Pathology: Endocarditis, Myocarditis and Pericarditis

Question 1

Why are about 10% of all infective endocarditis cases extremely difficult to treat?

Answer 1

Question 2

Pericarditis

• Primary Pericarditis
  
  • How common is it?
  • What is it usually due to?
• Secondary Pericarditis
  
  • What conditions is it usually secondary to?
  • Where does pain radiate to?
  • Are other structures usually involved?
• What is the most common systemic disorder associated with pericarditis?

Answer 2

Question 3

Describe the mortality rates for infective endocarditis caused by

• Low-virulence organisms, eg, Streptococcus viridans or Streptococcus bovis
• Enterococci and S. aureus infections
• Aerobic gram-negative bacilli or fungi

Answer 3

Question 4

Clinical Features of Infective Endocarditis

• What is the most consistent sign of infective endocarditis?
  
  • What patient population would result in the absence of a fever?
    
    • What manifestations would occur in this group of PTs instead?

Answer 4

Question 5

In viral myocarditis

• How do you ID pathogens?
• What is the reason for cardiac injury?

Answer 5

Question 6

How can organisms even get into the body so that endocarditis can occur?

Answer 6

Question 7

What are the histological features of Chagas myocarditis?

Answer 7

Question 8

For infective endocarditis, what are the poor prognostic indicators?

Answer 8

• Septicemia
• Arrhythmias
  
  • Suggesting extension to the underlying conduction system
• Systemic embolization

Question 9

Non Infective Vegetations (Nonbacterial thrombotic endocarditis [NBTE])

• What is this disease characterized by?
• Do the lesions from this condition destroy the cardiac tissue?
• Describe the vegetations associated with NBTE?

Answer 9

Question 10

Where do sterile platelet-fibrin deposits occur, and how do they relate to infective endocarditis?

Answer 10

Question 11

Morphology of Infective Endocarditis

• What can occur because of the friable nature of the vegetations?
• Of acute and subacute endocarditis, which is associated with valvular destruction?

Answer 11

Question 12

• This shows acute endocarditis on an aortic valve.
  
  • Because this is the acute form and this heart is from an IV drug user, what organism would most likely cause it?
  • What is odd about this aortic valve?
    
    • What valve is associated with IV drug use and infective endocarditis?
  • What is the arrow pointing to?

Answer 12

Tricuspid valve a frequent target in the setting of IV drug abuse.

Question 13

Morphology of Infective Endocarditis

• What occurs in both acute and subacute forms?
• What valves are usually affected? How does IV drug use affect this?
• What is a ring abscess?

Answer 13

Question 14

This shows Nonbacterial thrombotic endocarditis (NBTE) on a mitral valve.

• What is indicated at the arrows?
• What condition(s) are precursors to NBTE?

Answer 14

Question 15

Morphology of Pericarditis

• In acute viral pericarditis or uremia,
  
  • What does the exudate usually look like?
• In acute bacterial pericarditis,
  
  • What does the exudate usually look like?
    
    • What is noted about Tuberculous pericarditis?

Answer 15

Question 16

Clinical Features of Pericarditis

• What symptoms does Pericarditis classically manifests with?
• What can acute pericarditis cause when associated with significant fluid accumulation?
• What does Chronic constrictive pericarditis produce in terms of heart function?

Answer 16

Question 17

Define the following

• Roth spots
• Janeway lesions
• Osler nodes

Answer 17

• Retinal hemorrhages (Roth spots)
• Painless palm or sole erythematous lesions (Janeway lesions)
• painful fingertip nodules (Osler nodes).

Question 18

In NBTE, the local effect on the valve is usually benign. How then, does this condition become clinically significant?

Answer 18

Question 19

Morphology of Myocarditis

• Microscopically, what is myocarditis characterized by? What is the most common microscopic feature of myocarditis?
• How does the myocardial injury heal?

Answer 19

Question 20

Pericarditis

• What are the immediate hemodynamic complications associated with pericarditis?
• What can this eventually progress into?

Answer 20

Question 21

This shows Infective endocarditis. What valve seems to be affected, and what are the arrows pointing to?

Answer 21

Question 22

Pathogenesis of Myocarditis

• What viruses are usually associated with Myocarditis?

Answer 22

Question 23

Acute endocarditis

• What does it refer to?
• What organisms are generally responsible for it?
• What kind of patient outcomes is it associated with?

Answer 23

Question 24

This is Lymphocytic myocarditis. How can you tell?

Answer 24

Lymphocytic myocarditis, with edema and associated myocyte injury.

Question 25

Pathogenesis of Infective Endocarditis * What organism accounts for most infections that occur on damaged or deformed valves? * What organism is associated with infective endocarditis in IV drug abusers? * What makes the HACEK group, and where are they found in the body?

Answer 25

Question 27

Clinical Features of Myocarditis * Describe the broadness of the clinical features of Myocarditis

Answer 27

Question 28

* What organism is responsible for Chagas disease? * Where does this organism live? * What happens to about 10% of people who have this disease? * What can happen to patients 10 to 20 years after getting Chagas?

Answer 28

Question 29

Describe the prognosis and adverse sequelae of Infective Endocarditis

Answer 29

Untreated IE is generally fatal.

Question 30

* Infective Endocarditis is a microbial infection of the heart valves or the mural endocardium. * What forms because of this infection, and what is it made of? * What is usually destroyed in this condition? * Why does the classification of subacute and acute endocarditis sometimes not make sense?

Answer 30

Question 31

Clinical Features of Infective Endocarditis * How does acute endocarditis manifest? * When do murmors typically manifest? * What happens when patients are not treated properly? * How do you diagnosis this condition?

Answer 31

Question 32

1. What bacteria is responsible for Lyme disease? * How often does this cause myocarditis? How is it treated? 2. What other bacteria can cause myocarditis? 3. What helminth can cause myocarditis?

Answer 32

Question 33

This is a photomicrograph of an NBTE lesion * What does the t and C stand for? * What do you notice about any inflammation in this photo?

Answer 33

Question 34

What host factors are associated with increased risk for infective endocarditis?

Answer 34

Question 35

This is Chagas myocarditis. How can you tell? What is at the arrow?

Answer 35

Question 36

* What is Pericarditis due to malignancy often associated with? * Describe how chronic pericarditis occurs

Answer 36

Question 37

Pathogenesis of Infective Endocarditis * Infective endocarditis can develop on previously normal valves, but cardiac abnormalities predispose to such infections. What abnormalities does this include? * What accounts for 10-20% of all cases of IE?

Answer 37

Question 38

How are acute and subacute endocarditis separated?

Answer 38

Question 39

Subacute endocarditis * What does it refer to? * What organisms are generally responsible for it? * What kind of patient outcomes is it associated with?

Answer 39