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bjbjqPqP VEGETATIONS: The prototypic lesion of endocarditis, with a mass of platelets,
fibrin, microorganisms, and inflammatory cells. VEGETATIONS ARE SEEN IN: Infective endocarditis,
Rheumatic carditis, Non bacterial thrombotic endocarditis, Libman sacks endocarditis, Antiphospholipid
syndrome, Q fever, Aspergillus endocarditis CAUSATIVE AGENTS: Streptococci (alpha-hemolytic)
Staphylococcus aureus Enterococci HACEK group of organisms Fungal agents MECHANISM: Microbes
enter blood stream I Procoagulant stage I Fibrin deposition+ platelet aggregation+microbes
I VEGETATION MSCRAMMs (microbial surface components recognizing adhesin matrix molecules) mediate
adherence to NBTE sites or injured endothelium. Fibronectin binding protein Clumping factor
(S aureus), Glucans or FimA (Streptococci) . INFECTIVE ENDOCARDITIS: It is an infection
of the endocardial surface of the heart with valvular insufficiency. ACUTE IE Vegetations
are associated with valvular destruction. SUBACUTE IE Less valvular destruction. Microscopically,
vegetations often have granulation tissue at their bases, suggesting chronicity. As
time passes, fibrosis, calcification, and a chronic inflammatory infiltrate may develop.
RING ABSCESS Vegetations erode into underlying myocardium. SYSTEMIC EMBOLI This is due to
friability of vegetations. They may cause infarcts in various organs. SEPTIC INFARCTS
Abscess at the site of infarcts. Rheumatic fever: RF is an acute, immunologically mediated,
inflammatory disease . ACUTE RHEUMATIC HEART DISEASE : It is the cardiac manifestation
of RF and is associated with inflammation of the valves, myocardium, or pericardium.
ASCHOFF BODIES Inflammatory lesions found in various tissues -pathognomonic. They consist
of a central zone of degenerating, hypereosinophilic extracellular matrix with lymphocytes, plasma
cells, plump activated macrophages . THE ANITSCHKOW CELLS They have abundant cytoplasm and central
nuclei with chromatin arrayed in a slender, wavy ribbon NONBACTERIAL THROMBOTIC ENDOCARDITIS
Marantic endocarditis. Deposition of small masses of fibrin, platelets.. VEGETATIONS
Small sterile, non destructive(1-5mm). Occur singly or multiply along line of closure of
leaflets. MICROSCOPY Bland thrombus without inflammatory reaction LIBMAN-SACKS ENDOCARDITIS
Nonbacterial endocarditis that is seen in SLE. VEGETATIONS Small sterile, granular pink
(1-4 mm). MICROSCOPY Finely granular, fibrinous eosinophilic vegetations containing nuclear
debris. An intense valvulitis is often present, with fibrinoid necrosis of the valve substance
adjacent to the vegetation. ANTIPHOSPHOLIPID SYNDROME The syndrome occurs due to the autoimmune
production of antibodies against phospholipid,a cell membrane substance. hXM hXM hXM hz_n
hz_n hz_n hXM hz_n hXM hz_n hz_n hXM hXM gdXM n valves. Detected best in transesophagal
echocardiography. ASPERGILLUS ENDOCARDITIS Most cases are prosthetic valve infections.
Culture-negative endocarditis with large vegetations is the most common presentation, but embolectomy
reveals the diagnosis in a few cases. ECHOCARDIOGRAPHY Transesophagal Echocardiography (TEE) is more
sensitive- 90% than Transthoracic Echocardiography (TTE)- 65% ~;"4d ^46\J kduX ~;"4 'v3j ,.k&
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