أسئلة المحاضرة السادسة باثولوجي CVS (قبل التعديل)
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What are the characteristics of the vegetations observed in infective endocarditis?

  • Formed of fibrin, platelets, and microorganisms (correct)
  • Contain high levels of red blood cells
  • Composed mainly of neutrophils and bacteria
  • Only consist of inflammatory cells

    • Which of the following is NOT a typical sign of subacute bacterial endocarditis (SBE)?

  • Splinter hemorrhages
  • Petechiae
  • Janeway lesions
  • Hyperkalemia (correct)

    • What are the potential outcomes for untreated infective endocarditis within 6 months to 2 years?

  • Development of chronic hypertension
  • Progression to Non-Hodgkin lymphoma
  • Spontaneous recovery without complications
  • Death from cardiac or renal failure, or embolic effects (correct)

    • What is a common neurological manifestation of toxemia in infective endocarditis?

    <p>Sub-acute combined degeneration of the spinal cord</p> Signup and view all the answers

    Which of the following describes Roth spots?

    <p>Small clear centers with surrounding edema in the retina</p> Signup and view all the answers

    What is the primary causative organism in cases of acute infective endocarditis?

    <p>Staphylococcus Aureus</p> Signup and view all the answers

    Which heart valves are most commonly affected in acute infective endocarditis?

    <p>Aortic and mitral valves</p> Signup and view all the answers

    Which of the following is a significant effect of acute infective endocarditis?

    <p>Rapid bone marrow depression</p> Signup and view all the answers

    What is a notable characteristic of vegetations in acute infective endocarditis?

    <p>Irregular, yellow, and friable</p> Signup and view all the answers

    Which of the following best describes subacute infective endocarditis?

    <p>Involves non-suppurative inflammation with low virulence organisms</p> Signup and view all the answers

    In subacute infective endocarditis, what is the predominant causative organism?

    <p>Streptococcal viridans</p> Signup and view all the answers

    Which predisposing factor is associated with acute infective endocarditis in drug addicts?

    <p>Intravenous infections</p> Signup and view all the answers

    What characterizes the vegetations observed in subacute infective endocarditis compared to acute infective endocarditis?

    <p>Smaller and less irregular</p> Signup and view all the answers

    What is the primary cause of infective bacterial endocarditis?

    <p>Bacterial infections</p> Signup and view all the answers

    Which type of endocarditis is characterized by the presence of vegetations on heart valves?

    <p>Infective bacterial endocarditis</p> Signup and view all the answers

    What condition is often a precursor to infective endocarditis?

    <p>Pre-existing valvular disease</p> Signup and view all the answers

    Which of the following is NOT classified as a non-infective type of endocarditis?

    <p>Infective bacterial endocarditis</p> Signup and view all the answers

    What is a likely symptom of infective endocarditis for patients aged 35 to 65 years?

    <p>Development of a new regurgitation murmur</p> Signup and view all the answers

    What stage of infective bacterial endocarditis involves rapid adherence to valve surfaces?

    <p>Initial adhesion stage</p> Signup and view all the answers

    What type of endocarditis is primarily associated with drug addiction?

    <p>Infective endocarditis</p> Signup and view all the answers

    Which bacteria is specifically noted for its access to valve endothelium in the context of infective endocarditis?

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

    What is a distinguishing feature of acute endocarditis compared to subacute endocarditis?

    <p>Caused by highly virulent organisms</p> Signup and view all the answers

    Which organism is most commonly associated with subacute endocarditis?

    <p>Streptococcus viridians</p> Signup and view all the answers

    What previous condition is typically associated with acute endocarditis?

    <p>Usually previously normal heart</p> Signup and view all the answers

    Which statement best describes the duration of subacute endocarditis?

    <p>Occurs over a period of over 6 weeks</p> Signup and view all the answers

    In cases of culture-negative infective endocarditis, what is a common reason for the negative result?

    <p>Previous use of antibiotics before blood cultures are taken</p> Signup and view all the answers

    What type of endocarditis is most commonly associated with prosthetic valves?

