Path Cardio Outline - TMedWeb

Path Cardio OutlineRed bumps should notbe thereInfectious EndocarditisNormal ChordeaInfective Endocarditis has large,friable vegetative lesions usuallyon one side of the valveFibrosisInflammatory cells‐ Causeo Predisposing factors• Rheumatic heart disease, mitral valve prolapsed, calcified aortic stenosis,prosthetic heart valves, or any condition that causes abnormal flow or creates apocket for the organism to hide inooLots of inflammatory cells and fibrousspots on the valveOrganisms• S. Pyogenes = RHD, noninfective fibrosis is more of a predisposition than aninfection• S. Viridans = 50‐60% of all cases of normal heart valves, the dental organisms• S. Aureus = Highly virulent, seen commonly in IV drug users• S. Epidermis = commonly infect prosthetic valves• Other = Fungi or Gram negative BacilliRoutes• The foremost predisposing factor is bacterial seeding (you have to let them in)• Obvious infection, dental work, IV drug use, penetrating trauma, occult gut‐ Morphologyo Vegetations• Effect mitral or aortic valves usually, though right sided is possible• Vegetations are friable (they break), bulky, potentially destructive containingfibrin, inflammatory cells, and the bacteria• They may erode into the myocardium forming a ring abscesso Changes• Systemic Emboli may break off and cause infarcts with abscesses because of thebacteria (called septic infarcts)• Subacute Endocarditis = less destruction of the valve, presence of granulationtissue, and, with time, calcification or fibrosis• Acute Endocarditis = giant holes and abscesses in valves without inflammation‐ Clinicalo Fever = Most consistent sign of Infectious Endocarditis, though may be falsely low insubacute (nonsevere) cases or in the elderlyo Murmurs = occur in 90% of cases but may represent a predisposing condition, not a signo Autoimmune = glomerular nephritis (Ag‐Ab deposition) with hematuria and proteinuriao Duke Criteria• System of labs, clinical, echo, cultures that identify IE• Used to use outdated clinical appearance• Roth Spots = retinal hemorrhage• Osler Nodes = Subcutaneous Nodules in the Digits• Janeway Lesions = Erythmatous Nontender Nodules on Palms/Soles• Petechial Rashes‐ Treatment/Preventiono Find the bug, find what it is vulnerable to, and give that antibiotico Prophylaxis broad spectrum antibiotics or targeted therapy for area of surgery (dental,gut, etc)19 | O wl Club Review Sheets