications of endocarditis?
A
- Acute Endocarditis
- Subacute Endocarditis
- Non-Infective Endocarditis
4
Q
What characterizes Acute Endocarditis?
A
Rapid onset, typically caused by virulent organisms, severe illness with high fever.
5
Q
What characterizes Subacute Endocarditis?
A
Insidious onset, often caused by less virulent organisms, gradual presentation with nonspecific symptoms.
6
Q
What is Non-Infective Endocarditis?
A
Includes Libman-Sacks Endocarditis and Nonbacterial Thrombotic Endocarditis (NBTE).
7
Q
List some cardiac risk factors for endocarditis.
A
- Pre-existing Valve Disease
- Prosthetic Heart Valves
- Congenital Heart Diseases
- Previous History of Endocarditis
- Hypertrophic Cardiomyopathy
8
Q
What is a common cause of endocarditis in intravenous drug users?
A
Staphylococcus aureus.
9
Q
What are some healthcare-associated risk factors for endocarditis?
A
- Invasive Procedures
- Dental Procedures
- Central Venous Catheters
- Dialysis Access
- Cardiac Devices
10
Q
What are systemic conditions that increase the risk of endocarditis?
A
- Malignancy
- Chronic Alcoholism
- Poor Dental Hygiene
11
Q
What is the most common etiologic agent of infective endocarditis?
A
Staphylococcus aureus.
12
Q
What organism is associated with subacute NVE after dental procedures?
A
Streptococcus viridans.
13
Q
What are the steps in the pathogenesis of infective endocarditis?
A
- Endothelial Damage
- Bacteremia
- Bacterial Adhesion
- Vegetation Formation
- Local Destruction and Embolization
- Systemic Spread
14
Q
What is the role of endothelial damage in infective endocarditis?
A
It predisposes to thrombus formation, allowing microbes to adhere and form vegetations.
15
Q
What is the significance of transient bacteremia in infective endocarditis?
A
It introduces microorganisms into the bloodstream, increasing the risk of infection.
16
Q
What are Janeway lesions?
A
Non-tender, erythematous macules on palms/soles caused by microembolism.
17
Q
What are Osler nodes?
A
Painful, tender nodules on fingers and toes caused by immune complex deposition.
18
Q
What are the clinical manifestations of infective endocarditis?
A
- Systemic Manifestations
- Cardiac Manifestations
- Vascular Manifestations
- Immunologic Manifestations
- Neurological Manifestations
- Renal Manifestations
19
Q
What is a common neurological manifestation of infective endocarditis?
A
Ischemic Stroke.
20
Q
What can cause glomerulonephritis in infective endocarditis?
A
Immune complex deposition in glomeruli.
21
Q
What is persistent bacteremia in the context of infective endocarditis?
A
Vegetations periodically shed bacteria into the bloodstream.
22
Q
Fill in the blank: The most common site of infection in infective endocarditis is the _______.
A
heart valve.
23
Q
True or False: Right-sided endocarditis typically leads to emboli in the brain.
A
False.
24
Q
What can septic emboli from right-sided endocarditis lead to?
A
Pulmonary embolism.
25
What are the characteristics of vegetations in infective endocarditis?
* Microorganisms
* Platelets
* Fibrin
* Inflammatory cells
26
What is the mechanism of fever in infective endocarditis?
Cytokine release due to infection and inflammation.
27
What is the relationship between IV drug use and infective endocarditis?
Direct injection of pathogens increases risk, often involving the tricuspid valve.
28
What are splinter hemorrhages?
Linear red streaks under fingernails caused by microembolism to capillaries.
29
What can cause acute kidney injury in infective endocarditis?
Reduced renal perfusion or embolic events.
30
What are the primary renal manifestations of infective endocarditis?
Hematuria, proteinuria, renal failure, flank pain
## Footnote
Primarily due to immune-mediated glomerulonephritis or septic emboli.
31
What causes glomerulonephritis in the context of renal manifestations?
Immune complex deposition in glomeruli
32
What are the features of renal infarction?
Flank pain, hematuria
33
What is the mechanism behind renal infarction?
Septic embolism to renal arteries
34
What are the signs of Acute Kidney Injury (AKI)?
Reduced urine output, rising creatinine
35
What mechanisms can lead to Acute Kidney Injury (AKI) in infective endocarditis?
Reduced renal perfusion or embolic events
36
What are the musculoskeletal manifestations of infective endocarditis?