    <p>Acute bacterial endocarditis</p> Signup and view all the answers

    Which of the following features characterizes Libman-Sacks endocarditis?

    <p>Multiple, small vegetations near the valve ring</p> Signup and view all the answers

    Which of the following is not a feature of subacute endocarditis?

    <p>Highly virulent organisms leading to systemic infections</p> Signup and view all the answers

    Which of the following is a significant potential complication of untreated infective endocarditis?

    <p>Emboli leading to infarctions and mycotic aneurysms</p> Signup and view all the answers

    What is a distinctive feature of Osler nodes as observed in subacute bacterial endocarditis (SBE)?

    <p>Tender subcutaneous nodules on the digits</p> Signup and view all the answers

    Which characteristic change may be observed in the myocardium associated with infective endocarditis?

    <p>Cloudy swelling and fatty changes</p> Signup and view all the answers

    Which clinical manifestation is often seen in conjunction with toxemia in infective endocarditis?

    <p>Clubbing of fingers accompanied by bone marrow depression</p> Signup and view all the answers

    Which type of glomerulonephritis is associated with infective endocarditis?

    <p>Focal or diffuse glomerulonephritis as a result of emboli</p> Signup and view all the answers

    What is the primary cause of the severe valve destruction found in acute infective endocarditis?

    <p>Presence of high virulence organisms</p> Signup and view all the answers

    What type of organism is primarily responsible for the majority of subacute infective endocarditis cases?

    <p>Streptococcus viridans</p> Signup and view all the answers

    Which symptom is NOT typically associated with acute bacterial endocarditis?

    <p>Chronic fatigue</p> Signup and view all the answers

    What is a common consequence of septic emboli formed during acute infective endocarditis?

    <p>Renal failure and organ dysfunction</p> Signup and view all the answers

    In which patient population is tricuspid valve involvement in acute infective endocarditis most commonly seen?

    <p>Intravenous drug users</p> Signup and view all the answers

    What characteristic defines the vegetations in subacute infective endocarditis as compared to those in acute endocarditis?

    <p>Smaller and less organized</p> Signup and view all the answers

    Which pathological effect is associated with toxemia resulting from acute infective endocarditis?

    <p>Necrosis of parenchymatous organs</p> Signup and view all the answers

    What is the primary clinical presentation that suggests infective endocarditis in patients aged 35 to 65 years?

    <p>Fever and a newly developed regurgitation murmur</p> Signup and view all the answers

    What is the typical appearance of the myocardial tissue in acute infective endocarditis?

    <p>Acute suppurative inflammation with abscesses</p> Signup and view all the answers

    Which of the following pathogens is NOT commonly associated with the infectious form of endocarditis?

    <p>Rheumatoid factor</p> Signup and view all the answers

    What is the role of pathogenic proliferation on the endothelium during the pathogenesis of endocarditis?

    <p>It leads to the formation of vegetation on the valves</p> Signup and view all the answers

    Which type of endocarditis is primarily triggered by autoimmune responses rather than infection?

    <p>Libman-Sacks endocarditis</p> Signup and view all the answers

    In the context of infective endocarditis, what is the significance of mechanically injured valve surfaces?

    <p>They provide a surface for pathogen adherence</p> Signup and view all the answers

    Which clinical condition is a potential precursor to infectious bacterial endocarditis?

    <p>Congenital heart disease</p> Signup and view all the answers

    What feature distinguishes acute infective endocarditis from subacute infective endocarditis?

    <p>Duration of symptoms and severity</p> Signup and view all the answers

    What is a common complication of endocarditis due to embolization of vegetations?

    <p>Stroke</p> Signup and view all the answers

    What characteristic differentiates acute infective endocarditis from subacute infective endocarditis?

    <p>Duration of symptoms</p> Signup and view all the answers

    What is the most common organism associated with subacute infective endocarditis?

    <p>Streptococcus viridians</p> Signup and view all the answers

    Which characteristic is associated with culture-negative infective endocarditis?

    <p>Prior antibiotic use before cultures</p> Signup and view all the answers

    In patients with Libman-Sacks endocarditis, which valve is primarily affected?

