BMS 200 - Cardiology 9 Quiz
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Questions and Answers

What is the most common late manifestation of Lyme disease?

  • Aseptic meningitis
  • Fatigue and headaches
  • Lyme arthritis of one or a few large joints (correct)
  • Erythema migrans skin rash

Which organism is noted for producing FimA, facilitating adherence to the endocardium?

  • E. Faecalis
  • Spirochetes
  • Streptococci (correct)
  • Staphylococcus aureus

What is a notable complication associated with Stage 2 Lyme disease?

  • Myocarditis (correct)
  • Chronic pain syndromes
  • Erythema migrans reoccurrence
  • Post-treatment Lyme disease syndrome

Which feature of endocarditis-causing streptococci assists in binding to platelet-fibrin complexes?

<p>Extracellular dextrans (C)</p> Signup and view all the answers

In Lyme disease, when is the optimal time for antibiotic therapy to clear the infection?

<p>During Stage 1 with erythema migrans (B)</p> Signup and view all the answers

What is a primary challenge in diagnosing Lyme disease?

<p>Antibodies don't indicate current infection (C)</p> Signup and view all the answers

How does the exposure of fibronectin influence microbial adherence during endocarditis?

<p>It provides a binding site for microbes (C)</p> Signup and view all the answers

What post-treatment effect is commonly observed in a significant proportion of Lyme disease patients?

<p>Chronic fatigue and neurocognitive disturbances (A)</p> Signup and view all the answers

What is the primary composition of vegetations in acute bacterial endocarditis?

<p>Fibrin, microorganisms, and inflammatory cells (A)</p> Signup and view all the answers

Which organism is commonly associated with acute bacterial endocarditis?

<p>Staphylococcus aureus (A)</p> Signup and view all the answers

What symptom occurs in 80 – 90% of infective endocarditis cases?

<p>Fever and chills (C)</p> Signup and view all the answers

What is a common peripheral manifestation of infective endocarditis?

<p>Osler nodes (B)</p> Signup and view all the answers

What describes the typical progression of subacute bacterial endocarditis?

<p>Present for weeks to months with minimal symptoms (D)</p> Signup and view all the answers

What distinguishes Borrelia burgdorferi in terms of its biological needs?

<p>It is a tick-borne spirochete specifically requiring a complex medium to culture. (A)</p> Signup and view all the answers

Which condition is NOT a risk factor for developing non-bacterial thrombotic endocarditis (NBTE)?

<p>Recent dental work (B)</p> Signup and view all the answers

What is the most common clinical feature of infective endocarditis?

<p>Heart murmur (D)</p> Signup and view all the answers

Which microbe is primarily responsible for myocarditis?

<p>Coxsackie virus (D)</p> Signup and view all the answers

Which feature of acute bacterial endocarditis relates to its physiological impacts?

<p>Formation of vegetations causing valve destruction (D)</p> Signup and view all the answers

What is a characteristic feature of acute pericarditis that differentiates it from myocardial infarction?

<p>Pericardial friction rub often detected (B)</p> Signup and view all the answers

Which treatment approach is typically used for managing idiopathic or viral pericarditis?

<p>High-dose aspirin or NSAIDs (D)</p> Signup and view all the answers

What is a common cause of constrictive pericarditis following acute pericarditis?

<p>Chronic inflammation of the visceral pericardium (A)</p> Signup and view all the answers

Which statement correctly describes pericardial tamponade?

<p>Hypotension and distended neck veins are clinical indicators. (B)</p> Signup and view all the answers

In myocarditis, which of the following outcomes is most commonly associated with severe inflammation of the myocardium?

<p>Sudden cardiac death due to arrhythmias (B)</p> Signup and view all the answers

Which of the following is rarely a cause of myocarditis but can have serious implications?

<p>Trypanosomiasis cruzi (B)</p> Signup and view all the answers

What is often observed in the ECG findings of acute pericarditis?

<p>Nonspecific ST-segment elevation in multiple leads (D)</p> Signup and view all the answers

Which scenario is most likely to result in cardiac tamponade?

<p>Acute accumulation of fluid from trauma or rupture (D)</p> Signup and view all the answers

Which feature distinguishes constrictive pericarditis from other types of pericarditis?

<p>Irreversible scarring of the pericardial cavity (A)</p> Signup and view all the answers

Which statement accurately represents the presentation of acute pericarditis?

