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*Pance Re-Up * > Cardiology #5 Endocarditis, Pericarditis, Effusion, Tamponade, AAA > Flashcards

Cardiology #5 Endocarditis, Pericarditis, Effusion, Tamponade, AAA Flashcards

1
Q

What is endocarditis, what is the MC valve affected (in general), and what is the MC valve affected in IVUD?

A

Infection of the valves due to bacteria

-Mitral MC in general
-Tricuspid MC in IVDU

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2
Q

What is the pathophysiology of endocarditis?

A

Thrombus forms on valve –> damaged endothelium attracts platelets and bacteria –> vegetative growth develops

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3
Q

Risk Factors for endocarditis

A

-Age
-Rheumatic Heart Disease
-IVDU
-Prosthetic valves
-Immunosuppression

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4
Q

MCC acute endocarditis

-What kinds of valves does it affect
-Is it common in IVDU?

A

Staph Aureus

-Affects normal valves
-Common in IVDU (MRSA)

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5
Q

MCC subacute endocarditis

-What kinds of valves does it affect
-What else is it associated with?

A

Strep Viridans

Affects damaged/abnormal valves
-Part of oral flora (poor dentition and dental procedures)

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6
Q

On the other hand, what bacteria affects prosthetic valves (within 60 days of surgery)?

A

Staph Epidermidis (Coag-Negative)

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7
Q

Regarding the post-op period, what bacteria should you be concerned with in the following time periods?

-First 2 months
-After the first 2 months

A

-Staph Epidermidis
-Staph Aureus after two months

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8
Q

In men with recent GI or GU procedures, what bacteria should you be worried about with endocarditis?

A

Enteroccocus

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9
Q

If negative blood cultures, what organisms should you look for in endocarditis?

A

HACEK organisms (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)

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10
Q

Symptoms of endocarditis

A

-Persistent fever (MC)
-New onset murmur or worsening murmur
-Osler nodes: painful on pads of digits/palms
-Janeway lesions: painless macules on soles and palms
-Splinter hemorrhages: linear red lesions under nail bed
-Roth Spots: retinal hemorrhages with central clearing
-Splenomegaly
-Glomerulonephritis

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11
Q

What diagnostics should be obtained for endocarditis?

A

-Blood cultures: 3 sets at least 1 hour apart
-ECG at regular intervals
-Echo: TEE more sensitive than TTE
-Labs: Leukocytosis, High ESR/RF

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12
Q

Explain the Duke Criteria including 1) what is needed to make the diagnosis of Endocarditis, 2) what the major and minor criteria are

A

Need (2 major OR 3 minor + 1 major OR 5 minor)

MAJOR:
-2 positive blood cultures of typical organisms
-Either: + echo (vegetation, abscess) OR new valvular regurgitation

MINOR:
-Fever
-Vascular Issue: Janeway lesion, pulmonary emboli
-Immunologic Issue: Osler, Roth, + RF, acute glomerulonephritis
-Worsening of existing murmur
-+ blood culture in organism not known to cause endocarditis
-Predisposition (abnormal valve, IVDU, etc.)

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13
Q

How long does the treatment for endocarditis usually continue?

A

4-6 weeks

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14
Q

Management for the following cases of Endocarditis:

-Native Valve
-Prosthetic Valve
-Fungal Cause

A

-Native Valve
–Nafcillin/Oxacillin + Ceftriaxone/Gentamicin
—Vancomycin if PCN allergic

-Prosthetic Valve
–Vanco + Gentamicin + Rifampin

-Fungal (Candida, Aspergillus)
–Amphotericin B (6-8 weeks)

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15
Q

What kinds of things do patients with a history of endocarditis need prophylaxis for in the future?

What is given for prophylaxis?

A

Cardiac Conditions: Prosthetic valves, heart repairs (not stents), prior history of endocarditis, congenital heart disease

Procedures: dental, respiratory, involving skin/MSK (abscesses, I&D)

Amoxicillin 2g 30-60 min before procedure
–Clindamycin 600mg or Azithromycin 500mg if PCN allergic

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16
Q

What is Libman-Sacks Endocarditis?

