Cardiology #2 (Endocarditis, Pericarditis) Flashcards
What is the MC valve affected with endocarditis?
Mitral
However, if the patient has a history of IVDU, the MC valve affected is
Tricuspid
Risk factors for endocarditis
- Increased age
- IVDU
- rheumatic heart disease
- immunosuppression
- prosthetic heart valves
- Congenital heart disease
What is acute bacterial endocarditis and what is the main cause?
- Infection of normal valves with a virulent organism
- Staph Aureus
What is subacute bacterial endocarditis and what is the main cause?
- Infection of abnormal valves with less virulent organism
- Strep Viridans
IV-drug related endocarditis is MC due to which organism?
Staph Aureus (especially MRSA)
If the patient has prosthetic valve endocarditis, and the infection occurs early (within 60 days of the operation), what is the MC organism involved?
Staph Epidermis
Which organism of endocarditis is associated with poor dentition or dental procedures?
Strep Viridans
What organisms should be suspected with endocarditis in patients with endocarditis and negative blood cultures?
HACEK organisms
Haemophilus aphrophils Actinobacillus Cardiobacteirum hominis Eikenella corodens Kingella kingae
What organism with endocarditis is associated with men > 50 years old with recent history of GI or GU procedure?
Enterococcus
In patients with colon cancer or ulcerative colitis, this organism is more prominent with endocarditis
Strep Bovis
Symptoms of endocarditis (7)
- Generalized constitutional symptoms (persistent fever MC)
- New onset murmur or worsening of existing murmur
- Osler nodes: painful or tender raised violaceous nodules on pads of digits and palms
- Janeway lesions: painless macules on palms and soles
- Splinter hemorrhages: linear brown lesions under nail beds
- Roth spots: retinal hemorrhages with central clearing
- Splenomegaly, glomerulonephritis
Diagnostic studies for endocarditis
- Blood cultures (before ABX initiation): 3 sets at least 1 hour apart
- ECG: at regular intervals (patient prone to arrhythmias)
- Echocardiogram: TEE much more sensitive than TTE
- Labs: Increased ESR/RF
What are the 2 MAJOR Duke criteria for endocarditis?
- Sustained Bacteremia: 2 + blood cultures by organism known to cause endocarditis
- Endocardial Involvement: either + endocardiogram (vegetation, abscess, etc.) OR new valvular regurgitation (aortic or mitral regurgitation)
What are the MINOR Duke Criteria for endocarditis. There are 4 different ones.
1) Predisposing condition: abnormal valves, IVDA, indwelling catheters
2) Fever
3) Vascular phenomena: Janeway lesions, pulmonary emboli
4) Immunologic phenomena: Osler nodes, Roth spots, + RF, worsening/existing murmur
To diagnose as endocarditis, how many MAJOR and MINOR criteria need to be met?
2 MAJOR OR 1 MAJOR + 3 MINOR OR 5 MINOR
If the endocarditis is associated with a native valve, what is the treatment of choice?
- Anti-Staph PCN (Nafcillin, Oxacillin) + either Ceftriaxone or Gentamicin
- Vancomycin if PCN allergy or MRSA suspected
If prosthetic valve is involved with endocarditis, what is the treatment?
-Vancomycin + Gentamicin + Rifampin
If the endocarditis is fungal in nature, what is the treatment?
Amphotericin B (treat 6-8 weeks)
What is the duration of therapy usually in a patient with endocarditis?
Usually 4-6 weeks (with aminoglycosides such as Gentamicin used for only the first 2 weeks)
What cardiac conditions are indications for prophylaxis regarding endocarditis?
- Prosthetic heart valves
- Heart repairs (not including stents)
- Prior history of endocarditis
- Congenital heart disease
- Transplanted heart
What is the prophylaxis needed for endocarditis?
- Amoxicillin 2g 30-60 minutes prior to procedure
- Clindamycin 600 mg if PCN allergic
What is Libman-Sacks Endocarditis and what is it associated with?
Nonbacterial thrombotic endocarditis is a noninfectious endocarditis due to sterile platelet thrombi deposition in affected valve (MC in mitral and aortic valves)
-SLE (Lupus)
What are the 2 MCC of pericarditis
Idiopathic and viral (Coxsackievirus and Echovirus)
Other causes of pericarditis
- Dressler Syndrome
- Autoimmune
- Radiation
- Medications
What is Dressler Syndrome?
-Post MI Pericarditis + Pleural effusion + Fever
Symptoms of pericarditis
- Chest pain: sudden onset of Pleuritic (sharp, worse with inspiration), Persistent, Postural (worse when supine and improved with sitting forward). Pain may radiate to shoulder, back, neck, arm, or epigastric area.
- Pericardial friction rub: best heard at end expiration while upright and leaning forward.
What is seen on an ECG for pericarditis?
-Diagnostic of choice: diffuse ST elevations in precordial leads with associated PR depression in those leads
However, in aVR, it is opposite. ST depression and PR elevation
What is the management of a patient with pericarditis?
- NSAIDs or Aspirin (1st line) x 7-14 days
- Colchicine is 2nd line
For Dressler syndrome, what is the treatment?
Aspirin or Colchicine (avoid NSAIDs because they interfere with myocardial scar formation)