Septic arthritis, vertebral osteomyelitis, polymyalgia-like symptoms
## Footnote
Often due to septic emboli or immune complex deposition.
37
What are the features of septic arthritis?
Acute joint pain, swelling, fever
38
What is the mechanism of septic arthritis?
Hematogenous spread of bacteria
39
What are the symptoms of vertebral osteomyelitis?
Back pain, tenderness, fever
40
What causes vertebral osteomyelitis?
Embolic seeding of the vertebrae
41
What are the features of polymyalgia-like symptoms in infective endocarditis?
Muscle aches, stiffness
42
What causes polymyalgia-like symptoms?
Inflammatory response
43
What is anemia of chronic disease in the context of hematologic manifestations?
Normocytic, normochromic anemia
44
What causes thrombocytopenia in infective endocarditis?
Due to splenomegaly or consumption
45
What is leukocytosis and its cause in infective endocarditis?
Inflammatory response
46
What do elevated ESR and CRP indicate?
Reflects systemic inflammation
47
What are the key features of acute endocarditis?
Rapid onset, high fever, septicemia, valve destruction, embolic events
48
What distinguishes subacute endocarditis from acute endocarditis?
Gradual onset, nonspecific symptoms, low-grade fever, immune phenomena
49
What is associated with right-sided infective endocarditis?
IV drug use, often causing septic pulmonary emboli
50
What is more likely to occur with left-sided infective endocarditis?
Systemic emboli (e.g., stroke, renal infarction)
51
What is the primary diagnostic challenge in infective endocarditis (IE)?
Varied clinical presentation requiring a combination of clinical evaluation, microbiological evidence, and imaging findings.
52
What are the major criteria for the Modified Duke Criteria in diagnosing IE?
* Positive Blood Cultures
* Evidence of Endocardial Involvement
53
What constitutes a positive blood culture in the context of IE diagnosis?
Typical microorganisms from 2 separate blood cultures, such as:
* Viridans streptococci
* Staphylococcus aureus
* Enterococci
* HACEK group organisms
54
What is required for persistently positive blood cultures?
≥2 positive cultures drawn >12 hours apart or 3 out of 4 separate cultures within at least 1 hour.
55
What are the minor criteria for the Modified Duke Criteria?
* Predisposing Cardiac Condition or IV Drug Use
* Fever ≥ 38°C (100.4°F)
* Vascular Phenomena
* Immunologic Phenomena
* Microbiological Evidence
56
How is definite IE diagnosed according to the Modified Duke Criteria?
2 major criteria, or 1 major + 3 minor criteria, or 5 minor criteria.
57
What is the key diagnostic test for infective endocarditis?
Blood cultures.
58
What is the significance of elevated inflammatory markers in IE?
Indicates systemic inflammation and infection.
59
What imaging study is preferred for detecting vegetations in IE?
Transesophageal Echocardiogram (TEE).
60
What are the findings that can be seen on echocardiography in IE?
* Vegetations
* Valve Dysfunction
* Abscess Formation
* Prosthetic Valve Dehiscence
61
What is the role of CT Angiography in the diagnosis of IE?
Detects embolic phenomena.
62
What laboratory findings are indicative of IE?
* Normocytic, normochromic anemia
* Elevated creatinine
* Hematuria
* Positive rheumatoid factor
63
What does a valve biopsy show in IE?
Fibrin, platelets, neutrophils, and microorganisms within vegetations.
64
What are the general principles of managing infective endocarditis?
* Early Diagnosis
* Targeted Antibiotic Therapy
* Monitoring for complications
* Multidisciplinary Approach
65
What is the empirical antibiotic therapy for Native Valve, Acute IE?
Vancomycin + Ceftriaxone or Gentamicin.
66
What are indications for surgical intervention in IE?
* Heart Failure
* Uncontrolled Infection
* Embolic Events
* Large Vegetation (>10 mm)
* Prosthetic Valve Dysfunction
* Fungal Endocarditis
* Valve Perforation or Rupture
67
What is the most common cardiac complication of IE?
Heart Failure.
68
What are the clinical features of pulmonary embolism as a complication of IE?
Pleuritic chest pain, dyspnea, hemoptysis.
69
True or False: Surgical intervention is necessary for all cases of infective endocarditis.
False.
70
What should patients with high risk of IE receive before high-risk procedures?
Prophylactic antibiotics.
71
Fill in the blank: The Modified Duke Criteria are used for _______.
