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CPR Exam 1 > Cardiac Clinical Med 2 (Selby) > Flashcards

Cardiac Clinical Med 2 (Selby) Flashcards

1
Q

What typically causes acute infective endocarditis?

A
  • Staph aureus
  • Develops on normal heart valve
  • If left untreated, will be fatal in < 6 weeks
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2
Q

What typically causes subacute infective endocarditis?

A
  • A less virulent bacteria (Strep viridans or enterococcus)
  • Develops on damaged heart valve
  • If left untreated, will be fatal in > 6 weeks
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3
Q

What is marantic endocarditis?

A
  • A sterile platelet vegetation on cardiac valves
  • Typically seen in patients with metastatic malignancy
  • Often found in autopsy
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4
Q

What is Libman-Sacks endocarditis?

A
  • Sterile platelet vegetations on cardiac valves

- Seen in SLE

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5
Q

What are the risk factors for infective endocarditis?

A
  • Older age
  • Male
  • IV drug use
  • Poor dentition or dental infection
  • Structural heart disease
  • Implantable cardiac device
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6
Q

What are the most likely pathogens that cause infective endocarditis?

A
  • Staph aureus (31%)
  • Strep viridans (17%)
  • Enterococci (11%)
  • Strep bovis (7%)
  • HACEK (2%)
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7
Q

What are the clinical manifestations of infective endocarditis?

A
  • Fever >38 C
  • Constitutional symptoms
  • New cardiac murmur
  • Vascular embolic events
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8
Q

What could we find on a physical exam in someone with infective endocarditis?

A
  • Petechiae
  • Splinter hemorrhage
  • Osler’s nodes
  • Janeway lesions
  • Roth spots
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9
Q

How do you diagnose infective endocarditis?

A
  • Modified DUKE criteria:
  • Echocardiography
  • Blood cultures
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10
Q

What are some cardiac complications with infective endocarditis?

A
  • Heart failure
  • Perivalvular abscess
  • Pericarditis
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11
Q

What are some metastatic infections that can be from infective endocariditis?

A
  • Septic embolism
  • Metastatic abscess
  • Meningitis
  • Mycotic aneurysm
  • Osteomyelitis
  • Septic arthrits
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12
Q

What are some renal complications with infective endocarditis?

A
  • Septic embolization

- Glomerulonephritis with renal failure

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13
Q

How do we treat and manage infective endocarditis?

A
  • 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
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14
Q

When would we use endocarditis prophylaxis?

A
  • 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
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15
Q

What is myocarditis?

A
  • An inflammatory disease of the myocardium diagnosed by cardiac biopsy
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16
Q

What are some causes of myocarditis?

A
  • Idiopathic
  • Infectious (viral: coxsackie B virus)
  • Autoimmune diseases
  • Cardiac toxins
  • Hypersensitivity reactions
  • Radiation
17
Q

What viruses can cause viral mycarditis?

A
  • Coxsackie B virus
  • Human Herpes Virus 6
  • Parvovirus
18
Q

What is the clinical manifestations of myocarditis?

A
  • Recent viral infection within a few weeks of developing myocarditis
  • New onset or worsening heart failure
  • Cardiac conduction abnormalities
  • Acute myocardial infarction like syndrome
19
Q

How do you diagnose myocarditis?

A
  • Endomyocardial biopsy
  • Imaging
  • Lab testing
20
Q

What are the different types of imaging used in diagnosing myocarditis? What does each look for?

A
  • 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
21
Q

How do we treat viral myocarditis?

A
  • Patients with heart block should be treated with standard AHA heart failure recommendations
22
Q

What drugs can be given to help reduce heart failure in myocarditis?

A
  • ACEi or ARB
  • B-blockers
  • Diuretics
  • Aldosterone-receptor blockers
  • Refractory heart failure
  • Antiarrhythmic therapy
23
Q

What is pericarditis?

A
  • Inflammation of the pericardium
24
Q

What is cardiac tamponade?

A
  • A life threatening accumulation of pericardial fluid that compresses the heart and impairs diastolic filling and decreases cardiac output
25
Q

What is constrictive pericarditis?

A
  • Results from a scarred, thickened, and frequently calcified pericardium which constricts the heart impairing cardiac filling and cardiac output
26
Q

What is the cause of acute pericarditis? Developed world vs developing?

A
  • Idiopathic or viral (developed)

- TB (developing)

27
Q

What is the clinical manifestation of acute pericarditis?

A
  • Chest pain (sudden onset, retrosternal, sharp, pleuritic)
  • Pericardial friction rub
  • Dyspnea
  • Fever
  • Leukocytosis
28
Q

What makes the chest pain worse in acute pericarditis? Make is better?

A
  • Made worse with lying down

- Made better with sitting up and leaning forward

29
Q

How do we diagnose acute pericarditis?

A
  • CBC with diff
  • Elevated ESR and CRP
  • Troponin I
  • CXR
  • ECHO
  • ECG changes
30
Q

What is the clinical presentation of cardiac tamponade?

A
  • Beck’s Triad
  • Pericardial friction rub
  • Jugular venous waveforms
  • Pulsus paradoxus
  • ECG changes
31
Q

What is Beck’s Triad?

A
  • Hypotension
  • JVD
  • Muffled heart sounds
32
Q

How do you diagnose cardiac tamponade?

A
  • CXR
  • ECG
  • ECHO
33
Q

What is the clinical manifestation of constrictive pericarditis?

A

Either:

  • Symptoms of volume overload
  • Symptoms of reduced cardiac output
34
Q

What does the physical exam look like for constrictive pericarditis?

A
  • JVD
  • Pulsus paradoxus
  • Kussmaul’s sign
  • Pericardial knock
35
Q

How do we diagnose constrictive pericarditis?

A
  • CXR
  • ECG
  • ECHO
  • CMR
  • Cardiac catheterization
36
Q

What is used to treat acute pericariditis?

A
  • Treat underlying etiology first
  • Avoid strenuous activity
  • Anti-inflammatory therapy (NSAIDS, Colchicine, Glucocorticoids)
37
Q

What is used to treat cardiac tamponade?

A
  • Pericardial fluid removal

- Therapeutic pericardiocentesis

38
Q

What is used to treat constrictive pericarditis?

A
  • Pericardiectomy

CPR Exam 1 (21 decks)

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