Term
| what is marantic endocarditis? how does it appear morphologically? does it cause valve damage? embolize? |
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Definition
| nonbacterial thrombotic endocarditis, consisting of small nodules on the valves that tend to not damage the valve - but they can embolize as well as predispose pts to superimposed bacterial infections (otherwise, valves should be free of bacteria and inflammation) |
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Term
| what other diseases is marantic endocarditis associated with? |
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Definition
| malignancies/wasting; esp adenocarcinomas and other mucin secreting CAs, which can produce hypercoagulable states that produce the deposition of thrombi on the valves |
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Term
| what is the underlying pathology with marantic endocarditis? how are they usually found? resolved? |
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Definition
| malignancy. they are usually found incidentally and resolve spontaneously |
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Term
| what is infective endocarditis? can it cause destruction of the valves? |
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Definition
| colonization of the heart valves/mural endocardium by a microbe, which appear as bulky, friable vegetations containing fibrin and organisms. it can cause destruction of the valves and most cases are bacterial in origin (though some do involve fungi/rickettsiae) |
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Term
| why is tx of bacterial IE difficult? |
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Definition
| valves are not highly vascularized, and therefore antibx have a hard time reaching the site of infection |
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Term
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Definition
| septic emboli may be thrown from IE to the brain, kidney, etc |
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Term
| what are pathologic criteria for IE? |
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Definition
| microorganisms need to be IDed by cx/histologic exam in a vegetation, embolus, or intracardial abscess (these cxs need to be monitored over time and during antibx therapy). ideally, there also needs to be histologic confirmation of IE in the vegetation or intracardial abscess |
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Term
| what are major clinical criteria for IE? |
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Definition
| vegetations, positive cx (characteristic/unusual organism), emboli, new valvular regurgitation and echocardiographic findings (valve/implant related masses or abscess or partial separation of artificial valves) |
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Term
| what are minor clinical criteria for IE? |
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Definition
| predisposing heart lesion, IV drug user, new onset murmur, fever, and vasular lesions (petichiae, nailbed hemorrages, emboli, septic infarcts, intracranial hemorrhages, mycotic aneurysms, septic infarcts, and janeway lesions) |
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Term
| when does acute endocarditis generally happen? what is it characterized by? |
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Definition
| acute endocarditis takes place within several days, is usually an aggressive infection of previously normal valves, presents with a high fever, cardiac insufficiency (dyspnea, inability to walk), virulent organisms that produce necrotizing, ulcerative, and invasive lesions of the valves/other parts of the heart |
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Term
| why are cases of acute endocarditis difficult to treat? |
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Definition
| IE is difficult to treat quickly with antibx - which makes sx hard (however, if valvular deformity and therefore insufficiency is extremely severe you will perform the surgery) |
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Term
| what characterizes most cases of subacute IE? |
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Definition
| these organisms usually have lower virulence, often in previously abnormal valves. the organisms may appear insidously and there may be a protracted course of weeks to months. most pts will however recover after antibx therapy |
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Term
| what do the symptoms of subacute IE resemble? |
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Definition
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Term
| when does the infection of IE occur? |
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Definition
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Term
| what are pre-existing cardiac abnormalities that can predispose IE? |
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Definition
| rheumatic heart disease, MVP, congenital changes, prosthetic valves, and IV drug users |
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Term
| what are previously damaged valves commonly affected by? what form of IE does this generally produce? |
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Definition
| previously damaged valves are commonly infected with strep viridans, producing sub acute endocarditis |
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Term
| what are prosthetic valves commonly affected by? |
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Definition
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Term
| what are heart valves in IV drug users commonly affected by? |
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Definition
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Term
| why is IE difficult to treat? |
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Definition
| avascular nature of valves |
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Term
| what heart valves are the most commonly affected by IE? what about those in IV drug abusers? |
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Definition
| normally: aortic and mitral valves, IV drug users: tricuspid valve |
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Term
| what are the possible effects of IE? do different kinds of valve damage correlate with different ausculatory findings? |
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Definition
| the infection can become large and destroy the valve. valve vegetations typically cause systolic murmurs, but if they progress to valve insufficiency - that will typically cause diastolic murmurs |
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Term
| can IE throw clots? what is a unique problem with IE-related clots? |
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Definition
| yes, systemic emboli from the vegetations can lead to secondary infection and vascular occulsion (brain, kidney, GI problems etc). |
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Term
| what are cardiac abnormalities that can contribute to infection? |
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Definition
| MVP, degenerative calcific valvular stenosis, bicuspid AV |
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Term
| can a dental exam give pts IE? |
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Definition
| yes, this is why people with these IE-predisposing conditions are often given prophylaxis antibiotics at the dentist office following a visit |
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Term
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Definition
| the IE vegetation can erode into the annulus and myocardium |
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Term
| what are IE vegetations composed of? |