[diagnosing infective endocarditis].
72
What is the purpose of monitoring blood cultures in the management of IE?
To monitor response to therapy.
73
What are the key points regarding the prognosis of infective endocarditis?
* Depends on causative organism
* Timing of diagnosis
* Effectiveness of treatment
* Presence of complications
74
What is Splenic Infarction?
Arterial embolism affecting the spleen, leading to left upper quadrant pain and splenomegaly
## Footnote
Common clinical features include pain and splenomegaly.
75
What are the clinical features of Renal Infarction?
Flank pain, hematuria, acute kidney injury (AKI)
## Footnote
Caused by embolic obstruction of renal arteries.
76
What symptoms are associated with Mesenteric Ischemia?
Abdominal pain, bloody stools, bowel ischemia
## Footnote
Results from embolic occlusion of mesenteric arteries.
77
What are the main clinical features of Limb Ischemia?
Acute limb pain, pallor, pulselessness
## Footnote
Occurs due to embolism to peripheral arteries.
78
True or False: Embolic risk is highest during the first 2 weeks of antibiotic therapy.
True
## Footnote
Important clinical tip for monitoring during treatment.
79
What percentage of cases experience neurological complications?
Up to 40%
## Footnote
Often due to septic emboli or mycotic aneurysms.
80
What are the clinical features of Ischemic Stroke?
Focal neurological deficits, altered consciousness
## Footnote
Caused by embolization to cerebral arteries.
81
What symptoms indicate Intracranial Hemorrhage?
Headache, neurological decline, coma
## Footnote
Resulting from rupture of mycotic aneurysm.
82
What are the symptoms of a Brain Abscess?
Fever, headache, focal deficits, seizures
## Footnote
Caused by septic emboli lodging in cerebral parenchyma.
83
What is a Mycotic Aneurysm?
Infection of arterial wall leading to dilation, causing sudden headache and risk of rupture
## Footnote
Can lead to subarachnoid hemorrhage.
84
What should be done when neurological symptoms in IE are observed?
Immediate brain imaging (CT/MRI)
## Footnote
Important to detect embolic infarcts or hemorrhage.
85
What are the clinical features of Glomerulonephritis?
Hematuria, proteinuria, renal failure
## Footnote
Caused by immune complex deposition.
86
What are the symptoms of Renal Abscess?
Fever, back pain, positive urine cultures
## Footnote
Resulting from septic emboli causing localized infection.
87
What are the clinical features of Septic Arthritis?
Joint pain, swelling, erythema, fever
## Footnote
Caused by embolic seeding of joints.
88
What are the symptoms of Osteomyelitis?
Localized bone pain, swelling, fever
## Footnote
Resulting from bacteremia leading to bone infection.
89
What are the clinical features of Vasculitis?
Palpable purpura, petechiae
## Footnote
Caused by immune-mediated small vessel inflammation.
90
What factors impact the prognosis of Infective Endocarditis?
Causative organism, valve involvement, heart failure, neurological complications, prosthetic valve endocarditis, early diagnosis and treatment
## Footnote
Each factor affects outcomes significantly.
91
What is the mortality rate for Acute IE caused by S. aureus?
Up to 30-50%
## Footnote
Considered high mortality.
92
What is the mortality rate for Subacute IE caused by Streptococcus spp.?
About 5-10%
## Footnote
Generally better prognosis than acute IE.
93
What is the mortality rate for Fungal IE?
As high as 50-80%
## Footnote
Indicates poor prognosis.
94
What is the mortality rate for Prosthetic Valve IE?
Up to 20-40%
## Footnote
Higher risk of relapse and mortality.
95
What are the most common complications of Infective Endocarditis?
Heart failure and embolic events
## Footnote
Key points to remember for prognosis.
96
What is crucial in cases with severe valvular damage or uncontrolled infection?
Surgical intervention
## Footnote
Important for improving outcomes.
97
What is necessary for long-term follow-up in Infective Endocarditis?
Detection of recurrence or late complications
## Footnote
Essential for patient management.
98
What is myocarditis?
An inflammatory disease of the myocardium characterized by myocyte necrosis and inflammatory infiltrate.
99
What are the most common infectious causes of myocarditis?
* Viral Agents
* Bacterial Agents
* Protozoal Agents
* Fungal Agents
* Parasitic Agents
100
Name two viral agents that are common causes of myocarditis.