    <p>Mitral valve</p> Signup and view all the answers

    Which feature is indicative of acute infective endocarditis?

    <p>Invasive and damaging lesions</p> Signup and view all the answers

    What is the typical duration of symptoms for subacute infective endocarditis?

    <p>More than 6 weeks</p> Signup and view all the answers

    Which of the following is a common cause for endocarditis in patients with prosthetic valves?

    <p>Drug-resistant Staphylococcal infections</p> Signup and view all the answers

    What is a notable feature of vegetations in Libman-Sacks endocarditis?

    <p>Multiple and small near the valve ring</p> Signup and view all the answers

    Study Notes

    Endocarditis Definition

    • Inflammation of the inner lining of the heart, including the heart chambers and valves.

    Classification of Endocarditis

    • Infective endocarditis is the most common clinically seen form.
      • Acute Infective Endocarditis: Virulent microorganisms on a normal valve.
      • Subacute Infective Endocarditis: Low virulence organisms attacking a diseased valve.
      • Prothetic Valve Endocarditis: Occurs 2 months after surgery, often due to contamination with drug-resistant pathogens.
    • Non-infective endocarditis
      • Rheumatic fever
      • Systemic Lupus Erythematosus (SLE)
      • Endocarditis of Carcinoid syndrome
      • Marantic (Terminal) endocarditis

    Pathogenesis of Infective Endocarditis

    • Pathogens gain access to the bloodstream through healthcare procedures or intravenous drug use.
    • Pathogens can adhere to an injured valve surface, a pre-existing valvular disease, or an inflamed valve surface (without pre-existing disease).
    • Some pathogens, like S. aureus, can invade the valve endothelium, causing inflammation and tissue destruction.
    • Proliferation of pathogens leads to vegetation formation on the valve.
    • Vegetation can embolize, spreading the infection systemically.
    • Tissue injury can result from immune complex deposition or immune responses to bacterial antigens.

    Acute Infective Endocarditis

    • Causative Organism: Staphylococcus aureus (50% of cases)
    • Typically affects mitral and aortic valves, and tricuspid in drug addicts.
    • Naked Eye: Large, polypoid, irregular, yellow and friable vegetations on the valve cusps, with abscesses in the myocardium.
    • Microscopic Examination: Acute suppurative inflammation of the cusps with excess neutrophils.
    • Vegetations are composed of platelets, fibrin, microorganisms, and neutrophils.
    • Effects and Prognosis: Severe valve destruction, destruction of chordae tendineae leading to regurgitation, and septic emboli.
    • Clinical Features: Rapidly fatal within 8 weeks due to toxic myocarditis (acute heart failure), sepsis, congestive heart failure, renal failure, stroke, and septic emboli.

    Subacute Infective Endocarditis

    • Causative Organism: Streptococcus viridans (over 50% of cases)
    • Affects valves damaged by rheumatic fever, syphilis, or congenital abnormalities.
    • Naked Eye: Irregular, polypoid vegetations, smaller than those in acute endocarditis, with a yellowish-grey to brown color (friable). The myocardium shows cloudy swelling and fatty changes.
    • Microscopic Examination: Edema and hyperemia of the valve cusps with inflammatory cells. Vegetations are composed of fibrin, platelets, and microorganisms (few neutrophils).
    • Effects and Prognosis: Less severe valve destruction, infective emboli leading to infarctions and mycotic aneurysms, toxic capillaritis (causing petechial hemorrhage, focal or diffuse glomerulonephritis), clubbing of fingers, fatty change, bone marrow depression, and subacute combined degeneration of the spinal cord.
    • Clinical Features: Low-grade fever, heart murmurs, arrhythmia, petechiae, splinter hemorrhages, Osler's nodes, Janeway lesions, Roth spots, neurologic disease, splenomegaly, and abdominal symptoms including right upper quadrant pain.

    Endocarditis on Prosthetic Valves

    • Occurs 2 months after surgery.
    • Etiology: Staphylococcus infection (more than 50% of cases) due to intraoperative contamination with drug-resistant pathogens.

