3.1.1 Infectious and Valvular Heart Disease

Question 1

Differentiate b/t Osler’s nodes and Janeway Lesions, both of which are associated with embolic complications of infectious endocarditis?

Answer 1

Osler’s nodes - tender, red, raised punctate lesions of the hands and feet (painful - Ouch, Ouch, Osler)

Janeway lesions - painless hemorrhagic raised areas on the palms and soles

Question 2

What is this and what is it caused by?

(hint: bacterial culture is negative)

Answer 2

Non-bacterial thrombotic endocarditis

Caused by pro-coagulatory state like pregnancy

Question 3

What is this an image of? When is the typical onset of this condition?

Answer 3

Calcific Aortic Stenosis

Occurs in late 50s to early 70s

Question 4

How can infective endocarditis lead to this?

Answer 4

Septic emboli leading to vascular occlusion

Question 5

What is valvular insufficiency (regurg)?

Answer 5

Failure of a valve to close completely, thereby allowing reverse flow

Question 6

What are some risk factors for endocarditis?

Answer 6

Rheumatic heart dz, small VSD, PDA, degerative calcific valvular stenoses, bicuspid aortic valve, artificial valves, drug abuse

Question 7

Rheumatic fever results in fibrinous vegetation. This causes what type of appearance?

Answer 7

Question 8

What is this?

Answer 8

Calcific stenosis of the mitral valve

Question 9

What is this?

When might this person require surgical intervention?

Answer 9

Calcific stenosis of congenitally bicuspid aorta valve (most frequent congenital CV malformation in humans)

Typically needs replaced around 50, which is when they’ll become symptomatic

Question 10

What condition to a click-like murmur?

Answer 10

Mitral valve prolapse

Question 11

What are the fastidious organisms that can cause endocarditis?

Answer 11

HACEK group

Hemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

Question 12

What are two unique features found in histologic slides of Rheumatic Fever?

Answer 12

Aschoff bodies: foci of chronic inflammation

Anitschow Cells: histiocytes w/ abundant basophilic cytoplasm w/ slender, wavy nuclei

Question 13

What are the pathologic criteria for infective endocarditis?

Answer 13

1. Microorganisms demonstrated by blood culture or septic embolus
2. Active endocarditis

Question 14

What is the most common bacterial cause of sub-acute bacterial endocarditis (SBE)?

Answer 14

Streptococcus Viridans

Question 15

What are the two types of valvular disorders?

Answer 15

Stenosis and Insufficiency (regurgitation)

Question 16

What is Libman-Sack endocarditis associated with?

Answer 16

SLE

Question 17

What are the major JONES criteria for acute rheumatic fever?

Answer 17

J - Joints (migratory polyarthritis (knee))

O - Heart, pancarditis

N - Nodules - subcutaneous

E - Erythema marginatum

S - Sydenham’s Chorea

Question 19

What is the most commonly affected valve?

Answer 19

Aortic valve

Question 20

Rheumatic fever can have what effects on the mitral valve leaflets? chordae tendinae?

Answer 20

Mitral valve leaflets: Thickening and fusion

Chordae tendinae: shortening, thickening, and fusion

Question 21

What is the prevalence of mitral valve prolapse? What is its typical clinical presentation?

Answer 21

20% of women; usually asymptomatic but on rare occasion can lead to sudden death

Question 22

What are some major and minor clinical criteria in identifying infective endocarditis?

Answer 22

Question 23

What condition does this illustrate? What does the blood tissue represent?

Answer 23

Mitral valve prolapse

Myxomatous degeneration

Question 24

What do the terms isolated and combined meaned in terms of valvular disorders?

Answer 24

Isolated: 1 valve

Combined: > 1 valve

Question 25

What process causes the body to attack the valves (mitral > aortic) rather than the streptococcus? What are some of the bacterial Ag’s that the body might try to be targeting?

Answer 25

Molecular mimicry

Streptococcal M proteins (streptolysin O and DNAseB)

Question 26

What the terms mixed and pure mean in relation to valvular disorders?

Answer 26

Pure: only stenosis or only insufficiency

Mixed: Stenosis w/ regurgitation

Question 27

Describe the virulence of Staph Aureus

Answer 27

High virulence. Leading cause of acute infectious endocarditis

Question 28

What is this?

Answer 28

Infective endocarditis

Question 29

What are some common contaminants of blood cultures?

Answer 29

Coag-neg staphylococcus, Bacillus spp, Corynebacterium spp, Propionibacterium spp

Question 30

What disease preferentially affects the mitral valve?

Answer 30

Rheumatic Fever

Question 31

If a woman is diagnosed with a mitral valve prolapse, what is different about the approach to dental procedures or GI surgery?

Answer 31

Anti-microbial prophylaxis (These procedures are notorious for increasing blood borne microbes)

Question 32

What is valvular stenosis?

Answer 32

Failure of a valve to open completely, thereby impeding forward flow

Question 33

What are the two broad categories of endocarditis?

Answer 33

Acute and sub-acute infectious endocarditis (SABE)