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Cardiovascular: Endocarditis, Chronic vs Acute Rheumatic Fever
Terms in this set (33)
Most common cause of acute endocarditis
Acute = high virulence bacteria infects healthy valves (large vegetations)
Most common cause of subacute endocarditis
Subacute = low virulence strep infections previously damaged valves (i.e. via chronic rheumatic fever)
Strep viridans (alpha-hemolytic) - must
Bacteria associated with endocarditis due to prosthetic valves
Bacteria associated with endocarditis due to IV drug use
Others: Pseudomonas, candida
Most commonly affected valve in IV endocarditis
Valve most commonly affected by endocarditis
Difference in valve damage between acute vs. subacute endocarditis
Subacute = small vegetations that do not destroy valve
Acute = massive vegetations that destroy the valve
Bacteria associated with endocarditis with negative blood cultures
Bacteria associated with endocarditis + negative blood cultures
H = Haemophilus
A = actinobacillus
C = Cardiobacterium
E = Eikenella
K = Kingella
Clinical features of bacterial endocarditis
F = fever
R = Roth spots (retinal hemorrhages from bacterial emboli)
O = Osler nodes (painful nodes on finger pads from emboli)
M = murmur (vegetations on heart valve)
J = Janeway lesions (painless red lesions on hands/feet
A = anemia (of chronic disease)
N = Nail hemorrhages (splinter nail)
E = Emboli to brain (stroke) to kidney (renal failure) etc.
Three lab findings in endocarditis
1. Positive blood cultures (except HACEK)
2. Anemia of chronic disease (microcytic anemia = decrease Hb, MCV, TIBC, serum iron, % saturation; increased Ferritin)
3. Transesophageal echocardiogram - lesions on valves
Causes of nonbacterial endocarditis
Cause of vegetations on both sides of mitral valve
Libmann-Sacks endocarditis in lupus
What valve does Libmann-Sacks endocarditis affect?
Mitral valve (vegetations on both side)
Pulmonary embolism is caused by endocarditis of what valve?
Tricuspid = because bacterial vegetation embolizes to lungs
Stroke or splenic enlargement is due to endocarditis of what valve?
Mitral = because bacterial vegetation embolizes into systemic circulation - can obstruct cerebral vasculature or splenic vasculature
Valvular defect produced by acute vs. chronic rheumatic fever
Acute rheumatic fever = mitral regurgitation (tiny vegetations)
Chronic rheumatic fever = mitral stenosis
Bacteria that causes acute rheumatic fever
Group A (beta-hemolytic strep) = Strep pyogenes
Labs to prove group A (beta-hemolytic) strep infection
Elevated ASO titers
Anti-DNAase B titers
Minor criteria for acute rheumatic fever
Nonspecific: Fever, elevated ESR
Major criteria for acute rheumatic fever
J = migratory polyarthritis (involving wrist, ankle, knees)
O = pancarditis
N = Nodes
E = erythema marginatum
S = Syndeham's chorea
Describe that rash that appears in acute rheumatic fever
Erythema marginatum = annular, non-pruritic rash with erythematous borders or "margins" (hence, marginatum); commonly on trunk or limbs
Describe the heart symptoms of acute rheumatic fever
Pericardium = pericarditis (friction rub and chest)
Myocardium = myocarditis - most common cause of death
Endocardium = endocarditis (mitral valve ALWAYS involved)M
What valve is always affected in acute rheumatic fever?
Mitral valve (aortic can be affected but MITRAL will always be affected)
What layer of the body are anitschow cells found?
Myocardium - in myocarditis caused by acute rheumatic fever
What is an Aschoff body?
Granulomatous inflammation in the myocardium which includes:
Anitschkow cells (macrophages with caterpillar nuclei)
Most common cause of death in acute rheumatic fever
What type of hypersensitivity is acute rheumatic fever?
Type II hypersensitive (autoantibodies generated via M-protein of strep pyogenes molecular mimicry)
What causes chronic rheumatic heart disease?
Repeat exposure to group A beta-hemolytic strep that causes repeated acute rheumatic fever
Fish-mouth appearance of valves
Often occurs on aortic valves due to chronic rheumatic heart disease (mitral valve will also be involved)
What happens to the heart in chronic rheumatic heart disease?
Valvular stenosis due to fushion of valves (most commonly mitral)
Thickening of chordae tendinae and cusps
Causes aortic stenosis
Chronic rheumatic heart disease
How to distinguish aortic stenosis due to chronic rheumatic heart disease vs. "wear and tear"?
Chronic rheumatic disease = mitral valve will ALWAYS be involved and aortic valves will have "fused" fish-lips appearance
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