<p>Often includes fever and sharp chest pain coinciding with a viral infection. (A)</p> Signup and view all the answers

Which of the following statements about acute pericarditis is most accurate?

<p>It commonly presents with sharp, pleuritic chest pain. (A)</p> Signup and view all the answers

What distinguishes constrictive pericarditis from acute and subacute pericarditis?

<p>It results in a rigid pericardium that restricts diastolic filling of the heart. (D)</p> Signup and view all the answers

Which of the following is a major virulence factor of Coxsackie virus?

<p>A cytolytic effect that leads to cell death. (D)</p> Signup and view all the answers

What role does Staphylococcus epidermidis play in endocarditis?

<p>It is frequently related to prosthetic valve infections. (D)</p> Signup and view all the answers

In postural-tachycardia syndrome (POTS), which physiological change is most characteristic?

<p>Elevated heart rate exceeding 30 beats per minute within 10 minutes of standing. (C)</p> Signup and view all the answers

Which stage of the Ixodes tick lifecycle is most associated with the transmission of Lyme borreliae to humans?

<p>Nymphs (B)</p> Signup and view all the answers

What characteristic of Borrelia burgdorferi allows it to evade the immune system effectively?

<p>Constantly altering surface proteins (C)</p> Signup and view all the answers

When do nymphal ticks primarily feed on infected rodents to facilitate the transmission cycle of Lyme disease?

<p>Late spring and early summer (B)</p> Signup and view all the answers

In which environment do Borrelia burgdorferi tend to hide and multiply within the host?

<p>Avascular areas like tendons and joints (D)</p> Signup and view all the answers

What is one of the primary functions of the pericardium?

<p>Anchoring and protecting the heart (A)</p> Signup and view all the answers

What is the primary method of Lyme borreliae transmission from ticks to the next generation of ticks?

<p>Feeding on rodents which harbor the bacteria (D)</p> Signup and view all the answers

Which type of inflammation is characterized by a shaggy-looking inflammatory exudate on the heart's surface?

<p>Fibrinous inflammation (D)</p> Signup and view all the answers

Acute pericarditis is most commonly caused by which of the following?

<p>Viral infections such as coxsackie virus (A)</p> Signup and view all the answers

What is a distinguishing feature of pericardial effusion compared to acute pericarditis?

<p>Limited inflammation and little protein (A)</p> Signup and view all the answers

Which condition is least likely to be a direct cause of acute pericarditis?

<p>Heart valve replacement (A)</p> Signup and view all the answers

The clinical feature of chest pain in acute pericarditis is often characterized as what?

<p>Severe and sharp (C)</p> Signup and view all the answers

In which age group is acute pericarditis more likely to occur?

<p>Younger patients (D)</p> Signup and view all the answers

Which type of fluid accumulates in the pericardium as a result of acute pericarditis?

<p>Serous fluid (A)</p> Signup and view all the answers

What is one of the common accompanying symptoms of the erythema migrans rash in Lyme disease?

<p>Arthralgias (D)</p> Signup and view all the answers

Which organ system is least likely to be affected during Stage 2 Lyme disease?

<p>Liver (C)</p> Signup and view all the answers

What is a characteristic of post-treatment Lyme disease syndrome?

<p>Long-lasting chronic pain (D)</p> Signup and view all the answers

Which of the following statements about the virulence factors of streptococci causing endocarditis is true?

<p>Fibronectin assists in microbial adherence when exposed. (A)</p> Signup and view all the answers

What is a major challenge when diagnosing Lyme disease in patients?

<p>Difficulty in culturing the organism (D)</p> Signup and view all the answers

What anatomical feature facilitates the adherence of endocarditis-causing streptococci to thrombotic vegetations?

<p>Extracellular dextrans (D)</p> Signup and view all the answers

Which symptom is associated with Stage 3 Lyme disease?

<p>Lyme arthritis (C)</p> Signup and view all the answers

Which factor contributes to the difficulty in diagnosing Lyme disease using serologic tests?

<p>Antibodies can indicate past infections (A)</p> Signup and view all the answers

Which symptom is most characteristic of acute pericarditis compared to myocardial infarction?

<p>Chest pain relieved by sitting forward (C)</p> Signup and view all the answers

What is the primary diagnostic method used for acute pericarditis?

<p>Echocardiography (B)</p> Signup and view all the answers

Which complication is most commonly associated with untreated acute pericarditis?