* Coxsackievirus B
* Adenovirus
101
Which bacterial agent causes rheumatic myocarditis through molecular mimicry?
Streptococcus pyogenes
102
What is the role of Trypanosoma cruzi in myocarditis?
Causes chronic Chagas cardiomyopathy.
103
List three autoimmune diseases that can cause myocarditis.
* Systemic Lupus Erythematosus (SLE)
* Rheumatoid Arthritis (RA)
* Sarcoidosis
104
What is the mechanism of injury in viral myocarditis?
Direct viral injury and immune-mediated cytotoxicity.
105
Fill in the blank: The pathogenesis of viral myocarditis is divided into three phases: acute, subacute, and _______.
chronic
106
What is the acute phase of viral myocarditis characterized by?
Viral entry and replication.
107
What cytokines are commonly released during the acute phase of viral myocarditis?
* IL-1
* IL-6
* TNF-α
* IFN-γ
108
During which phase of viral myocarditis does autoimmunity and excessive cytokine release occur?
Subacute phase
109
What are the key pathological features of viral myocarditis?
* Myocyte Necrosis
* Lymphocytic Infiltration
* Interstitial Edema
* Fibrosis
* Granulomatous Infiltrate
110
What are common systemic symptoms of myocarditis?
* Fever
* Fatigue and Malaise
* Myalgias
* Arthralgias
111
What cardiac symptom might mimic acute coronary syndrome in myocarditis?
Chest Pain
112
What signs indicate heart failure in myocarditis?
* Peripheral Edema
* Jugular Venous Distention (JVD)
* Hepatomegaly
* Pulmonary Crackles
* Tachypnea and Tachycardia
* Hypotension
113
What is the defining characteristic of fulminant myocarditis?
Abrupt, severe presentation with cardiogenic shock.
114
True or False: Chronic myocarditis often presents with progressive dyspnea over weeks to months.
True
115
What is a common complication of myocarditis that can lead to sudden cardiac death?
Ventricular arrhythmias
116
What is localized myocardial irritation?
Palpitations
## Footnote
Palpitations are often a symptom of localized myocardial irritation.
117
What characterizes Fulminant Myocarditis?
• Rapid Onset: Hours to days
• Severe Cardiogenic Shock: Hypotension, cool extremities, oliguria
• Severe Arrhythmias: Life-threatening VT or VF
• Acute Heart Failure: Pulmonary oedema, marked JVD
• High Mortality: Without aggressive support
## Footnote
Aggressive support may include mechanical circulatory support.
118
What are the symptoms of Chronic Myocarditis?
• Progressive Dyspnoea: Worsening over weeks to months
• Dilated Cardiomyopathy (DCM)
• Chronic Heart Failure: Fatigue, fluid retention, orthopnoea
• Thromboembolism
## Footnote
Thromboembolism occurs due to stasis in a dilated, poorly functioning ventricle.
119
What is Giant Cell Myocarditis associated with?
• Rapidly Progressive Heart failure and arrhythmias
• Associated with Autoimmune Disorders
• High Mortality: Despite aggressive immunosuppression
## Footnote
Autoimmune disorders may include sarcoidosis or autoimmune thyroiditis.
120
What unique clinical feature is associated with Viral Myocarditis?
Flu-like symptoms, chest pain, palpitations
## Footnote
Coxsackievirus B is an example of a virus that can cause myocarditis.
121
What are the symptoms of HIV-associated Myocarditis?
Progressive dyspnoea, opportunistic infections
## Footnote
HIV can lead to various complications, including myocarditis.
122
What clinical features are associated with Lyme Disease myocarditis?
Heart block, arthralgia, erythema migrans
## Footnote
Borrelia burgdorferi is the causative agent.
123
What are the symptoms of Chagas Disease myocarditis?
Megacolon, megaesophagus, chronic cardiomyopathy
## Footnote
Chagas Disease is caused by Trypanosoma cruzi.
124
What are the symptoms of COVID-19 Myocarditis?
Fever, dyspnoea, chest tightness, elevated troponins
## Footnote
Elevated troponins indicate myocardial injury.
125
What does an S3 Gallop indicate?
Ventricular dysfunction
## Footnote
S3 Gallop is a physical examination finding.
126
What can cause murmurs of Mitral/Tricuspid Regurgitation?
Ventricular dilation or papillary muscle dysfunction
## Footnote
Murmurs are detected during physical examination.
127
What does a pericardial rub indicate?
