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Group A beta-hemolytic streptococcal infection usually following pharyngitis
- Rheumatic fever, cardiac and extra-cardiac manifestations
- inflammatory disease
long term vale effects still constitute chronic valve disease today; blood cultures are sterile
Extra-cardiac manifestations of Rheumatic fever
fever, arthritis, arthralgia, skin lesions, chorea
cardiac manifestations of rheumatic fever
pancarditis(inflammation of endocardium, myocardium, and pericardium)
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
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
Accumulation of infected thrombotic material on valves and adj endocardium
Staph Aureus(50%), streptococci(35%), infective fungi
rapidly progressive, highly virulent organisms, affects prev. normal valve, poor prognosis
Strep viridans(50%), other streptococci(15%), gram neg bacilli(10%), other fungi
indolent(wks to months), low virulent organism, affects abnormal valves
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
Patient presents clinically with fever, petechial splinter hemorrhages, cardiac mumur and positive blood culture
lg friable vegetations, acute form bulkier ones, of fibrin, platelets and infecting organisms
can break off and form emboli, septic infarcts
What are the numerous complications with infective endocarditis?
- perforation valve cusps
- rupture chordae
- dehiscence prosthetic valves
- valve ring, myocardial abscess
- deposition of circulating immune complexes in kidney-may result diffuse glomerulonephritis
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
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
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
An abnormal communication between the heart chambers or great vessels
stenosis or atresia of valves, abnormal vessel narrowing such as coarctation of the aorta
How are congenital heart diseases classified?
Shunt, Obstructive lesion, cyanotic, acyanotic
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
Left to right shunt and adequate but increased blood flow through lungs
acyanotic congenital heart disease
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
L-R shunts usually in infants
patent ductus arteriousus
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
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