<p>Constrictive pericarditis (B)</p> Signup and view all the answers

Which statement about pericardial fluid accumulation is correct?

<p>It can cause heart sound muffling as the fluid increases. (D)</p> Signup and view all the answers

In acute pericarditis, which pattern of ECG findings is typically unexpected for myocardial infarction?

<p>Generalized ST-elevation across multiple leads (C)</p> Signup and view all the answers

What is a common infectious cause of myocarditis?

<p>Coxsackie virus (D)</p> Signup and view all the answers

Which drug class is NOT typically used for managing idiopathic or viral pericarditis?

<p>Diuretics (A)</p> Signup and view all the answers

Which symptom is commonly associated with pericardial tamponade?

<p>Hypotension and distended neck veins (D)</p> Signup and view all the answers

In which scenario would pericardiocentesis be indicated?

<p>Pericardial tamponade with shock (D)</p> Signup and view all the answers

What results from prolonged or untreated inflammation of the pericardium?

<p>Calcification and scarring of the pericardium (D)</p> Signup and view all the answers

What distinguishes the types of infectious agents in bacterial endocarditis regarding their presentation?

<p>Acute agents cause rapid, life-threatening symptoms. (A)</p> Signup and view all the answers

What is a common feature shared by vegetations in acute bacterial endocarditis?

<p>Composition of platelets, fibrin, and microorganisms. (D)</p> Signup and view all the answers

Which of the following clinical features is most strongly associated with acute bacterial endocarditis?

<p>Very high fevers. (D)</p> Signup and view all the answers

Which condition is most likely to lead to the development of non-bacterial thrombotic endocarditis (NBTE)?

<p>Aortic regurgitation. (D)</p> Signup and view all the answers

What are Osler nodes in the context of infective endocarditis?

<p>Painful raised papules on the fingers. (D)</p> Signup and view all the answers

Which group of organisms is associated with endocarditis but is less virulent than staphylococcus aureus or streptococcal species?

<p>Coagulase-negative staphylococci. (A)</p> Signup and view all the answers

Which neurological manifestation is likely to occur with infective endocarditis due to arterial emboli?

<p>Cerebrovascular accidents (CVAs). (B)</p> Signup and view all the answers

What is a characteristic sign of the acute phase of bacterial endocarditis?

<p>Rapid onset of significant emboli. (A)</p> Signup and view all the answers

Which of the following statements correctly summarizes the characteristics of the HACEK group of organisms?

<p>They are slow-growing and can be less damaging. (B)</p> Signup and view all the answers

In a patient with congenitally defective heart structures, what is a likely complication they may develop?

<p>Non-bacterial thrombotic endocarditis. (A)</p> Signup and view all the answers

What defines orthostatic intolerance in relation to POTS?

<p>Increased heart rate without a significant drop in blood pressure (A)</p> Signup and view all the answers

Which physiological mechanism primarily contributes to the pathophysiology of POTS?

<p>Hyperactivity of the sympathetic nervous system (A)</p> Signup and view all the answers

Which clinical feature must be present to meet the diagnostic criteria for POTS?

<p>Heart rate increase of more than 30 beats/min (C)</p> Signup and view all the answers

Which statement best describes the clinical implications of orthostatic intolerance in POTS patients?

<p>Patients show no symptoms when lying down. (A)</p> Signup and view all the answers

What distinguishes POTS from other dysautonomias?

<p>Increase in heart rate without accompanying hypotension (D)</p> Signup and view all the answers

Which of the following factors is significant in diagnosing POTS?

<p>Non-significant variations in blood pressure (C)</p> Signup and view all the answers

In the context of POTS, how is a normal blood pressure response defined when standing?

<p>A drop of less than 20/10 mm Hg (D)</p> Signup and view all the answers

What primary symptom must patients with POTS report when transitioning to standing?

<p>Dizziness or lightheadedness (A)</p> Signup and view all the answers

Which symptom is commonly associated with orthostatic intolerance?

<p>Tachycardia (B)</p> Signup and view all the answers

What physiological change occurs in the lower limbs in patients with neuropathic POTS?

<p>Pooling of blood (A)</p> Signup and view all the answers

Which factor is hypothesized to lead to hypovolemic POTS?

<p>Reduced blood volume (A)</p> Signup and view all the answers

What defines the complexity in diagnosing POTS?

<p>Inconsistent pathophysiologic mechanisms (A)</p> Signup and view all the answers

Which demographic is more frequently affected by POTS?

