Path 2-2

  1. Group A beta-hemolytic streptococcal infection usually following pharyngitis
    • Rheumatic fever, cardiac and extra-cardiac manifestations
    • non-suppurative
    • inflammatory disease

    long term vale effects still constitute chronic valve disease today; blood cultures are sterile
  2. Extra-cardiac manifestations of Rheumatic fever
    fever, arthritis, arthralgia, skin lesions, chorea
  3. cardiac manifestations of rheumatic fever
    pancarditis(inflammation of endocardium, myocardium, and pericardium)
  4. Patient has an Aschoff body surrounded by activated histocytes(also called anitschkows or aschoff cells) and lymphocytes in the pericardium, myocardium and valves; what is this characteristic of?
    Rheumatic Fever; leads to verrucae on valves- fibrotic vegetations along closure of leaflets

    • clinical manifestations:
    • chamber dilation
    • conduction abnormalities
  5. chronic cardiac manifestations of rheumatic fever?
    fibro-calcific valvulitis with shortening and fusion of chordae tendinea

    long term sequela, manifests decades after acute

    stiff thickening of leaflets- "fishmouth" "buttonhole"

    occasionally cause mitral insufficiency b/c leaflets shrink
  6. Accumulation of infected thrombotic material on valves and adj endocardium
    infective endocarditis
  7. Staph Aureus(50%), streptococci(35%), infective fungi
    Acute endocarditis

    rapidly progressive, highly virulent organisms, affects prev. normal valve, poor prognosis
  8. Strep viridans(50%), other streptococci(15%), gram neg bacilli(10%), other fungi
    Subacute endocarditis

    indolent(wks to months), low virulent organism, affects abnormal valves
  9. There are a number of predisposing factors for infective endocarditis. What are they?
    • Valves damages from rheumatic carditis
    • mitral valve prolapse
    • congenital cardiac abnormalities
    • atherosclerotic valve disease
    • previous cardiac surgery
    • prosthetic valves
    • intravenous drug addiction
    • immunosuppression or deficiency
  10. Patient presents clinically with fever, petechial splinter hemorrhages, cardiac mumur and positive blood culture
    infective endocarditis

    lg friable vegetations, acute form bulkier ones, of fibrin, platelets and infecting organisms

    can break off and form emboli, septic infarcts
  11. What are the numerous complications with infective endocarditis?
    • embolization
    • perforation valve cusps
    • rupture chordae
    • sepsis
    • arrhythmia
    • dehiscence prosthetic valves
    • valve ring, myocardial abscess
    • deposition of circulating immune complexes in kidney-may result diffuse glomerulonephritis
  12. elderly individual or congenitally abnormal valve suffers from syncope(loss of consciousness), chest pain, heart failure, increased mortality.
    degenerative calcific aortic valve stenosis

    nodular dystrophic calcific deposits at bases of cusps that extend to sinuses of valsalva. prevents normal cusp opening

    risk of superimposed infective endocarditits
  13. Congenital condition showing ventricular or supraventricular arrhythmia. May be sudden death and there is an increased risk of infective endocarditis.
    • Mitral valve prolapse-
    • hooding or ballooning valve leafelts, elongated chordae with abnormal leaflet insertions, valve annulus dilated
    • expansion spongiosa (inner leaflet zone) by accumulating proteoglycans
    • duplication of elastic fibers
  14. Trisomes 21, 18, and 13 and exposure to Rubella, thalidomide, alcohol and other exposures during the first six weeks of gestation is dangerous why?
    Can lead to Congenital heard disease
  15. An abnormal communication between the heart chambers or great vessels
  16. stenosis or atresia of valves, abnormal vessel narrowing such as coarctation of the aorta
    obstructive lesion
  17. How are congenital heart diseases classified?
    Shunt, Obstructive lesion, cyanotic, acyanotic
  18. poorly oxygenated venous blood, right to left shunt across septal or patent ductus arteriousus defect OR pulmonaric stenosis(inadequate blood flow to lungs)
    cyanotic congenital heart disease
  19. Left to right shunt and adequate but increased blood flow through lungs
    acyanotic congenital heart disease
  20. Most common congenital heart defect, in large lesion L-R shunt, right ventricular hypertrophy, sm lesions can be complicated by infective endocarditis downstream to endothelium
    Ventricular septal defect

    may result in flow reversal and cyanosis because it wants to follow the path of least resistance
  21. L-R shunts usually in infants
    patent ductus arteriousus
  22. L-R shunt There are three different types based on their location, its also often associated with other cardiac abnormalities, symptoms depend on size and lg ones may not be present until adult
    arterial septal defect- can increase pulmonary vascular resistance, paradoxical embolism may occur
  23. ventricular septal defect, obstructed right ventricular outflow tract, overriding aorta, and right ventricular hypertrophy
    Tetralogy of Fallot

    narrowing of infundibulum and stenosis or atresia of pulmonic valve
Card Set
Path 2-2
Rheumatic fever, valvular disease, and congenital heart disease