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59 Cards in this Set

  • Front
  • Back
What is endocarditis?
Inflammation of endocardium, predominantly of the lining of the cardiac valves.
Endocarditis is usually due to __________________.
bacterial infection
Most common overall cause of endocarditis?
Streptococcus viridans
The virulence of S. viridans is _________ (high/low).
low, therefore it can only infect previously damaged valves
S. viridans infects ______________ (intact/previously damaged) valves.
previously damaged (low-virulence)
What is the result of a S. viridans infection of the valves, what happens to the valve?
Small vegetations that do not destroy valve (low virulence)
Infection with S. viridans of previously damaged cardiac valves is also called ___________________.
subacute endocarditis
Pathogenesis of endocarditis?
(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.
A person is undergoing a dental procedure. Why is this sometimes important when talking about IE?
Can force bacteria into blood (transient bacteremia) that can be trapped in the thrombotic vegetations created by the previously damaged heart valve.
What is the MCC of IE in IV-drug users?
S. aureus
The virulence of S. aureus is _________ (high/low) and it infects ____________ (healthy/previously dmged valves).
high; healthy
An heroin addict has endocarditis. What valve is usually involved?
Tricuspid (they travel by veins)
What is the result of S. aureus infective endocarditis?
Results in large vegetations that destroy the valve (acute endocarditis)
Results in large vegetations that destroy the valve (acute endocarditis)
What organism causes endocarditis of prostatic valves?
S. epidermidis
A patient with colorectal cancer is known to have infectious endocarditis. What organism is most likely involved?
S. bovis
A patient presents with infectious endocarditis. The organism is S. bovis, what should you check for?
Colorectal carcinoma
An endocarditis blood culture comes back negative. What organisms could you suspect?
HACEK organisms

Clinical features of infective endocarditis?
(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
Which one is a painful lesion, Janeway lesions or Osler nodes?
Osler nodes ("Ouch Ouch Osler")
Infectious endocarditis is associated with what hematologic disease?
Anemia of chronic disease
Laboratory findings in infectious endocarditis?
(1) Generally positive blood culture
(2) Anemia of chronic disease (high ferritin, TIBC low)
What can be done to detect lesions on valves?
Transesophageal echocardiography (TEE)
What is nonbacterial thrombotic endocarditis?
Sterile vegetations that arise with hypercoagulable state or underlying adenocarcinoma. Vegetations arise on mitral valve along lines of closure and results in regurgitation.
This endocarditis is seen in systemic lupus erythematosus. Describe it.
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.
Libman-Sacks endocarditis is highly characteristic of having ______________.
Sterile vegetations on both sides of leaflets
What is a cardiomyopathy?
Myocardial diseases that lead to cardiac dysfunction
What is the MC form of cardiomyopathy?
Dilated cardiomyopathy
What parts of the heart are dilated in dilated cardiomyopathy?
All four chambers
All four chambers
What is the physiologic problem in dilated cardiomyopathy?
It's gonna result in a systolic dysfunction leading to biventricular CHF.
Complications of dilated cardiomyopathy?
(1) Mitral & tricuspid regurgitation
(2) Arrhythmia

Both are due to stretching.
Most commonly the cause of dilated cardiomyopathy is __________.
What causes are there of dilated cardiomyopathy?
(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)
Treatment of dilated cardiomyopathy?
What is hypertrophic cardiomyopathy?
Massive hypertrophy of the left ventricle
Hypertrophyic cardiomyopathy is due to what?
AD genetic mutations in sarcomere proteins (e.g., myosin heavy chain gene)
What is the MCC of sudden death in young individuals?
Hypertrophic cardiomyopathy
How are patients with hypertrophic cardiomyopathy going to present?
(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
Why do we see syncope with exercise in people with hypertrophic cardiomyopathy?
Because of the preferential involvement of the interventricular septum close to the aortic valve (relative block, like aortic stenosis).
Because of the preferential involvement of the interventricular septum close to the aortic valve (relative block, like aortic stenosis).
On biopsy of a person with hypertrophic cardiomyopathy you would see what?
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.
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.
What is restrictive cardiomyopathy?
Decreased compliance of ventricular endomyocardium. It restricts filling during diastole.
Causes of restrictive cardiomyopathy? (7)
(1) Amyloidosis
(2) Sarcoidosis
(3) Hemachromatosis
(4) Endocardial fibroelastosis (children)
(5) Loeffler syndrome
(6) After open-heart surgery
(7) Systemic sclerosis
What is Loeffler syndrome?
There is peripheral eosinophilia with increase in toxic products (esp. MBP) --> Endomyocardial necrosis --> Scarring --> Thrombi covers area and gets organized
Endocardial fibroelastosis is seen in the first ______ years of life.
Patients with restrictive cardiomyopathy will present with?
CHF (blood backs up)
A classic finding in EKG in restrictive cardiomyopathy?
Low-voltage EKG with diminished QRS amplitudes.
What is a cardiac myxoma?
Cardiac tumor. Benign mesenchymal proliferation with a gelatinous appearance.
What would a cardiac myxoma show on histology?
Abundant ground substance on histology.
What is the MC primary cardiac tumor in adults?
Cardiac myxoma
How and where does a cardiac myxoma grow?
Pedunculated mass in the left atrium.
Cardiac myxomas can cause what?
Syncope due to obstruction of mitral valve.
What is a rhabdomyoma?
Benign hamartoma of skeletal muscle.
What is the most common primary cardiac tumor in children?
What heart tumor is associated with tuberous sclerosis?
In tuberous sclerosis we see multisystem _____________.
Tuberous sclerosis is an _______ (AR/AD) disease.
Rhabdomyomas usually arise in what part of the heart?
What is more common, metastasis or primary tumors of the heart?
Common metastasis to the heart include?
(1) Breast carcinoma
(2) Lung carcinoma
(3) Melanoma
(4) Lymphoma
A melanoma metastasizes to the heart. Where would it typically go?
Pericardium. It results in a pericardial effusion.