<p>Women aged 20-40 (D)</p> Signup and view all the answers

What is one proposed mechanism for blood pooling in patients with POTS?

<p>Improper venous constriction (C)</p> Signup and view all the answers

Which testing method is typically required to diagnose POTS?

<p>Tilt-table testing (C)</p> Signup and view all the answers

Which statement reflects the current understanding of POTS subtypes?

<p>A variety of underlying mechanisms exist (A)</p> Signup and view all the answers

What does a low aldosterone:renin ratio in POTS patients suggest?

<p>Inadequate secretion of aldosterone (D)</p> Signup and view all the answers

Which physiological change is commonly observed in POTS patients upon standing?

<p>Tripling to quadrupling of norepinephrine levels (A)</p> Signup and view all the answers

Which factor is associated with the reduction of blood volume in deconditioned POTS patients?

<p>Prolonged periods of microgravity (C)</p> Signup and view all the answers

What underlying mechanism may lead to excessive norepinephrine secretion in some individuals with hyper-adrenergic POTS?

<p>Missense mutations in catecholamine transporters (D)</p> Signup and view all the answers

How might activating auto-antibodies to adrenoreceptors affect patients with hyper-adrenergic POTS?

<p>Increase blood pressure upon standing (D)</p> Signup and view all the answers

What is one common non-pharmacological recommendation for managing POTS symptoms?

<p>Drinking more water (C)</p> Signup and view all the answers

What is a potential therapeutic approach for patients with hypovolemic POTS?

<p>Midodrine (B)</p> Signup and view all the answers

Which condition may reveal inadequate aldosterone secretion in predisposed individuals suffering from POTS?

<p>Deconditioning (A)</p> Signup and view all the answers

Flashcards

Acute Pericarditis

Inflammation of the pericardium, often viral, causing chest pain, worsened by lying down, and a distinctive rub sound.

Pericardial Friction Rub

Scratchy sound heard in acute pericarditis due to inflamed pericardial surfaces rubbing together.

Pericardial Tamponade

Life-threatening condition where fluid buildup in the pericardium compresses the heart, hindering its function.

Constrictive Pericarditis

Chronic inflammation of the pericardium, causing scarring and restriction of heart filling.

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Myocarditis

Inflammation of the heart muscle, potentially leading to heart failure, conduction blocks, or sudden death.

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Viral Pericarditis

Inflammation of the pericardium that usually originates from a viral infection.

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Echocardiography

Diagnostic method to visualize the heart using ultrasound, used to diagnose pericarditis.

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Pericardiocentesis

Procedure to drain fluid from the pericardial sac, used to treat pericardial tamponade.

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Chest Pain (Pericarditis)

Sharp, worsening when laying down chest pain associated with pericardial inflammation or infection. Often confused with angina

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Cardiac Tamponade Cause

Rapid buildup of fluid in the pericardial sac caused by various conditions (e.g., ruptured aneurysm, acute pericarditis, trauma).

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Lyme disease Stage 1

Characterized by erythema migrans rash, often accompanied by arthralgias, myalgias, fever, and fatigue. This is the ideal time for antibiotic treatment.

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Lyme disease Stage 2

Disseminated infection, weeks to months after initial infection, affecting multiple organs like the central nervous system (meningitis, cranial nerve palsies), heart (myocarditis), skin (more rashes), joints (Lyme arthritis, often knee).

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Lyme disease Stage 3

Late stage, primarily characterized by arthritis in one or a few large joints, potentially intermittent.

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Post-treatment Lyme disease syndrome

Chronic condition of pain, neurocognitive problems, and fatigue following Lyme disease treatment, often resistant to antibiotics.

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Erythema migrans rash

Characteristic, spreading rash of Lyme disease; not painful or itchy but frequently accompanied by other symptoms.

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Lyme arthritis

Joint inflammation, a common manifestation of Lyme disease, particularly affecting the knee.

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Serologic testing (Lyme)

Two-tiered blood test (ELISA followed by immunoblot) for Lyme antibodies. Doesn't differentiate past/current infection.

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Endocarditis virulence factors

Streptococcal bacteria producing dextrans and FimA for adhesion to damaged heart valves/endothelium.

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Acute Bacterial Endocarditis

A serious infection of the heart valves or inner lining caused by bacteria, often causing rapid and severe valve damage.

