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mitral stenosis: Rheumatic fever. increases LA pressure, normal LV pressure. Diastolic murmur, opening snap of diseased valve. Mitral area
Mitral Regurgitation: Systolic murmur. holosystolic. Mitral area
Mitral valve prolapse: systolic murmur. click followed by murmur due to "parachute effect" mitral area
Aortic stenosis: Systolic murmur. crescendo decrescendo. aortic area. leads to concentric hypertrophy
aortic regurgitation: diastolic murmur, decrescendo starting at S2. head bobbing, water hammer pulses. Causes valve leaflets or aortic root dilation
Infectious endocarditis: 3 types- Pathogenic (virulence factor, single organism) Opportunistic (mechanical, normal flora, multiple organisms), Immunodeficiency
acute infection (days): high fever, chills, CHF, normal preexisting valve, usually Staph Aureus, few extra cardiac
subacute (weeks): SIRS: fever, night sweats, weight loss, malaise; abnormal underlying valves: aortic stenosis, mitral valve prolapse; normal flora; extracardiac - Jenway lesions, Roth spots, splinter hemorrhages (fingernails), immune complex; Osler, Glomerular nephritis
Acute: direct access to vein- IV drug user (tricuspid valve), iatrogenic (s. aureus)
Subacute: abnormal epithelium (normal flora) S. viridians (mouth), Group D strep (colon), staph epidermis (skin), S. bovis (colon cancer)
Culture negative IE - fastidious organisms (HACEK: Eikenella corrodens-smells like bleach, cat bites)
NBTE (non bacterial thrombotic endocarditis - not an infection): hyper coagulable (malignancy), Antiphospholipid antibodies (APLA) - 30% seen in SLE (liebman Sachs vegetations). they can embolize and cause strokes
Clinical presentations: fever/murmur
Dx: major criteria - negation on valves (echo), new murmur, positive blood cultures
Minor criteria - risk factor (IV drug user), abnormal valve, fever, septic emboli, immune complex.
2 major or 1 major and 3 minor
Rx - 4-6 weeks of IV antibiotic, abnormal valve requires prophylactic tx
Rheumatic fever: no cases in America, common in undeveloped world. Pathology: autoimmune 3% of strep pharyngitis (only with sore throat) 2-3 weeks after infection. Cross reactivity between myocardial proteins vs bacterial antigens. Acute condition: fibrinoid necrosis (granulomatous inflammation - Aschoff bodies - distinctive macrophage anitschow cell). chronic: 20 - 30 years Dx = Jones criteria
Major criteria: heart, arthritis, skin (erythema marginatum), CNS (Sydenham chorea), subcutaneous nodules.
Minor criteria: arthralgia, fever, increased PR interval, Acute phase reactant (SED, CRP), gp A strep infection (titers, culture)
2 major, or 1 major and 2 minors
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