Cardiac Infection Flashcards
TB pericarditis symptoms
*fever
*generally unwell
*normal or low BP
*JVP raised
*pulseless pluses paradoxes
*apex not palpable
*tender hepatomegaly and ascites
TB pericarditis spread
*retrograde lymphatic spread by mediastinal lymph node
*haematogenic spread
*direct spread from adjacent structures
Cardiac effusion pathophysiology
1-cardiac chambers conpressed
2-compromise venous return
3-septal shift to the left ventricle
4-diminished stroke vol and cardiac output
Diagnose TB pericarditis
1-confirm pericardial effusion(cxr show cardiomegaly, ECG show concave ST elevation and height of QRS change the whole time)
2-pericardial synthesis to confirm TB etiology
Rule out the following before diagnosis of tb pericarditis
-PUS
-Uremia
-Hypothyroidism
Tb pericarditis complication
-tamponade
-heart failure
-constrictive pericarditis
Treatment for TB pericarditis
HIV pos
-pericardial synthesis
-anti tb therapy
-no vorticosteroids
HIV negative
-pericardial synthesis
-anti tb drug
-Corticosteroid(reduce constrictive pericarditis)
Higher risk for endocarditis
-vsd
-repaired tetrology of fallot
-prosthetic valve or abnormal valves
Symptoms of infective endocarditis
Fever
Night sweats
Rigors
Weight loss
Malaise
Arthralgia
Pallor
Examine patient with infective endocarditis
Splinter hemorrhages(proximal)
Clubbing
Oslers node
Jane way lesions
IV drug use signs
Dental health
Subconjuctival haemorrhages
Roth spots
Blood culture with Infective endocarditis
3 an hour apart, at three different sites
Organism that cause infective endocarditis
-oropharynx: streptococcus viridans
-GIT: enterococcus and strep bovis
-skin:staph aureus
-urogenital: neisseria gonorrhea
Investigations of infective endocarditis
-anaemia
-ESR and CRP elevated
-hematuria and proteinuria
3 major duke criteria
-microbiological evidence
-echo evidence of vegitations
-new valve regurgitation
7 minor duke criteria
Predisposing condition
Fever more than 38
Microbiological criteria not meeting major criteria
Elevated inflammatory markers
Embolic phenomena
Immunological phenomena
Suspicious echo
Criteria for endocarditis
2major
Or
1major and 3 minor
Or
5 minor
Association with infective endocarditis
Valve regurgition
Heart failure
Heart block
Neurological complications of IE
Mycotic aneurysm(arterial wall dilation)
Embolic stroke
Meningitis
Encephalitis
Renal complication of IE
Glomeruloneohritis
Embolic infarct
Musculoskeletal complications of IE
Arthralgia
Arthritis
Lumbar back ache
Limb ischemia
IE treatment
Antibiotics for organism and monitor bactericidal levels
Surgical
Prevention and prophylaxis for IE
Good dental health
Antibiotic prophylaxis if undergo surgery