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Vegetations

Clusters of platelets, fibrin, bacteria, and inflammatory cells that grow on heart valves, devices or damaged endocardium.

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Etiology (Endocarditis)

The cause of acute bacterial endocarditis, often stemming from high bacterial loads (dental issues, IV drug use), or pre-existing valvular damage.

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Duke Criteria

Diagnosing criteria for infective endocarditis (IE).

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Peripheral Manifestations (IE)

Physical symptoms outside the heart, such as Osler nodes, Janeway lesions, or Roth spots.

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Subacute Bacterial Endocarditis

Slower, less severe form of infective endocarditis, often developing over weeks, with gradual and less extensive valve damage.

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Non-bacterial Thrombotic Endocarditis (NBTE)

A condition where blood clots form on the heart valves, often a precursor to infected vegetation and most often in individuals with heart valve disease.

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Infective Endocarditis Symptoms

Symptoms include fever, chills, sweats, anorexia, weight loss, and heart murmurs, potentially leading to embolic events.

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Lyme Disease

Tick-borne illness caused by Borrelia burgdorferi and causes damage to heart tissue.

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Myocarditis

Heart muscle inflammation, often caused by viruses.

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Acute Pericarditis

Inflammation of the pericardium, often viral, causing chest pain, worsened by lying down.

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Myocarditis Types

Inflammation of the heart muscle, with infectious and non-infectious causes.

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Constrictive Pericarditis

Chronic inflammation of the pericardium, causing scarring, restricting heart filling.

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Bacterial Endocarditis

Infection of heart valves or inner lining, either acute or subacute.

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Postural Tachycardia Syndrome (POTS)

A condition causing rapid heart rate upon standing.

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Acute Pericarditis

Inflammation of the pericardium, often due to viruses, causing chest pain, sometimes worse when lying down.

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Pericardial Effusion Cause

Fluid buildup in the pericardium, potentially due to chronic heart failure or kidney disease, limiting heart function.

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Fibrinous Inflammation

A type of inflammation where the heart's smooth surface becomes coated with inflammatory material including fibrin.

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Pericardial Effusion

Accumulation of fluid in the pericardial sac, often with little protein or leukocytes.

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Pericardial Functions

Anchors heart, protects heart, keeps friction-free action

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Causes of Acute Pericarditis

Viral (Coxsackie, echovirus), bacterial, fungal infections, autoimmune diseases, cancer, cardiac injury, or idiopathic (unknown cause).

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Acute Pericarditis Symptoms

Chest pain (often sharp and pleuritic), worsened by lying down, frequently linked to infectious, idiopathic, or autoimmune causes.

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Pericardium Layers

Double-layered sac (visceral and parietal layers) surrounding the heart, composed of mesothelium (thin tissue).

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Acute Pericarditis

Inflammation of the pericardium, often viral, causing chest pain, worsened by lying down, and sometimes a rub sound.

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Pericardial Friction Rub

Scratchy sound heard in acute pericarditis due to inflamed tissues rubbing together.

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Pericardial Tamponade

Life-threatening fluid build-up around the heart, squeezing it & hindering blood flow.

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Constrictive Pericarditis

Chronic inflammation of pericardium, causing scarring & restricting heart filling.

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Myocarditis

Inflammation of the heart muscle, often viral, potentially leading to heart failure or rhythm problems.

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Viral Etiology (Pericarditis)

Inflammation arising from a viral infection of the pericardial tissue.

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Acute Chest Pain (Pericarditis)

Sharp chest pain made worse by lying down, linked to pericardial inflammation.

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Cardiac Tamponade Cause

Rapid fluid accumulation in the pericardium, restricting heart function.

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Myocarditis Etiology

Inflammation of heart muscle, frequently linked to viral infections (e.g., echovirus, coxsackie).

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Constrictive Pericarditis Cause

Chronic inflammation leading to scarring and thickening of pericardium, restricting heart filling

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Acute Bacterial Endocarditis

Serious bacterial infection of heart valves or lining causing rapid valve damage.

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Vegetations

Clusters of bacteria, fibrin, and inflammatory cells on heart valves or damaged tissue.

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Etiology (Endocarditis)

Cause of endocarditis, often high bacterial loads or valvular damage.

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Duke Criteria

Diagnosing criteria for infective endocarditis (IE).

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Peripheral Manifestations (IE)

Physical symptoms outside the heart, like Osler nodes, Janeway lesions, or Roth spots.