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Definition
| fibrin, inflammatory cells, and bacteria |
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Term
| which will creat larger vegetations; fungal or bacterial IE? |
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Definition
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Term
| what is a problem with systemic emboli thrown by IE? |
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Definition
| these can embolize to the brain, kidneys, and myocardium and potentially cause septic infarcts, strokes, and renal infarcts |
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Term
| what are *clinical features of IE? |
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Definition
| fever (varying degrees whether subacute or acute), janeway lesions, osler nodes, roth spots, and red streaks in nail beds |
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Term
| what are janeway lesions? |
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Definition
| nontender lesions on the soles and palms |
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Term
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Definition
| tender subcutaneous nodules in the pulps of the fingers |
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Term
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Definition
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Term
| what is nonbacterial thrombotic endocarditis? |
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Definition
| deposition of fibrin, platelets on the leaflets of valves that are sterile and do not caontain bacteria on the line of closure of leaflets or cups |
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Term
| who is usually seen with nonbacterial thrombotic endocarditis? |
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Definition
| debilitated pts, often with a hypercoagulable state such as DIC or CA |
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Term
| what is endocarditis associated with SLE called? how does it manifest itself? |
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Definition
| endocarditis of SLE or libman sacks endocarditis occurs on the MV and TV w/small sterile vegetations that are multiple, granular and pink (similar to marantic endocarditis) |
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Term
| what characterizes endocarditis of SLE or libman sacks endocarditis? |
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Definition
| this may be located on the *undersurfaces* (most other types on upperside) of the AV, valvular endocardium or on the mural endocardium. it may have fibrinoid necrosis or chronic fibrosis |
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Term
| is endocarditis of SLE or libman sacks endocarditis? usually severe? |
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Definition
| no, generally it has minimal clinical significance and is unlikely to embolize or cause functional flow problems |
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Term
| what are the four general kinds of endocarditis? |
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Definition
| RF: very small nodules, IE:larger, destroys valve, chordae tendinae, annulus, non-bacterial thrombotic endocarditis/marantic: small vegetations on one side of the valve, libman sacks/SLE: small sterile nodules seen on both sides of the valve |
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Term
| what are carcinoid tumors? |
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Definition
| tumors that are well circumscribed with cells of very monotonous cytoplasm/nuclei. they may be aggressive and metastasize depending on location and are seen mainly in the respiratory and GI |
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Term
| what is carcinoid syndrome? |
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Definition
| a release of various symptoms that cause skin flushing, cramps, nausea, vomiting and diarrhea concurrent with pts having carcinoid tumors |
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Term
| how can carcinoid tumors affect the heart grossly? |
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Definition
| carcinoid tumors can cause fibrous intimal thickening on the insides of the cardiac chambers and valvular leaflets |
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Term
| where are carcinoid tumors' effects seen in the heart? why? |
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Definition
| mostly on the R sided valves; tricuspid and pulmonary - because in the lung monoamine oxidase inactivates serotonin and bradykinin during the bloods passage through the pulmonary vascular endothelium |
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Term
| how does carcinoid heart disease affect the heart histologically? how are underlying structures affected? |
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Definition
| carcinoids can cause endocardial plaquelike thickenings consisting of SMCs and collagen fibers in a rich acid mucopolysaccharide matrix. underlying structures are *intact* including valve layers and the subendocardial elastic tissue layer |
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Term
| how do carcinoids specifically cause heart disease? |
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Definition
| through release of bioactive products; serotonin, kallikrein, bradykinin, histamine, prostaglandins, and tachykinins |
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Term
| what would L sided carcinoid heart disease be due to? |
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Definition
| pulmonary carcinoid or patent foramen ovale |
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Term
| what are the 2 categories of heart valves? which of these is most likely to produce thrombi? |
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Definition
| mechanical (which is most likely to produce thrombi, pts w/these need to be on blood thinners etc) and tissue |
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Term
| when do most complications associated with prosthetic heart valves occur? |
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Definition
| within the first 10 years postop |
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Term
| what causes thromboembolic complications associated with prosthetic mechanical heart valves? |
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Definition
| obstruction by a thrombus or distant thromboemboli may be seen in mechanical valves which then need long term anticoagulation tx (which can also cause complications) |
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Term
| can IE occur again with a prosthetic valve? |
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Definition
| yes, IE can cause a ring abscess that may lead to regurgitant blood leakage, where vegetations may form |
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Term
| of the 2 categories of prosthetic valves, which is more likely to deteriorate? |
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Definition
| structural deterioration is more common in bioprosthetic valves |
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Term
| what are other complications with prosthetic cardiac valves? |
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Definition
| hemolysis, mechanical obstruction to blood flow, and inadequate or exuberant healing |
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Term
| what is commonly administered to pts with mechanical prosthetic valves? what if this is not an option? |
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Definition
| anticoagulant therapy, which if is not an option - a bioprosthetic valve may be a better choice |
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