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CVD > 13. Cardiovascular Infections > Flashcards

13. Cardiovascular Infections Flashcards

1
Q

What is endocarditis?

A

Infection of the endocardial surface of the heart

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2
Q

Classify endocarditis

A

Native valve endocarditis (hospital vs community acquired)
Prosthetic valve
IV Drug users

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3
Q

Where is the most common location for endocarditis in IV drug users?

A

Tricuspid valve

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4
Q

What are the risk factors for endocarditis?

A

Surgery of GIT, GU, URT
Indwelling devices
Dental and tonsillectomy

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5
Q

What patient factors are risks for endocarditis?

A

Heart lesions
IV Drug use
Animal exposure
Dialysis, chronic liver disease, malignancy

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6
Q

What heart lesions increase the risk of endocarditis?

A

Prosthetic valves
Previous endocarditis
Patent ductus arteriosus (turbulence)
Valve diseases

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7
Q

Give the pathogenesis of endocarditis

A

Defect or lesion causes turbulent flow
Turbulent flow causes damage to endocardial surface, which platelets and fibrin stick to
BSI
Bacteria stick to platelets and fibrin and form a vegetation

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8
Q

Which are the most common pathogens involved in endocarditis?

A

Staph and strep

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9
Q

What are rarer pathogens in endocarditis?

A 
Chlamydia
Q fever
Brucella
Legionella
Mycoplasma
HACEK organisms
Fungi
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10
Q

What are the clinical features of endocarditis?

A

Non specific infection: low grade fever, chills, rigors, night sweats, malaise, fatigue, weight loss, arthralgia, myalgia
Resp symptoms in right sided

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11
Q

What are the immunological features of endocarditis?

A

Osler’s nodes

Roth spots

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12
Q

What are the embolic manifestations of endocarditis?

A

Splinter haemorrhages
Pulmonary infarctions
Ischaemic limb
Stroke

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13
Q

How is infective endocarditis diagnosed?

A

3 blood cultures 1 hour apart
Transoesophageal echo
Serology, PCR, ESR, urinalysis, FBC
Culture of any valves removed

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14
Q

What set of criteria determines the likelihood the patient has infective endocarditis?

A

Modified Duke Criteria

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15
Q

What are the major Dukes criteria?

A

Positive cultures and imaging

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16
Q

What are the minor Dukes criteria?

A

Risk factors
Fever
Vascular or immunological criteria
Micro evidence

17
Q

What combinations of criteria mean a patient definitely has infective endocarditis?

A

2 major
1 major and 3 minor
5 minor

18
Q

What combinations of criteria mean a patient has a possible infective endocarditis?

A

I major and 1 minor

3 minor

19
Q

What are the steps in the management of infective endocarditis?

A

Confirm aetiology
Help from micro
Combo of antibiotics for 4-6 weeks
Consultation with cardiac surgery

20
Q

How can endocarditis be prevented?

A

Avoid bacteraemia
Reduce rates rheumatic fever
Dental hygiene in at-risk patients
Antibiotic prophylaxis in high risk patients

21
Q

What is pericarditis?

A

Inflammation of the pericardium, often accompanied by effusion (which can be seen on CT)

22
Q

What pathogens can cause pericarditis?

A

Coxsackie, influenza, adenovirus

Staph, strep, chlamydia, TB

23
Q

What are the clinical features of pericarditis?

A

ECG changes: ST elevation or PR depression
Acute chest pain, resolved when sitting up and leaning forward
Pericardial friction rub
Systemic infection signs

24
Q

What is the treatment of pericarditis?

A

Drain effusion (serology/culture)
restrict activity
NSAIDs, colchicine, steroids
Antimicrobials if bacteria identified

25
Q

What are the causes of myocarditis?

A

Coxsackie, influenza, COVID-19
Diphtheria
Toxoplasmosis

26
Q

What are the features of myocarditis?

A

Increase in troponin
ECG changes
Acute chest pain
SOB, fatigue, palpitations, arrhythmia

27
Q

What is the treatment of myocarditis?

A 
Manage sequelae (heart failure and arrhythmia)
Avoid exacerbating
Antimicrobial if bacteria identified
28
Q

What should be avoided in myocarditis?

A

NSAIDs, exercise, alcohol

29
Q

What are the features of device infections?

A

Local cellulitis, BSI, endocarditis

30
Q

What is a vascular infection?

A

Infection from grafts

31
Q

Why can enteric bacteria contaminate grafts?

A

Grafts are often put in around the groin

CVD (22 decks)

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