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Subacute Bacterial Endocarditis

Slower, less serious endocarditis, developing over weeks with gradual valve damage.

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Non-bacterial Thrombotic Endocarditis (NBTE)

Blood clots form on heart valves, often a precursor to infection.

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Infective Endocarditis Symptoms

Symptoms include fever, chills, sweats, anorexia, weight loss, heart murmurs.

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Lyme Disease

Tick-borne illness caused by Borrelia burgdorferi.

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Myocarditis

Inflammation of the heart muscle, often viral.

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Lyme disease transmission

Ticks transmit Lyme disease bacteria from reservoir animals to other ticks, with nymphs (baby ticks) being more efficient transmitters than adults, leading to spring peaks in human cases.

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Lyme disease virulence factors

Lyme bacteria use mechanisms like binding to complement regulatory proteins to evade immune attack, and constantly change surface proteins to avoid recognition by the immune system.

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Lyme disease preferred sites

Lyme bacteria tend to multiply in avascular tissues like tendons and joints, causing chronic infections.

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Tick life cycle stages

Ixodes ticks, the carriers of Lyme disease, have a 2-year cycle with four stages: eggs, larvae, nymphs, and adults.

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Lyme disease peak season

The highest incidence of Lyme disease in humans occurs in late spring and early summer, due to nymphs feeding on humans.

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Lyme disease Stage 1

Characterized by erythema migrans rash, often accompanied by arthralgias, myalgias, fever, and fatigue. Optimal time for antibiotic treatment.

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Lyme disease Stage 2

Disseminated infection, weeks to months after initial infection, affecting multiple organs (nervous system, heart, skin, joints).

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Lyme disease Stage 3

Late stage, primarily characterized by arthritis in one or a few large joints, potentially intermittent.

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Post-treatment Lyme disease syndrome

Chronic condition of pain, neurocognitive problems, and fatigue following Lyme disease treatment, often resistant to antibiotics.

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Erythema migrans rash

Characteristic, spreading rash of Lyme disease; not painful or itchy but frequently accompanied by other symptoms.

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Lyme arthritis

Joint inflammation, a common manifestation of Lyme disease, particularly affecting the knee.

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Serologic testing (Lyme)

Two-tiered blood test (ELISA followed by immunoblot) for Lyme antibodies. Doesn't differentiate past/current infection.

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Endocarditis virulence factors

Streptococcal bacteria producing dextrans and FimA for adhesion to damaged heart valves/endothelium.

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Postural Tachycardia Syndrome (POTS)

A condition characterized by a rapid increase in heart rate when standing up.

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POTS causes

Multiple and varied, often involving uneven blood flow.

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Orthostatic symptoms

Troublesome symptoms like lightheadedness, weakness, and blurred vision that occur when standing up.

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Baroreceptor reflex

A mechanism that regulates blood pressure by sensing blood pressure changes.

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Hypovolemic POTS

A type of POTS possibly caused by reduced blood volume.

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Blood pooling (POTS)

Blood accumulating in the lower parts of the body, potentially impacting blood pressure regulation and leading to symptoms.

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Neuropathic POTS causes

In POTS, unknown reasons cause blood to pool in lower body causing issues with blood pressure regulation.

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Diagnostic challenges in POTS

No clear single mechanism or diagnostic criteria for the various causes of POTS.

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Hypovolemic POTS

Postural Orthostatic Tachycardia Syndrome (POTS) where low blood volume is a key factor; often related to deconditioning.

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Deconditioning

Reduced physical fitness and stamina, leading to changes in blood volume and POTS-like symptoms.

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Hyper-adrenergic POTS

POTS subtype characterized by excessive norepinephrine release, often in response to standing.

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Catecholamine Transporters

Proteins responsible for transporting norepinephrine and epinephrine within the body.

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Auto-antibodies (POTS)

Antibodies that inappropriately activate receptors, potentially leading to hyper-adrenergic POTS.

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Beta-1 Adrenoreceptors

Heart receptors, inappropriate activation leading to increased heart rate and potentially blood pressure.

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Midodrine (POTS)

Alpha-1 agonist used to treat some POTS instances.

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Beta-blockers (POTS)

Medication that generally inhibits activation of beta receptors, often helpful for certain POTS cases.

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Acute Pericarditis

Inflammation of the pericardium (the sac surrounding the heart), often viral, causing chest pain, worsened by lying down, and sometimes a "rub" sound.

