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Cardio > Cardiac Infections > Flashcards

Cardiac Infections Flashcards

1
Q

What is the likely focus of a streptococcus pneumoniae infection?

A

Pneumonia

Menigitis

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2
Q

What is the likely focus of a E.coli/Klebsiella/coliform infection?

A

Urinary tract

Gut

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3
Q

What is the likely focus of a Staphylococcus aureus infection?

A

Skin, wound infection
Bone/joint infection
Endocarditis

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4
Q

Causes of Staphylococcus epidermidis in blood cultures?

A

Commonly a skin contaminant

Can infect prosthetic material (e.g intravascular line, prosthetic heart valve/joints)

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5
Q

What is infective endocarditis?

A

Infection of the endothelium of the heart valves

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6
Q

Predisposing factors for infective endocarditis?

A

Heart valve abnormality =
Calcification/scelrosis int he elderly
Congenital heart disease
Post rheumatic fever

Prosthetic heart valve
IV drug use
Intravascular lines

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7
Q

Pathogenesis of Endocarditis

A

Heart valve damaged
Turbulent blood flow over roughened endothelium
Platelets/fibrin deposited
Bacteraemia (e.g. dental treatment)
Organisms settle in fibrin/platelet thrombi becoming a microbial vegetation
These are friable and break off, lodging in the next capillary bed they encounter causing abscesses or haemorrhage

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8
Q

Which side of the heart is usually affected by endocarditis?

A

Left side

Mitral and Aortic Valves

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9
Q

What are the four most common organisms to cause endocarditis on a native valve?

A

Staphylococcus aureus
Viridans streptococci
Enterococcus sp
Staphylococcus epidermidis

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10
Q

Which “atypical” organisms can cause endocarditis?

A 
Bartonella 
Coxiella burnetti (Q fever, sheep) 
Chlamydia 
Legionella 
Mycoplasma 
Brucella
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11
Q

What is the typical presentation of acute endocarditis?

A

Overwhelming sepsis and cardiac failure

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12
Q

Symptoms of subacute endocarditis?

A 
Fever 
Malaise 
Weight loss
Tiredness
Breathlessness
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13
Q

Signs of subacute endocarditis?

A 
Fever 
New or changing heart murmur 
Finger clubbing 
Splinter haemorrhages 
Splenomegaly
Roth spots, Janeway lesions, Osler nodes 
Microscopic haematuria
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14
Q

How many blood cultures should be taken?

A

Three sets

Before receiving antibiotics

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15
Q

What imaging can be used for diagnosis of endocarditis?

A

Echocardiogram

Transoesophageal is more sensitive than transthoracic

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16
Q

What is early prosthetic valve endocarditis and which organisms are usually responsible?

A

Within 60 days
Usually infected at time of valve insertion
Staphylococcus epidermidis or Staphylococcus aureus

17
Q

What is late prosthetic valve endocarditis and which organisms can be responsible?

A

Occurs up to many years after valve insertion due to coincidental bacteraemia
Wide range of possible organisms

18
Q

Which side of the heart is usually affected by endocarditis in IV drug users?

A

Right side (tricuspid valve)

19
Q

Which organism usually causes endocarditis in IV drug users and how doe sit commonly present?

A

Staphylococcus aureus, often presenting as Staph aureus “pneumonia”

20
Q

What is the treatment for native valve endocarditis?

A

Amoxicillin and gentamicin IV

21
Q

What is the treatment for prosthetic valve endocarditis?

A

Vancomycin and gentamicin IV + Rifampicin PO

Valve replacement usually required

22
Q

What is the treatment for endocarditis in IV drug users?

A

Flucloxacillin IV

23
Q

What is the treatment for Staphylococcus aureus (non MRSA) endocarditis?

A

Flucloxacillin IV

24
Q

What is the treatment for MRSA endocarditis?

A

Vancomycin IV + Rifampicin PO

25
Q

What is the treatment for Viridans streptococci endocarditis?

A

Benzylpenicillin and gentamicin IV

26
Q

What is the treatment for Enterococcus sp. endocarditis?

A

Amoxicillin/vancomycin and gentamicin IV

27
Q

What is the treatment for Staphylococcus epidermidis endocarditis?

A

Vancomycin and gentamicin IV + Rifampicin PO

28
Q

How long are IV antibiotics given for endcarditis?

A

Usually 4-6 weeks

29
Q

What is myocarditis?

A

Inflammation of cardiac muscle
Commoner in young people
Cause of sudden death

30
Q

What are the symptoms of myocarditis?

A

Fever
Chest pain
Shortness of breath
Palpitations

31
Q

What are the signs of myocarditis?

A

Arrhythmia

Cardiac failure

32
Q

Which organisms cause myocarditis?

A 
Mainly enteroviruses (e.g. Coxsackie A + B, echovirus)
Others possible (e.g. influenza)
33
Q

How is myocarditis diagnosed?

A

Viral PCR
Throat swab and stool for enteroviruses
Throat swab for influenza

34
Q

How is myocarditis treated?

A

Supportively

No known effective treatment for enteroviruses

35
Q

What is pericarditis?

A

Inflammation of pericardium

Often occurs with myocarditis

36
Q

What is the main symptom of pericarditis?

A

Chest pain

37
Q

What are the causes of pericarditis?

A 
Mainly viral (e.g. Coxsackie)
Can be bacteraemic e.g. after cardiothoracic surgery 
Rarely secondary spread from endocarditis or pneumonia
38
Q

How is pericarditis treated?

A 
Viral = Supportive treatment 
Bacterial = Antibiotics and drainage

Cardio (19 decks)

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