Associated pericarditis
## Footnote
A pericardial rub is a finding during physical examination.
128
What does Pulsus Alternans indicate?
Severe LV dysfunction
## Footnote
Pulsus Alternans is characterized by alternating strong and weak pulses.
129
What does elevated troponins indicate?
Myocyte injury
## Footnote
Troponins are a laboratory finding relevant to myocardial injury.
130
What does elevated BNP or NT-proBNP indicate?
Heart failure
## Footnote
These biomarkers are used to assess heart failure.
131
What does elevated CRP and ESR indicate?
Systemic inflammation
## Footnote
CRP and ESR are laboratory tests that indicate inflammation.
132
What does positive viral serology/PCR indicate?
Identifying causative agent
## Footnote
This test helps in diagnosing viral myocarditis.
133
What ECG changes are associated with myocardial inflammation?
ST-T changes, arrhythmias, AV block
## Footnote
These changes can indicate myocardial scarring.
134
What can echocardiography reveal in myocarditis?
Regional wall motion abnormalities, reduced EF
## Footnote
Echocardiography is an important imaging modality in assessing heart function.
135
What does late gadolinium enhancement (LGE) indicate in cardiac MRI?
Myocardial inflammation
## Footnote
LGE is a specific finding in cardiac MRI for inflammation.
136
What can a chest X-ray show in cases of myocarditis?
Cardiomegaly, pulmonary oedema
## Footnote
Chest X-ray is used to visualize heart size and fluid status.
137
What is myocarditis?
An inflammatory disease of the myocardium
138
What are the goals of investigations for myocarditis?
* Confirm the diagnosis
* Identify the causative agent
* Assess the severity of myocardial involvement
* Evaluate complications (e.g., heart failure, arrhythmias)
139
What is the significance of elevated Troponin I/T in myocarditis?
Indicates myocyte necrosis due to inflammation
140
What does an elevated B-type Natriuretic Peptide (BNP) indicate?
Ventricular dysfunction and heart failure
141
What are common clinical symptoms of myocarditis?
* Chest pain
* Palpitations
* Dyspnea
* Fatigue
* Signs of heart failure (edema, JVD, rales)
142
True or False: Elevated troponin in myocarditis can mimic acute coronary syndrome.
True
143
What does the presence of giant cells in an endomyocardial biopsy indicate?
Giant cell myocarditis
144
What imaging study is the gold standard for tissue characterization in myocarditis?
Cardiac Magnetic Resonance Imaging (CMR)
145
What are the Dallas Criteria used for?
To standardize the histopathological diagnosis of myocarditis
146
What are the three categories of myocarditis according to the Dallas Criteria?
* Active Myocarditis
* Borderline Myocarditis
* No Myocarditis
147
What histopathological finding is characteristic of active myocarditis?
Inflammatory infiltrates with focal or diffuse myocyte necrosis
148
What is the significance of elevated C-Reactive Protein (CRP) in myocarditis?
Indicates acute inflammation
149
Fill in the blank: The definitive diagnostic test for myocarditis is _______.
Endomyocardial Biopsy (EMB)
150
What type of infiltrates are seen in eosinophilic myocarditis?
Dense infiltrates of eosinophils
151
What are the limitations of the Dallas Criteria?
* Sampling Error
* Lack of Sensitivity
* Histological Variability
* Subjectivity in Interpretation
* Evolving Concepts
152
What is the first-line imaging modality to assess cardiac function in myocarditis?
Echocardiography (TTE/TEE)
153
What does a positive viral serology indicate in the context of myocarditis?
Infection by specific viruses such as Coxsackievirus B, Parvovirus B19, or CMV
154
What is the significance of late gadolinium enhancement (LGE) in CMR?
Indicates myocyte necrosis and fibrosis
155
What is a key feature of chronic myocarditis histopathology?
More fibrosis and scarring with reduced cellular infiltrates
156
What management principle involves identifying patients at risk of rapid deterioration in myocarditis?
Early Diagnosis and Risk Stratification
157
What pharmacological therapy is used for acute decompensated heart failure in myocarditis?
* Diuretics (e.g., Furosemide)
* Vasodilators (e.g., Nitroglycerin)
* Inotropes (e.g., Dobutamine or Milrinone)
158
What is the role of corticosteroids in myocarditis management?
Indicated in autoimmune myocarditis and giant cell myocarditis
159
True or False: NSAIDs are recommended in the management of myocarditis.