    Libman-Sacks Endocarditis

    • Occurs in Systemic Lupus Erythematosus (SLE) mainly affecting the mitral valve.
    • Multiple, small vegetations near the valve ring.
    • Result from immune complex mediated endocardial injury followed by thrombosis.

    Endocarditis Definition

    • Inflammation of the inner most layer of heart that lines the chambers and covers the heart valves.
    • Two main types: Infective and Non-Infective.

    Infective Endocarditis

    • Most common type
    • Can be caused by bacteria, viruses, fungus, etc.
    • Commonly seen in drug addicts.

    Non-Infective Endocarditis

    • Rheumatic fever
    • Systemic lupus erythematosus (SLE)
    • Endocarditis of Carcinoid syndrome
    • Marantic (Terminal) endocarditis.

    Pathogenesis of Infective Endocarditis

    • Pathogens access the bloodstream during healthcare procedures or intravenous drug use.
    • Pathogens adhere to injured valves, causing inflammation and tissue destruction.
    • Proliferation of pathogens on the endothelium results in vegetations.
    • Vegetation emboli can cause systemic hematogenous spreading.
    • Tissue injury can follow deposition of circulating immune complexes or immune responses to bacterial antigens.

    Acute Infective Endocarditis

    • Acute suppurative inflammation.
    • Caused by virulent microorganisms and a normal valve.
    • Staph. Aureus is the most common organism (50% of cases).
    • Predisposing factors include septic focus, intravenous infections (drug addicts), and impaired defense mechanisms.
    • Mitral and aortic valves are most commonly affected, while tricuspid is affected only in drug addicts.
    • The valve cusps show acute suppurative inflammation with excess neutrophils.
    • Vegetations are formed of platelets, fibrin, microorganisms, and neutrophils.
    • Leads to valve destruction, chordae tendineae destruction, and regurgitation.
    • Septic emboli from vegetation breakdown can cause pyemia.
    • Toxemia can lead to bone marrow depression, fatty change, and necrosis of parenchymatous organs.
    • Rapidly fatal (within 8 weeks) due to toxic myocarditis and acute heart failure.

    Subacute Infective Endocarditis

    • Non-suppurative inflammation.
    • Caused by low-virulence organisms and diseased valves.
    • Streptococcal viridans is the most common organism (more than 50% of cases).
    • Predisposing factors include abnormal valves (rheumatic fever), syphilis, congenital abnormalities, bacteremia, and impaired defense mechanisms.
    • Valve cusps show edema, hyperemia, and vegetations.
    • Vegetations are smaller than those in acute endocarditis, irregular, polypoid, and yellowish-grey to brown.
    • Myocardium shows cloudy swelling and fatty changes.
    • The cusps are vascularized and show edema and inflammatory cells.
    • Vegetations are made of fibrin, platelets, and microorganisms (with few neutrophils).
    • Valve destruction is less severe.
    • Infective emboli can lead to infarctions and mycotic aneurysms.
    • Causes toxic capillaritis in the skin and kidneys, resulting in petechial hemorrhages and focal or diffuse glomerulonephritis.
    • Toxemia can lead to clubbing of fingers, fatty change, bone marrow depression, and sub-acute combined degeneration of the spinal cord.
    • Untreated cases can be fatal within 6 months to 2 years due to cardiac failure, renal failure, or embolic effects.
    • Diagnosis is aided by fever, heart murmurs, arrhythmias, petechiae, splinter hemorrhages, Osler nodes, Janeway lesions, Roth spots, signs of neurologic disease, splenomegaly, and abdominal symptoms.

    Endocarditis on Prosthetic Valves

    • Staphylococcal infection is the most common cause (more than 50% of cases).
    • Occurs 2 months after surgery.
    • Caused by intraoperative contamination with drug-resistant pathogens (staphylococcus, gram-negative bacteria, or fungi).

    Libman-Sacks Endocarditis

    • Occurs in systemic lupus erythematosus (SLE).
    • Mainly affects the mitral valve.
    • Multiple, small vegetations are found near the valve ring.
    • Caused by immune-complex mediated endocardial injury followed by thrombosis.

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