Cardiac Infections- Audia Flashcards
chest pain, sob, fever
cardiac infection, not MI
due to bacterial infection attacking valves of heart
endocarditis
due to viral infection attacking muscles of ventricle
myocarditis
due to viral infection attacking pericardial sac
pericarditis
most common cardiac infection
endocarditis
cardiac infection usually seen in immunocompromised patients
myocarditis
lymphocytes biomarker for what
viral infection
eosinophils biomarker for what
drug-associated
neutrophils biomarker for what
bacteria
giant cells biomarker for what
Idiopathic (no identifiable cause)
fever, chills, sob, cough, splinter hemorrhages
endocarditis
key to this is damaged heart valves
endocarditis
low grade fever, affects abnormal valves
subacute bacterial endocarditis
higher fever, affects normal valves
acute infective endocarditis
if tricuspid valve is affected, what do you look for
catheter or IV drug abuse
function of biofilms
protection
resist phagocytosis
limit penetration of Ab’s
endocarditis
L: normal
R: vegetation
risk factors for this include:
congenital heart abnormalities
structural defects
RHD
catheters
IV drug abuse
chronic alcoholism
Endocarditis
symptoms include:
fever
fatigue
splinter hemorrhages
janeway lesions
osler’s nodes
endocarditis
main bugs causing endocarditis
S. aureus
Viridans group strep
Enterococcus species
gram +, catalase and coagulase +
S. aureus
bug that most likely causes acute infectious endocarditis
S. aureus
bug that is in normal oral flora and is alpha hemolytic
Viridans strep (S. mutans)
bug that causes subacute bacterial endocarditis
Viridans Strep (S. mutans)
non-hemolytic and gram +; causes subacute bacterial endocarditis (2 names)
Group D strep
S. gallolyticus
alpha or non-hemolytic and can cause subacute bacterial endocarditis
Enterococcus species
main player that attacks prosthetic heart valve
S. aureus
to diagnose infectious endocarditis
+ blood cultures
echo
predisposed conditions
CXR
urine
troponin levels
to Rx infectious endocarditis
Ab’s (Vanco or gentamycin)
surgery
hallmark of this is cardiomegaly
infectious myocarditis
signs of this include:
abnormal heart beat
chest pain
fatigue
fever
arthralgia
lower leg edema
sob
syncope
myocarditis
3 main causes of myocarditis
infections
RF
drugs
toxins
specific toxin that can cause myocarditis
diphtheria toxin
main viral cause of myocarditis
coxsackie B
transmitted by fecal/oral route
Coxsackie B
fecal/oral route and starts in URT and can cause sore throat
Coxsackie B
phase of myocarditis where viremia is produced from GI tract
acute phase
phase of myocarditis (4-14 days) where there is infiltration of NK, macrophages, and T cells
subacute phase
phase of myocarditis (15-90) days
Chronic phase
worst case scenario for myocarditis
CHF
2 main causes of BACTERIAL myocarditis
Diphtheria
Lyme Disease (B. burgdorferi)
the protozoa Trypanosoma cruzi (Chagas disease) can cause what
infectious myocarditis
to diagnose myocarditis
imaging (CXR, MRI)
what grade?
grade 2
biomarkers for cardiac injury
troponin I
creatine kinase
lactate
CRP
ESR
leukocytosis
Rx myocarditis
supportive care (rest)
Rx HF w/ myocarditis
ACEIs, diuretics, digoxin
Rx arrhythmia w/ myocarditis
quinidine, procainamide
what to use to prevent thromboembolism w/ myocarditis
anticoags
what are you worried about with infectious pericarditis
cardiac tamponade
chest pain prominent especially while laying down
pericarditis
most common viral cause of pericarditis
coxsackie B
to treat pericarditis
ASPIRIN AND NSAIDs; treat symptoms or use Ab’s if bacterial; remove fluid
labs to order to diagnose pericarditis
CBC
BUN
CRP
ESR
cardiac biomarkers
blood cultures
patient w/ splenectomy is most likely to go into ____ shock
septic (distributive)
most common organism causing sepsis in asplenic patient
S. pneumoniae
most likely source of bacteremia for E. coli
urinary tract
most likely source of bacteremia for coxsackie B
GI
caused by HACEK, coxiella, bartonella species
blood culture - endocarditis
to diagnose culture - endocarditis
blood cultures (come back within 2 weeks)
serology (coxiella + bartonella)
to treat acute native valve blood culture negative endocarditis
vancomycin + cefepime for 6 wks
to Rx subacute native valve blood culture - endocarditis
vancomycin + ampicillin sulbactam
paramyxovirus that causes URTIs and LRTIs seen in children, elderly, and immunocompromised
human metapneumovirus (hMPV)
this virus related to RSV can cause myocarditis
hMPV
to dx hMPV
nucleic acid amplification test for viral genome
to Rx hMPV w/ HF sx’s
supportive care w/ HF drugs
patient presents w/ chest pain, fever, HA, lymphadenopathy; she recently traveled to south america
myocarditis secondary to Chagas disease
EKG: anterior ST depression
eye: Romana sign
what is the pathogen?
Trypanosoma cruzi
this drug is used to treat myocarditis from T. cruzi; produces free radicals
benznidazole
Romanas sign
T. cruzi
what 3 things are used to diagnose myocarditis secondary to chagas disease
blood smear
Ab test
ELISA
procedure done to drain excess fluid in the sac around the heart
pericardiotomy
pericardial effusion w/ chest pain and fever weeks after cardiac surgery
post pericardiotomy syndrome
how does PPS happen?
immune-mediated damage from tissue damage during surgery
to diagnose PPS
fever and elevated CRP w/ no evidence of infection
hx
echo
CXR
to treat post pericardiotomy syndrome
NSAIDs and colchicine