False
160
What type of arrhythmias can amiodarone be used to treat in myocarditis?
Tachyarrhythmias such as ventricular tachycardia or atrial fibrillation
161
What does the presence of perivascular inflammation indicate in myocarditis?
Lymphocytic cuffing around small coronary vessels
162
What is the significance of Holter monitoring in myocarditis management?
Detects paroxysmal arrhythmias
163
What is the primary treatment for bradyarrhythmias in the case of high-grade AV block?
Temporary pacing
164
What is the recommended dosage of corticosteroids for autoimmune or giant cell myocarditis?
1 mg/kg/day, tapered slowly
165
In which conditions is immunosuppressive therapy indicated?
* Autoimmune Myocarditis
* Sarcoidosis-related myocarditis
166
What is the drug of choice for anticoagulation in patients with severe LV dysfunction?
Warfarin (INR 2.0-3.0) or DOACs if non-valvular AF
167
What is the purpose of an Intra-Aortic Balloon Pump (IABP)?
Reduces afterload, improves coronary perfusion
168
What is the primary indication for cardiac transplantation?
Refractory heart failure not responsive to optimal medical therapy
169
What is the frequency of echocardiography monitoring in myocarditis?
Baseline and every 3-6 months
170
What dietary modification is recommended for patients with myocarditis?
Low-sodium diet to reduce fluid retention
171
What is the prognosis for fulminant myocarditis?
High mortality, but good recovery if survived
172
What are the primary cardiac complications of myocarditis?
* Heart Failure
* Dilated Cardiomyopathy (DCM)
* Cardiogenic Shock
* Acute Coronary Syndrome-like Syndrome
* Chronic Heart Failure
173
What arrhythmia is associated with scarring and fibrosis in myocarditis?
Ventricular Tachycardia (VT)
174
What is a significant risk associated with myocarditis?
Sudden Cardiac Death (SCD)
175
What complication can arise from myocarditis coexisting with pericarditis?
Pericardial Effusion
176
What is the most common long-term sequela of myocarditis?
Dilated Cardiomyopathy (DCM)
177
What is the anticipated outcome for patients with mild viral myocarditis?
Complete Recovery
178
What factors indicate a poor prognosis in myocarditis?
* Giant cell, fulminant, autoimmune etiology
* Severe heart failure, EF <30%
* Fulminant onset with cardiogenic shock
* Refractory to medical management
* Sustained VT or VF
179
What is the mortality rate for chronic myocarditis at 5 years?
20%
180
Which biomarkers are monitored weekly during the acute phase of myocarditis?
* Troponin
* BNP
181
What is the treatment for acute Chagas disease?
Benznidazole or Nifurtimox
182
True or False: Specific antiviral therapy is generally indicated for viral myocarditis.
False
183
What are the clinical features of pericardial effusion?
* Chest pain
* Muffled heart sounds
184
What is the mechanism behind heart failure as a complication of myocarditis?
Reduced cardiac output due to ventricular dysfunction
185
Fill in the blank: Patients with LV dysfunction (EF <35%) are at higher risk for _______.
thromboembolic complications
186
What is the recommended therapy for severe COVID-19 myocarditis?
Consider Remdesivir and corticosteroids if severe
187
What is the significance of a Left Ventricular Ejection Fraction (LVEF) <30%?
Associated with a poor prognosis
188
What is pericarditis?
Inflammation of the pericardium, the double-walled sac that encloses the heart.
189
What are the common clinical presentations of acute pericarditis?
Pleuritic chest pain, pericardial friction rub, and ECG changes.
190
List the infectious causes of pericarditis.
* Viral: Coxsackievirus, Echovirus, Adenovirus, HIV
* Bacterial: Streptococcus, Staphylococcus, Tuberculosis
* Fungal: Histoplasma, Coccidioides
* Parasitic: Toxoplasmosis, Echinococcus
* Spirochetal: Lyme disease
191
What autoimmune/inflammatory conditions can cause pericarditis?
* Connective tissue diseases: SLE, RA, Scleroderma
* Vasculitis: Polyarteritis nodosa, Kawasaki disease
* Post-MI: Dressler syndrome
* Sarcoidosis
192
What are the post-cardiac injury causes of pericarditis?
* Post-cardiac surgery: Post-pericardiotomy syndrome
* Trauma: Blunt or penetrating chest trauma
* Radiation therapy: Chest radiation
193
What neoplastic causes are associated with pericarditis?
