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Cardiovascular Infections


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Bacterial endocarditis is caused by microorganisms physically present in _______ (called vegetations).
endothelial lesions
Although the ________ are most commonly infected, by bacterial endocarditis, the disease may also occur on septal defects or on the mural endocardium
heart valves
In animal studies it is nearly impossible to produce infective endocarditis with intravenous injections of bacteria unless the valvular surface is first _______ or otherwise altered.
Trauma to valves results in fibrin-platelet deposits called _________ lesions.
“non bacterial thrombotic endocarditis” (NBTE)
In the setting of pre-existent NBTE, transient _________ may result in the colonization of these lesions and may lead to the development of infective endocarditis.
_______ can occur after dental, gastrointestinal, and gynecological procedures.
The ability of certain organisms to ______ to NBTE lesions is a crucial early step in the development of endocarditis.
only a relatively _____ number of strains of bacteria produce the vast majority of cases of endocarditis, whereas many others produce only bacteremia?
Not all bacteria are capable of _______ to non bacterial thrombotic endocarditic lesions on the endothelial surface of the heart. Most bacteria, in fact cannot adhere to the fibrin-platelet matrices
Once the colonization of an endothelial surface occurs, a critical mass of adherent bacteria develops, the vegetation enlarges by further _________ deposition and continued bacterial proliferation.
platelet- fibrin
IE is difficult to eradicate with _________ even though infecting organisms are often exquisitely sensitive to drugs in vitro
The vegetation creates an environment of impaired host defenses. Bacterial colonies are found beneath the surface of the vegetation at variable _____. This location inhibits the infiltration of phagocytic cells as well as penetration of antibiotics. Thes
_______ generated when bits of vegetation break off are swept downstream and may cause catastrophic infarctions in the brain, heart, kidney, spleen, and other organs.
___________ are a sign of infective endocarditis, they represent a vasculitic component of the infection
Splinter hemorrhages
________ are embolic in origin with microabscess formation in the dermis
Janeway lesions
_______ and _______ cause 80-90% of cases of native valve endocarditis.
____________ cause chronic or subacute endocarditis and usually involves previously abnormal hearts
Viridans streptococcus
________ also cause some cases of subacute endocarditis.
___________ usually causes acute bacterial endocarditis and previously normal surfaces may be invaded
Staphylococcus aureus
____ drug use predisposes to IE.
_______ was strongly associated with the presence of IE in 102 intravenous drug users in San Francisco, but no such correlation was found among febrile addicts who did not use cocaine.
In IV drug users, ________ is the most common etiologic agent followed by ________.
Staphylococcus aureus Pseudomonas aeruginosa
______ endocarditis is more common in addicts (Candida sp). Fungal endocarditis has a poor prognosis.
In early Prosthetic Valve Endocarditis (Early PVE), Infection occurs _______ days of insertion. The organisms probably are there due to __________ contamination
60 intraoperative
Late Prosthetic Valve Endocarditis (Late PVE), infection more than 60 days ____ insertion. Here the organisms usually arrive from a source of _________ , and localize on a prosthesis or area of damaged endocardium.
transient bacteremia
Those individuals that are at high risk of developing endocarditis should take antibiotics just before procedures that will create a ______.
Despite the availability of potent bactericidal drugs, endocarditis is often ______.
It is easier to achieve _______ cure than to eliminate long term morbidity and mortality.
________ is a major problem. The underlying cardiac lesion may lead to heart failure.
Cardiac failure
_________ lesions are fairly common.
_______ failure may develop and progress as a consequence of immune complex glomerulonephritis engendered by endocardial infection
Myocarditis results from direct invasion of ______(Coxsackie B virus, Chagas’ disease, toxoplasmosis)
Chronic Myocarditis can result in _______ activation (Coxsackie B virus, Chagas’ disease).
___________ probably are produced in response to direct myocyte damage, with associated release of intracellular proteins.
Anti-heart antibodies
The released antigens may be recognized as foreign and a second, _______ phase of disease may develop.
Mice infected with _______ virus acutely, go on to develop chronic dilated cardiomyopathy as a result of the host immune system recognizing and destroying myocytes.
Coxsackie B
Molecular ______ may also play a part in the autoimmune phase of myocarditis.
Antigens from _______ elicit antibodies that can cross react with heart proteins.