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Myocarditis

Inflammation of the heart muscle, often viral, potentially causing heart failure or rhythm problems.

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Postural Tachycardia Syndrome (POTS)

A condition causing a rapid increase in heart rate when going from lying down to standing.

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Acute Bacterial Endocarditis

A severe bacterial infection of the heart valves or inner lining, often causing rapid and severe valve damage.

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Vegetations

Clusters of bacteria, fibrin, and inflammatory cells growing on heart valves or damaged endocardium.

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Lyme Disease Stage 1

Early Lyme disease characterized by a skin rash (erythema migrans), sometimes with other symptoms like fever, fatigue, or joint pain.

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Coxsackie Virus

A virus that can cause myocarditis and pericarditis.

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POTS Symptoms

Symptoms include noticeable increase in heart rate, dizziness/lightheadedness, and sometimes fainting when standing. No low blood pressure though.

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Study Notes

BMS 200 - Cardiology 9

  • Course covers pericarditis, myocarditis, endocarditis, orthostatic, and vasovagal syndromes.
  • Outcomes include describing pathogenesis, major clinical features, and prognosis for various heart conditions.
  • Specific topics include acute, subacute, and constrictive pericarditis; infectious and non-infectious myocarditis; acute and subacute bacterial endocarditis; and the biology, life cycle, virulence factors, diagnosis, and clinical manifestations of Borrelia burgdorferi, trypanosoma cruzi, and ehrlichia chaffeensis.
  • Additional topics include coxsackie virus and echovirus, COVID19 cardiac complications, HACEK group bacteria, Staphylococcus epidermidis and viridans streptococci, and postural tachycardia syndrome (POTS).

Inflammation of Heart Structures

  • Pericarditis: Acute, subacute, and constrictive forms.
  • Myocarditis: Infectious and non-infectious causes, and an overview of inflammatory causes.
  • Endocarditis: Acute and subacute bacterial endocarditis.

Pericardium Recall

  • Double-walled sac containing the heart and great vessels.
  • Fibrous layer: Tough, inelastic, dense irregular connective tissue.
  • Serous layer: Thinner, more delicate, composed of mesothelium with visceral and parietal layers (aka epicardium).
  • Functions: Anchors and protects the heart; prevents overfilling; allows friction-free operation.
  • Note: Epicardium also contains coronary vessels, nerves, and fat.
  • Normal pericardial fluid: 15–50 mL.

Acute Pericarditis

  • Most common pathologic process impacting the pericardium, often affecting younger patients.
  • Major causes: Viral (Coxsackie A & B, echovirus), bacterial (extensions from pneumonia), fungal (opportunistic), rheumatic fever, autoimmune disorders (RA, SLE, AS), cancer (invasion of pericardium), CKD (increased filtration, excess pericardial fluid), cardiac injury (traumatic/post-infarction), and idiopathic (likely viral).
  • General pathogenesis: Excessive extracellular fluid (CHF, CKD) can limit inflammation, resulting in pericardial effusion rather than inflammation. Inflammation can be fibrinous type.
  • Clinical features: Severe, sharp chest pain (pleuritic), often better when sitting up and leaning forward, possibly radiating to ischemic chest pain, troponin/ECG changes, pericardial friction rub (raspy, scratchy sound).
  • ECG & auscultatory findings (FYI): Note "everywhere" ST elevation, not common in MI.
  • Diagnosis: Echocardiography primary method. CT/MRI can provide more detail about pericardial thickening.
  • Treatment: High-dose aspirin, NSAIDs, colchicine, steroids.
  • Prognosis: Most idiopathic or viral cases self-resolve, with recurrences possible depending on cause. Potential complications: Constrictive pericarditis, recurrences, cardiac tamponade.
  • Additional Info: Most cases viral, often occurring 10-12 days after infection; symptoms usually include fever, sharp chest pain; may transition to subacute or constrictive pericarditis (symptoms lasting more than 4-6 weeks). Increased pericardial fluid (up to 2 liters) can be tolerated, while significant pericardial effusions may require pericardiotomy.

Constrictive Pericarditis

  • Scarring of pericardium after acute pericarditis.
  • Often obliterates the pericardial cavity.
  • Can greatly restrict cardiac filling.
  • Causes: TB pericarditis, post-traumatic/surgical/radiation pericarditis, neoplastic disease, CKD, or idiopathic.
  • Clinical presentation: Often resembles restrictive cardiomyopathy (congestion; typically preserved stroke volume but lower EDV); fatigue, distended neck veins, hepatosplenomegaly.
  • Diagnosis: US or MRI.
  • Treatment: Pericardial resection.