* Primary: Mesothelioma
* Secondary (metastatic): Lung, breast cancer, lymphoma
194
What metabolic/endocrine causes can lead to pericarditis?
* Uremic pericarditis
* Hypothyroidism: Myxedema pericarditis
195
What drug-induced/toxic causes are known for pericarditis?
* Medications: Hydralazine, Isoniazid, Procainamide
* Chemotherapy: Doxorubicin, Cyclophosphamide
196
What are the clinical manifestations of chest pain in acute pericarditis?
* Sharp, pleuritic
* Retro-sternal or precordial
* Worsened by: Lying supine, deep breathing, coughing
* Relieved by: Sitting up and leaning forward
197
Describe the pericardial friction rub.
A high-pitched, scratchy sound resembling leather rubbing together, best heard at the left lower sternal border.
198
What are the ECG changes associated with acute pericarditis?
* Diffuse ST-segment elevation and PR depression
* ST segments normalize; T wave flattening
* T wave inversion (may persist for weeks)
* ECG returns to normal
199
What symptoms might indicate pericardial effusion?
* Dyspnea
* Dysphagia
* Hoarseness
200
What are the systemic symptoms of acute pericarditis?
* Fever
* Malaise and fatigue
* Myalgias or arthralgias
* Tachycardia
201
What physical examination findings are associated with pericarditis?
* Friction rub
* Diminished heart sounds
* Elevated Jugular Venous Pressure (JVP)
* Pulsus paradoxus
202
How does acute pericarditis differ from pulmonary embolism in terms of chest pain characteristics?
* Acute Pericarditis: Sharp, stabbing, pleuritic
* Pulmonary Embolism: Sharp, pleuritic (can also be dull or pressure-like)
203
What are the common associated symptoms of myocardial infarction?
* Crushing, pressure-like chest pain
* Diaphoresis
* Nausea
* Fatigue
204
What are the distinguishing features of ECG findings in acute pericarditis?
* Diffuse ST elevation (concave)
* PR depression
* T wave inversion in later stages
205
Fill in the blank: The classic ECG changes in acute pericarditis occur in _______ stages.
four
206
What imaging findings might indicate acute pericarditis?
* Normal or enlarged cardiac silhouette on chest X-ray
* Pericardial effusion on echocardiography
207
True or False: Fever is more likely in acute pericarditis than in myocardial infarction.
True
208
What is the typical duration of chest pain in acute pericarditis?
Hours to days
209
What is Beck's triad associated with pericardial tamponade?
* Hypotension
* JVD
* Muffled heart sounds
210
What clinical features are common in both acute pericarditis and pulmonary embolism?
* Dyspnea
* Tachycardia
* Pleuritic chest pain
211
What is Acute Rheumatic Fever (ARF)?
An inflammatory disease that can develop as a complication of untreated or poorly treated pharyngeal infection caused by Group A Streptococcus, particularly Streptococcus pyogenes.
## Footnote
It is an autoimmune reaction where the body's immune response to streptococcal antigens cross-reacts with human tissues.
212
What are the key characteristics of Acute Rheumatic Fever?
* Onset: 2–4 weeks after streptococcal throat infection
* Affected Populations: Mainly children and adolescents (ages 5–15)
* Pathogenesis: Molecular mimicry leads to autoimmune inflammation
* Major Manifestations: Carditis, Polyarthritis, Chorea, Erythema Marginatum, Subcutaneous Nodules
## Footnote
Major manifestations are based on the Jones Criteria.
213
What is Rheumatic Heart Disease (RHD)?
A chronic heart condition resulting from permanent damage to the heart valves caused by one or more episodes of acute rheumatic fever.
## Footnote
It primarily affects the mitral and aortic valves.
214
What are the key characteristics of Rheumatic Heart Disease?
* Chronic Sequelae: Develops from recurrent or severe ARF
* Valve Involvement: Mitral valve (most common) and aortic valve
* Pathology: Fibrosis and scarring of valves
* Clinical Manifestations: Symptoms of heart failure, arrhythmias, embolic events
* Complications: Heart failure, stroke, infective endocarditis
215
What triggers Rheumatic Fever (RF)?
An autoimmune disease triggered by a Group A Streptococcus infection, primarily involving the pharynx.
## Footnote
The most common causative organism is Streptococcus pyogenes.
216
What are the predisposing factors for Rheumatic Fever?
