Cardiac Clinical Med 2 (Selby) Flashcards
What typically causes acute infective endocarditis?
- Staph aureus
- Develops on normal heart valve
- If left untreated, will be fatal in < 6 weeks
What typically causes subacute infective endocarditis?
- A less virulent bacteria (Strep viridans or enterococcus)
- Develops on damaged heart valve
- If left untreated, will be fatal in > 6 weeks
What is marantic endocarditis?
- A sterile platelet vegetation on cardiac valves
- Typically seen in patients with metastatic malignancy
- Often found in autopsy
What is Libman-Sacks endocarditis?
- Sterile platelet vegetations on cardiac valves
- Seen in SLE
What are the risk factors for infective endocarditis?
- Older age
- Male
- IV drug use
- Poor dentition or dental infection
- Structural heart disease
- Implantable cardiac device
What are the most likely pathogens that cause infective endocarditis?
- Staph aureus (31%)
- Strep viridans (17%)
- Enterococci (11%)
- Strep bovis (7%)
- HACEK (2%)
What are the clinical manifestations of infective endocarditis?
- Fever >38 C
- Constitutional symptoms
- New cardiac murmur
- Vascular embolic events
What could we find on a physical exam in someone with infective endocarditis?
- Petechiae
- Splinter hemorrhage
- Osler’s nodes
- Janeway lesions
- Roth spots
How do you diagnose infective endocarditis?
- Modified DUKE criteria:
- Echocardiography
- Blood cultures
What are some cardiac complications with infective endocarditis?
- Heart failure
- Perivalvular abscess
- Pericarditis
What are some metastatic infections that can be from infective endocariditis?
- Septic embolism
- Metastatic abscess
- Meningitis
- Mycotic aneurysm
- Osteomyelitis
- Septic arthrits
What are some renal complications with infective endocarditis?
- Septic embolization
- Glomerulonephritis with renal failure
How do we treat and manage infective endocarditis?
- Obtain infectious disease consult
- Start empiric antibiotics like vancomycin
- Start IV antibiotics should be started once the bacteria is determined
- May need to remove cardiac devices
- Consider surgical consult for patients with complications
When would we use endocarditis prophylaxis?
- Hx of infective endocarditis
- Hx of prosthetic heart valve replacement
- Hx of cardiac valve repair with prosthetic material
- Hx of cardiac transplantation with valvular regurgitation
- Congenital heart disease
- Dental procedures
What is myocarditis?
- An inflammatory disease of the myocardium diagnosed by cardiac biopsy
What are some causes of myocarditis?
- Idiopathic
- Infectious (viral: coxsackie B virus)
- Autoimmune diseases
- Cardiac toxins
- Hypersensitivity reactions
- Radiation
What viruses can cause viral mycarditis?
- Coxsackie B virus
- Human Herpes Virus 6
- Parvovirus
What is the clinical manifestations of myocarditis?
- Recent viral infection within a few weeks of developing myocarditis
- New onset or worsening heart failure
- Cardiac conduction abnormalities
- Acute myocardial infarction like syndrome
How do you diagnose myocarditis?
- Endomyocardial biopsy
- Imaging
- Lab testing
What are the different types of imaging used in diagnosing myocarditis? What does each look for?
- Xray: look for signs of pulmonary edema
- ECG: look for signs of ischemia, arrhythmias, heart block
- Echocardiography: look for LV or RV dysfunction
- CMR: look for myocardial edema, myocardial necrosis
How do we treat viral myocarditis?
- Patients with heart block should be treated with standard AHA heart failure recommendations
What drugs can be given to help reduce heart failure in myocarditis?
- ACEi or ARB
- B-blockers
- Diuretics
- Aldosterone-receptor blockers
- Refractory heart failure
- Antiarrhythmic therapy
What is pericarditis?
- Inflammation of the pericardium
What is cardiac tamponade?
- A life threatening accumulation of pericardial fluid that compresses the heart and impairs diastolic filling and decreases cardiac output
What is constrictive pericarditis?
- Results from a scarred, thickened, and frequently calcified pericardium which constricts the heart impairing cardiac filling and cardiac output
What is the cause of acute pericarditis? Developed world vs developing?
- Idiopathic or viral (developed)
- TB (developing)
What is the clinical manifestation of acute pericarditis?
- Chest pain (sudden onset, retrosternal, sharp, pleuritic)
- Pericardial friction rub
- Dyspnea
- Fever
- Leukocytosis
What makes the chest pain worse in acute pericarditis? Make is better?
- Made worse with lying down
- Made better with sitting up and leaning forward
How do we diagnose acute pericarditis?
- CBC with diff
- Elevated ESR and CRP
- Troponin I
- CXR
- ECHO
- ECG changes
What is the clinical presentation of cardiac tamponade?
- Beck’s Triad
- Pericardial friction rub
- Jugular venous waveforms
- Pulsus paradoxus
- ECG changes
What is Beck’s Triad?
- Hypotension
- JVD
- Muffled heart sounds
How do you diagnose cardiac tamponade?
- CXR
- ECG
- ECHO
What is the clinical manifestation of constrictive pericarditis?
Either:
- Symptoms of volume overload
- Symptoms of reduced cardiac output
What does the physical exam look like for constrictive pericarditis?
- JVD
- Pulsus paradoxus
- Kussmaul’s sign
- Pericardial knock
How do we diagnose constrictive pericarditis?
- CXR
- ECG
- ECHO
- CMR
- Cardiac catheterization
What is used to treat acute pericariditis?
- Treat underlying etiology first
- Avoid strenuous activity
- Anti-inflammatory therapy (NSAIDS, Colchicine, Glucocorticoids)
What is used to treat cardiac tamponade?
- Pericardial fluid removal
- Therapeutic pericardiocentesis
What is used to treat constrictive pericarditis?
- Pericardiectomy
