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59 Cards in this Set
- Front
- Back
What is endocarditis?
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Inflammation of endocardium, predominantly of the lining of the cardiac valves.
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Endocarditis is usually due to __________________.
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bacterial infection
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Most common overall cause of endocarditis?
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Streptococcus viridans
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The virulence of S. viridans is _________ (high/low).
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low, therefore it can only infect previously damaged valves
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S. viridans infects ______________ (intact/previously damaged) valves.
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previously damaged (low-virulence)
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What is the result of a S. viridans infection of the valves, what happens to the valve?
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Small vegetations that do not destroy valve (low virulence)
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Infection with S. viridans of previously damaged cardiac valves is also called ___________________.
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subacute endocarditis
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Pathogenesis of endocarditis?
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(1) Damaged endocardial surface (exposes tissue factor and collagen) develops thrombotic vegetations (PLTs and fibrin)
(2) Transient bacteremia leads to trapping of bacteria in vegetations. |
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A person is undergoing a dental procedure. Why is this sometimes important when talking about IE?
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Can force bacteria into blood (transient bacteremia) that can be trapped in the thrombotic vegetations created by the previously damaged heart valve.
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What is the MCC of IE in IV-drug users?
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S. aureus
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The virulence of S. aureus is _________ (high/low) and it infects ____________ (healthy/previously dmged valves).
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high; healthy
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An heroin addict has endocarditis. What valve is usually involved?
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Tricuspid (they travel by veins)
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What is the result of S. aureus infective endocarditis?
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Results in large vegetations that destroy the valve (acute endocarditis)
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What organism causes endocarditis of prostatic valves?
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S. epidermidis
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A patient with colorectal cancer is known to have infectious endocarditis. What organism is most likely involved?
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S. bovis
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A patient presents with infectious endocarditis. The organism is S. bovis, what should you check for?
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Colorectal carcinoma
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An endocarditis blood culture comes back negative. What organisms could you suspect?
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HACEK organisms
Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella |
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Clinical features of infective endocarditis?
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(1) Fever
(2) Murmur (vegetations disrupt flow) - Can get septic embolization of vegetations (3) Janeway lesions (consequence of septic embolization) - Erythematous non-tender lesions on palms & soles (4) Osler nodes (painful lesions on fingers and toes) - Due to septic emboli (5) Splinter hemorrhages of the nail bed - Due to septic emboli |
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Which one is a painful lesion, Janeway lesions or Osler nodes?
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Osler nodes ("Ouch Ouch Osler")
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Infectious endocarditis is associated with what hematologic disease?
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Anemia of chronic disease
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Laboratory findings in infectious endocarditis?
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(1) Generally positive blood culture
(2) Anemia of chronic disease (high ferritin, TIBC low) |
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What can be done to detect lesions on valves?
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Transesophageal echocardiography (TEE)
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What is nonbacterial thrombotic endocarditis?
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Sterile vegetations that arise with hypercoagulable state or underlying adenocarcinoma. Vegetations arise on mitral valve along lines of closure and results in regurgitation.
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This endocarditis is seen in systemic lupus erythematosus. Describe it.
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Libman-Sacks endocarditis.
(1) Sterile vegetations associated with SLE (2) Vegetations present on surface and undersurface (both sides) of mitral valve (3) Result in mitral regurgitation. |
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Libman-Sacks endocarditis is highly characteristic of having ______________.
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Sterile vegetations on both sides of leaflets
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What is a cardiomyopathy?
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Myocardial diseases that lead to cardiac dysfunction
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What is the MC form of cardiomyopathy?
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Dilated cardiomyopathy
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What parts of the heart are dilated in dilated cardiomyopathy?
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All four chambers
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What is the physiologic problem in dilated cardiomyopathy?
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It's gonna result in a systolic dysfunction leading to biventricular CHF.
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Complications of dilated cardiomyopathy?
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(1) Mitral & tricuspid regurgitation
(2) Arrhythmia Both are due to stretching. |
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Most commonly the cause of dilated cardiomyopathy is __________.
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idiopathic
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What causes are there of dilated cardiomyopathy?
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(1) Idiopathic
(2) Genetic mutations (AD is MC, cytoskeletal prot. are affected) (3) Myocarditis (Coxsackievirus B) (4) Alcohol abuse (5) Drugs (doxorubicin, daunorubicin) (6) Pregnancy (late third trimester or within 6 months postpartum) |
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Treatment of dilated cardiomyopathy?
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Transplant
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What is hypertrophic cardiomyopathy?
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Massive hypertrophy of the left ventricle
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Hypertrophyic cardiomyopathy is due to what?
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AD genetic mutations in sarcomere proteins (e.g., myosin heavy chain gene)
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What is the MCC of sudden death in young individuals?
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Hypertrophic cardiomyopathy
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How are patients with hypertrophic cardiomyopathy going to present?
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(1) Decreased cardiac output (heart can't fill)
(2) Sudden death due to ventricular arrhythmias; common cause of sudden death in young athletes (3) Syncope with exercise |
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Why do we see syncope with exercise in people with hypertrophic cardiomyopathy?
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Because of the preferential involvement of the interventricular septum close to the aortic valve (relative block, like aortic stenosis).
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On biopsy of a person with hypertrophic cardiomyopathy you would see what?
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Myocytes should normally be lined up nicely in parallel. However, on this biopsy they are in a disarray (going in every single direction). This is what we see in this heart disease.
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What is restrictive cardiomyopathy?
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Decreased compliance of ventricular endomyocardium. It restricts filling during diastole.
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Causes of restrictive cardiomyopathy? (7)
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(1) Amyloidosis
(2) Sarcoidosis (3) Hemachromatosis (4) Endocardial fibroelastosis (children) (5) Loeffler syndrome (6) After open-heart surgery (7) Systemic sclerosis |
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What is Loeffler syndrome?
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There is peripheral eosinophilia with increase in toxic products (esp. MBP) --> Endomyocardial necrosis --> Scarring --> Thrombi covers area and gets organized
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Endocardial fibroelastosis is seen in the first ______ years of life.
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2
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Patients with restrictive cardiomyopathy will present with?
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CHF (blood backs up)
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A classic finding in EKG in restrictive cardiomyopathy?
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Low-voltage EKG with diminished QRS amplitudes.
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What is a cardiac myxoma?
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Cardiac tumor. Benign mesenchymal proliferation with a gelatinous appearance.
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What would a cardiac myxoma show on histology?
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Abundant ground substance on histology.
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What is the MC primary cardiac tumor in adults?
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Cardiac myxoma
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How and where does a cardiac myxoma grow?
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Pedunculated mass in the left atrium.
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Cardiac myxomas can cause what?
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Syncope due to obstruction of mitral valve.
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What is a rhabdomyoma?
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Benign hamartoma of skeletal muscle.
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What is the most common primary cardiac tumor in children?
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Rhabdomyoma
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What heart tumor is associated with tuberous sclerosis?
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Rhabdomyoma
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In tuberous sclerosis we see multisystem _____________.
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hamartomas
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Tuberous sclerosis is an _______ (AR/AD) disease.
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AD
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Rhabdomyomas usually arise in what part of the heart?
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Ventricle
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What is more common, metastasis or primary tumors of the heart?
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Metastasis
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Common metastasis to the heart include?
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(1) Breast carcinoma
(2) Lung carcinoma (3) Melanoma (4) Lymphoma |
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A melanoma metastasizes to the heart. Where would it typically go?
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Pericardium. It results in a pericardial effusion.
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