* Genetic Susceptibility: Certain HLA types
* Environmental Factors: Overcrowding, poor hygiene
* Age and Demographics: Common in children aged 5–15
* Preceding Infection: Follows streptococcal pharyngitis
## Footnote
Risk increases with repeated GAS infections and inadequate antibiotic treatment.
217
What is the pathogenesis of Rheumatic Fever?
Involves molecular mimicry where streptococcal antigens cross-react with host tissues, leading to autoimmune inflammation.
## Footnote
The process includes initial infection, immune response, and inflammation affecting various tissues.
218
What are the morphological features of Acute Rheumatic Fever?
* Cardiac Features: Pancarditis, Endocarditis, Myocarditis, Pericarditis
* Joint Features: Migratory Polyarthritis
* Skin Features: Erythema Marginatum, Subcutaneous Nodules
* CNS Features: Sydenham Chorea
## Footnote
Pancarditis is inflammation of all three layers of the heart.
219
What are the clinical manifestations of Rheumatic Fever based on the Jones criteria?
* Carditis: 50-70% of cases
* Migratory Polyarthritis: 75% of cases
* Sydenham’s Chorea: 10-30% of cases
* Subcutaneous Nodules: Rare, <5%
* Erythema Marginatum: Rare
## Footnote
Minor manifestations include fever, arthralgia, elevated acute phase reactants, and prolonged PR interval.
220
What are the common symptoms of Rheumatic Heart Disease?
* Dyspnea
* Palpitations
* Fatigue
* Angina (in aortic stenosis)
## Footnote
Symptoms vary based on the specific valvular disease.
221
What are the gross features of mitral valve involvement in Rheumatic Heart Disease?
* Thickened, fibrotic leaflets
* Fusion of commissures
* 'Fish-mouth' or 'buttonhole' stenosis
* Thickened, shortened, and fused chordae tendineae
## Footnote
The mitral valve is the most commonly affected valve.
222
What are the clinical signs of Mitral Stenosis?
* Mid-diastolic murmur
* Opening snap after S2
* Symptoms: Dyspnea, palpitations, hemoptysis
## Footnote
Best heard at the apex with the patient in the left lateral decubitus position.
223
What is a characteristic feature of Sydenham's Chorea?
Involuntary, irregular, rapid movements affecting the face, hands, and feet.
## Footnote
It often occurs weeks to months after infection and usually resolves spontaneously.
224
Fill in the blank: Rheumatic Fever typically follows a _______ episode.
[streptococcal pharyngitis]
225
True or False: Subcutaneous nodules are typically painful and fixed.
False
## Footnote
They are firm, painless, and mobile.
226
What are the microscopic features of valves in Rheumatic Heart Disease?
* Fibrosis and scarring
* Neovascularization
* Chronic inflammation
* Calcification
## Footnote
These changes replace normal valve architecture.
227
What is wide pulse pressure due to?
Increased stroke volume
## Footnote
Wide pulse pressure can indicate various cardiac conditions.
228
What is a characteristic pulse associated with wide pulse pressure?
Bounding pulses (Corrigan's pulse)
## Footnote
Corrigan's pulse is often seen in conditions like aortic regurgitation.
229
What are common symptoms of Aortic Stenosis (AS)?
Angina, syncope, heart failure
## Footnote
These symptoms arise due to reduced blood flow from the heart.
230
What is a key sign of Aortic Stenosis?
Harsh systolic ejection murmur: Radiates to the carotids
## Footnote
This murmur is a classic finding in Aortic Stenosis.
231
What does a weak, delayed pulse indicate in Aortic Stenosis?
Pulsus parvus et tardus
## Footnote
This term describes a pulse that is weak and has a delayed upstroke.
232
What cardiac condition can lead to atrial fibrillation?
Left atrial dilation (especially in mitral stenosis)
## Footnote
Atrial fibrillation is a common arrhythmia associated with structural heart changes.
233
What are the symptoms of left-sided heart failure?
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
## Footnote
These symptoms are due to pulmonary congestion.
234
What are the symptoms of right-sided heart failure?
Ascites, peripheral edema
## Footnote
Right-sided heart failure leads to systemic venous congestion.
235
What condition can arise from damaged valves?
Infective Endocarditis
## Footnote
This condition is often associated with pre-existing valve abnormalities.
236
What can thromboembolism be secondary to?
Atrial fibrillation and stasis of blood
## Footnote
Thromboembolic events are serious complications in patients with atrial fibrillation.
