Buchele Endocarditis Flashcards
What causes acute infective endocarditis? Where does it develop?
S. aureus
Develops on normal heart valve endothelium
What causes subacute infective endocarditis? Where does it develop?
- S. viridans and Enterococcus
- Develops on damaged heart endothelium
What is Marantic endocarditis, who is it seen in, and how is it found? (aka non bacterial thrombotic endocarditis)
- Develop on sterile platelet vegetations on cardiac valves
- Seen in patients with a metastatic malignancy
- Found on autopsy
What is Libman-Sacks endocarditis? Wo does it present in?
- Seen in patients with lupus
- sterile platelet vegetations on cardiac valves
How do those with Marantic and Libman Sacks endocarditis present?
- New cardiac murmur in setting of an embolic disease
Who does infective endocarditis effect?
- Older than 60
- Males
- IV drug use
- Poor dentition
- Structural heart disease
- Implanted cardiac device
How will an IV drug user with endocarditis present?
With right sided endocarditis due to S.aureus
What are the most common 3 pathogens of endocarditis?
- S. aureus
- S. viridans
- Enterococci
If you have a patient who has IE due to streptococcus bovis, what should you look for?
- Colon cancer or IBD
What are HACEK?
- Fastidious gram negative bacilli
- Haemophihlus
- Actinobacillus
- Cardiobacterium
- Eiknella
- Kingella
How will a patient with Infective endocarditis present?
- Fever >38
- Anorexia, weight loss, night sweats
- New cardiac murmur (usually regurgitation)
- Vascular embolic events
- Rarely:
- Oslers nodes
- Janeway lesions
- Roth spots
- Splinter hemorrhages
What are osler’s nodes?
Red raised painful lesions in distal extremeties
what is the modified duke criteria for diagnosing IE?
- Echocardiography
- Blood cultures (before abx)
clinical diagnosis of IE?
(dont need to memorize?)
- Major:
- positive blood culture
- persistent positive blood culture
- evidence of endocardial involvement via echo
- new regurgitation
- Minor:
- predisposition
- fever
- vascular phenomenon
- immunological phenomenon
- micro evidence
Cardiac complications of IE?
- HF
- Perivalvular disease
- Pericarditis
Metastatic infection complications of IE?
- Septic embolization
- stroke, paralysis, PE, renal infarct
- Metastatic abscess
- Meningitis
- Mycotic aneurysm
- Osteomyelitis
- Septic arthritis
Renal complications from IE?
- Septic embolization
- Glomerulonephritis with renal failure
Who gets endocarditis prophylaxis?`
High risk patients only:
- Hx of IE
- Hx of prosthetic valve replacement
- Hx of cardiac valve repair
- Hx of cardiac transplant with valvular regurgitation
- Congenital heart disease
- Dental procedures
What causes myocarditis?
- Idiopathic
- Viral infections
- Other organisms
What are the most common viral causes of myocarditis?
- Cocksackie B
- HHV6
- Parvovirus
How will myocarditis present?
- Recent viral infection
- Fever, myalgia
- Resp. or GI symptoms
- New or worsening HF
- Cardiac conduction abnormalities
- Acute myocardial infarction like syndrome
How do you dx myocarditis?
- Endomyocardial biopsy (EMB)
What images do you get for myocarditis?
- CXR
- ECG
- Echocardiography
- Cardiovascular magnetic resonance
What labs do you order/results expected for myocarditis suspicion?
- CBC with Diff
- Elevated ESR and CRP
- Elevated cardiac biomarkers
- Elevated BNP
How do you treat viral myocarditis?
- ACEi or ARB
- Beta blockers
- Diuretics if volume overload
What is the most common disorder involving the pericardium?
- Acute pericarditis
In the developing or 3rd world countries what causes acute pericarditis?
TB
What causes pericarditis in developed countries?
- Idiopathic
- Viral
- Non infectious:
- AI
- Malignancy
- Cardiac
- Trauma
- Radiation
How does acutd pericarditis present?
- Sudden onset
- Retrosternal sharp pleuritic pain
- Radiates to trapezius ridge or neck
- Pericardial friction rub
- Dyspnea
- Fever
- Leukocytosis
How do you diagnose acute pericarditis?
Two of the following:
- Pericardial chest pain
- Pericardial rub
- New widespread ST elevation or PR depresssion
- Pericardial effusion
EKG findings for acute pericarditis?
Widespread ST elevation
PR segment depression
What is Becks triad?
- Hypotension
- Muffled heart sounds
- JVD
Cardiac Tamponade
What are jugular venous waveforms?
- absent Y descent because of lack of right ventricular filling
- Manifestation of cardiac tamponade
What is Pulsus paradoxus?
- Abnormally large decrease in systolic BP during inspiration
How does constrictive pericarditis present?
- Symptoms of volume overload
- Symptoms of reduced cardiac output
- JVD
- Pulsus Paradoxus
- Kussmal sign
- Pericardial knock
What is kussmaul’s sign?
- JVP fails to decrease with inspiration due to fixed diastolic volume in right heart
How do you diagnose constrictive pericarditis?
- CXR shows pericardial calcifications
How do you treat acute pericarditis?
- Treat underlying etiology
- Avoid strenuous exercise
- Anti-inflammatory’s and Colchicine