Trypanosoma cruzi
Potentially pathogenic _________ to a variety of cellular components are found in a high percentage of patients with myocarditis and dilated cardiomyopathy (DCM). Autoantibodies recognize cardiac myosin, sarcolemmal proteins, the beta-1 adrenergic recept
Myocarditis can also result from damage due to circulating _____ such as the diphtheria toxin.
Chagas antibody recognizes both ______ and ________ receptor
T. cruzi
b-1 andrenergic
Patients with symptomatic disease have antibodies that recognize ________ protein, whereas only a few patients with asymptomatic disease have antibodies against B13 protein
T. cruzi B13
Viruses and bacteria may seed from the _____ stream.
Bacteria often invade myocardium from contiguous spread from _________.
Infective Endocarditis
________are the most important agents in the U.S. and Western Europe:
-Coxsackie B and other enteroviruses are the most common.
-Influenza viruses, adenoviruses, measles and mumps viruses
________ contributors are:
-Corynebacterium diptheriae causes a toxin
-Other bacterial causes are: Neisseria meningitidis, Salmonella, Brucella, Streptococcus and Staphylococcus, Borrelia bergdorferi, Rickettsia, Clostridium perfringens, Chlam
_____ infections can cause myocarditis:
-Coccidioides immitis and Histoplasma capsulatum
________ examples are:
Trypanosoma Cruzi- Myocarditis is the principal manifestation of chronic Chagas disease.
Toxoplasma gondii.
Trichinella spiralis- Myocarditis is the major cause of death in trichinosis.
________ is inflammation of the pericardium.
Pericarditis is generally an unusual complication of a common infectious disease or even of a noninfectious process such as neoplastic disease. Because of the difficulty in establishing a specific diagnosis, the _____ of acute self limited pericarditis i
in pericarditis, the ____ of infection may be blood lymph, direct extension from a primary infection, or direct inoculation from surgery or trauma.
_______ or _______may serve as the initial source of bacteria in pericarditis.
Infectious endocarditis myocarditis
The intensity of infection depends on the etiological agent. ______ pericarditis tends to be mild. The organism is usually blood borne and often also infects the myocardium.
________ pericarditis may be rapidly progressive and potentially fatal. The mortality without treatment is greater than 50%. In patients who survive healing is associated with extensive fibrosis and may lead to a chronic, constrictive pericarditis.
_________ pericarditis from hematogenous, lymphatic, or contiguous spread is more chronic and can obliterate the pericardial space with fibrosis, adhesions and even calcifications. These are usually fatal in untreated.
Viruses result in Acute _______ Pericarditis
Viral etiology is usually the picorna viruses: ______viruses or ______. Viruses are occasionally
isolated from pericardial fluid, but usually the diagnosis is based on isolation from
another body site or by a four fold rise in antibody tite
Bacteria is called Acute _______ Pericarditis
With pericarditis of bacterial origin _______is the most common in children.
Staphylococcus aureus
Stretococcus pneumoniae and other streptococci, Other _________ causes include Neisseria meningitidis and enteric gram negative rods including Salmonella
_________, a pancarditis
Characterized by polyarthritis and frequently pancarditis- involving endocardium, myocardium, and pericardium.
Acute Rheumatic Fever (ARF)
ARF is a delayed sequelae of upper respiratory infection due to ________.
group A streptococci
Group A streptococcal ___ infections do not lead to ARF.
Some serotypes of Streptococcus ______ are more rheumatogenic than others. They have highly mucoid colonial morphology.
Molecular mimicry may play a role in ARF. Cross reactive antibodies between streptococcal antigens and heart tissue, called _______ have been found in those with ARF. There seem to be shared epitopes.
heart reactive antibody (HRA)
Certain ____ types are over represented in groups suffering from ARF indicating a host predisposition for the disease.
Cell wall __ protein may give rise to antibody that can react with myocardium.
Capsule (_______) may give rise to antibody that can react with joint ______.
hyaluronic acid
hyaluronic acid
Epitopes of Streptococcal M protein have been identified that share antigenic determinants with _______ and ________.
articular cartilage
ARF is most common in children age 6-15. It has a low incidence in the U.S. but a much higher incidence in _______ countries.
________ is a predisposing factor, with ARF.
_______ is common in people who have had ARF.

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