Pericardial Tamponade

  • Severe pericardial fluid accumulation obstructing blood flow into ventricles.
  • Causes: Ruptured ventricular aneurysm, severe acute pericarditis, cardiac trauma, aortic dissection.
  • Clinical features: Hypotension, muffled heart sounds, distended neck veins, shock.
  • Treatment: Urgent pericardiocentesis (fluid removal).

Myocarditis

  • Heart inflammation, sometimes causing dilated cardiomyopathy, conduction block, or predisposition to ventricular tachycardia; rarely sudden cardiac death.
  • Etiologic agents: Common include viral (echovirus & Coxsackie virus), Lyme disease, trypanosomiasis cruzi (South America), Ricketsia ricketsii, ehrlichia chaffeensis (uncommon but potentially deadly).
  • Pathogenesis: Viral invasion of myocytes, cytokine release, and adaptive immune responses can damage heart tissue. Granuloma formation, prolonged cytokine release, and possible immune-mediated attack can cause fibrosis and damage to the extracellular matrix (ECM).
  • Clinical Features & Diagnosis: Symptoms and signs of acutely developing heart failure; chest pain; ECG changes (suggestive of pericarditis); atrial or ventricular tachyarrhythmias; progressive dyspnea, weakness; and myalgias. Standard diagnostic tools include ECG, echocardiogram, and troponin. MRI is often useful.

Bacterial Endocarditis

  • Infection of the endocardium, often initiated by damaged endocardium, a thrombus, and bacteria.
  • The resulting inflammatory mass can damage heart valves, break off and cause strokes, interfere with flow through blood vessels, and cause unique hemorrhagic/ischemic findings (like retinal hemorrhages).
  • Typical sequence: Damaged endocardium or abnormal heart surface forms a thrombus; bacteria with virulence factors invade and colonize the thrombus.
  • Most common causes: Large bacterial loads (e.g., dental/gingival disease, IV drug use); valvular damage/recent surgery; and congenital heart disease (particularly VSD).
  • Types: Acute bacterial/NBTE; infections have immediate/life threatening valve damage, or a less severe subacute presentation.
  • Clinical features: Fever, chills, sweats (acute or subacute); anorexia, weight loss; myalgias, arthralgias, back pain; heart murmur (may not be present immediately); arterial emboli; splenomegaly; nail clubbing; neurologic manifestations (and peripheral manifestations); use of Duke criteria to diagnose.

Endocarditis Microbes - General Virulence Factors

  • Streptococci: Extracellular dextrans to adhere to inflamed endothelium.

  • S. aureus: Tissue factor to build clots that may help them get to and stay in the heart,

  • HACEK: Gram-negative bugs often found in oral cavity. Fastidious (difficult to grow)bugs.

  • Other microbes causing endocarditis, Myocarditis have various virulence mechanisms.

Lyme Disease

  • Caused by Borrelia burgdorferi (tickborne spirochete, common in Northern Hemisphere).
  • 30,000 new cases in the US.
  • Structure: Inner membrane with peptidoglycan layer, outer membrane.
  • Infectious process: Larvae transmit to nymphs, nymphs to adults. Humans are not required.
  • Virulence factors: Attachment to complement regulatory proteins and variable antigenic surface proteins.
  • Life cycle & Virulence: Ticks transmit to rodents. Nymphs and adults also can feed on humans. Important to understand the stages.
  • Clinical stages: Stage 1=Erythema migrans rash (often accompanied by fever). Stage 2 involves systemic problems (sometimes months or weeks later); stage 3=arthritis.
  • Additional Clinical Details: Post-treatment Lyme disease syndrome is sometimes seen after treatment with antibiotics. Diagnosis is complex.

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Related Documents

BMS 200 - Cardiology 9 PDF
BMS200_PATMIC_Cardio9P2_Fall2023 (2) (1).pdf

Description

Test your knowledge on cardiology topics such as pericarditis, myocarditis, and endocarditis. This quiz covers the pathogenesis, clinical features, and prognosis of various heart conditions, including the impacts of specific pathogens. Review essential details on acute and subacute cases along with emerging complications related to COVID-19.

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