11. Endocariditis, Pericarditis and myocardial diseases Flashcards
A patient presents with a fever and a new heart murmur. What is the diagnosis?
Endocarditis until proven otherwise
What is the commonest infective agent in endocarditis
What makes you more susceptible to endocarditits?
Staph aureus
Skin breach, renal failure, immunosuppression, diabetes, heart valve transplantation
Explain the presentation of endocarditits
Sepsis- fever, rigors, night sweats, malaise
Cardiac lesions- vegetations may cause valve destruction
Immune complex deposition- heamaturia, glomerulonephritits, AKI
Emboli- janeway lesions, abscesses in organs
What investigations are undertaken when endocarditis is suspected?
Blood cultures- three sets at the peak of fever
Blood tests anemaia, neutrophilia, rheumatoid factor
urinalysis
ECG, ECHO, CXR
When should those with endocarditis receive surgery?
HF, valvular obstruction, repeated emboli, fungal cause, persistent bactereamia
How are antibiotics used to treat endocarditits?
Ampicillin, flucloxacillin and gentamicin
What is acute myocarditis?
Inflammation of the myocardium leads to altered ECG and heart attack like symptoms
What is dilated cardiomyopathy?
How is it treated?
A dilated flabby heart of unkown origins. It is associated with alcohol, increased BP, cheamotheraputics
Can be treated with drugs to reduce the strain on the heart
What is hypertrophic cardiomyopathy?
LV outflow obstruction from assymetrical septal hypertrophy. It is an autosomal dominant condition and sudden death may be the first sign of the condition
What are the causes of myocarditis?
Idiopathic Viral Bacterial Sphirocytes Protozoa Drugs Toxins Immunological
Describe the presentation of acute pericardititis?
Central chest pain worse on lying flat or inspiration, relieved by leaning forward.
May also have pericardial effusion or cardiac tamponade
How do you treat acute pericarditits?
NSAIDS or aspirin with a gastric protection for 2 weeks
Add colchine 500mg for 3 months to reduce recurrence
What is a pericardial effusion?
Accumulation of fluid in the pericardial sac. May be caused by pericarditits, myocardial rupture, stab wound.
How does a pericardial effusion present
How does a pericardial effusion resolve?
dyspnoea, chest pain, signs of local structures being compressed
Treat the cause
What is cardiac tamponade
a pericardial effusion that raises interpericardial pressure and reduces ventricular filling
It is an emergency and must be drained