What is it usually seen with?

A

Nonbacterial thrombotic endocarditis

Malignancy, Lupus (SLE)**, Rheumatic Fever

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17
Q

Management for Libman-Sacks Endocarditis?

A

Treat the SLE for the symptoms to resolve

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18
Q

Acute pericarditis, inflammation of the pericardium, has two common causes…name them.

Also name the other causes, such as what is Dressler Syndrome?

A

Idiopathic and Viral (Coxsackievirus and Echovirus)

-Others: Radiation, Meds (Hydralazine, Procainamide), Malignancy (lung, breast)

-Dressler Syndrome: post MI pericarditis + fever + pleural effusion

19
Q

Again, Dressler syndrome has three components. What are they?

A

Post MI pericarditis + fever + pleural effusion

20
Q

Symptoms of pericarditis (think of P’s).

A

Chest pain: sudden pleuritic (worse with inspiration), persistent, postural (worse with supine), pleuritic friction rub (end of expiration, upright, leaning forward). Pain may radiate to shoulder, back, or neck.

21
Q

In which position can you most likely hear a pericardial friction rub (be specific)?

A

Upright, leaning forward, end of expiration

22
Q

What is seen on ECG in a patient with pericarditis?

A

-Diffuse ST elevations in precordial leads with PR depressions in those leads (V1-V6)

-In aVR, though, ST depressions and PR elevations

23
Q

Management for pericarditis

Management for Dressler Syndrome (specifically)

A

-NSAIDs or Aspirin
-Colchicine (2nd line)

Dressler: Aspirin or Colchicine, NO NSAIDS (may impair healing process and cause ventricular rupture)

24
Q

Pericardial effusion, a complication of pericarditis, is fluid in the pericardial space. What are the symptoms of this condition?

A

-Decreased (muffled) heart sounds
-Chest pain
-Dyspnea
-Fatigue

25
Q

What is the diagnostic of choice for a pericardial effusion?

What is seen on an ECG? CXR?

A

Echo is DOC

-ECG: Low QRS voltage, tachycardia, electrical alternans (alternating amplitudes of QRS -tall-short-tall)
-CXR: water bottle heart

26
Q

Treatment for pericardial effusion

A

-Treat underlying cause
-Large effusions need pericardiocentesis

27
Q

On that same note, what is a cardiac tamponade?

What are some etiologies of this condition?

A

Pericardial effusion putting pressure on heart, impeding filling, leading to decreased CO and shock

Etiologies: acute pericarditis, trauma, malignancy

28
Q

Symptoms of a cardiac tamponade (triad and a specific other finding)

A

Beck’s Triad: muffled heart sounds + increased JVP + hypotension

Pulsus Paradoxus: > 10mmHg decrease in SBP with inspiration

29
Q

Diagnostics for cardiac tamponade

A

-Echo: effusion + diastolic collapse of chambers
-ECG: signs of pericardial effusion (low voltage QRS, electrical alternans)
-CXR: enlarged cardiac silhouette

30
Q

Management for a cardiac tamponade

A

-Pericardiocentesis (immediately)

31
Q

What is constrictive pericarditis?

What is the MCC in the US? The world?

A

Loss of pericardial elasticity (fibrosis) leading to restricted ventricular diastolic filling

US: Any cause of pericarditis
World: TB

32
Q

Symptoms of constrictive pericarditis

A

-Dyspnea (MC)
-Right Heart Failure Signs: Increased JVD, Peripheral Edema, Kussmaul’s Sign (increase in JVP with inspiration)
-Pericardial Knock: high pitched diastolic sound (like S3) = sudden cessation of ventricular filling

33
Q

What is seen on an echo with constrictive pericarditis?

A

Pericardial thickening and/or calcification. Square root sign = early diastolic dip followed by diastasis.

34
Q

Management for constrictive pericarditis

A

-Diuretics
-Pericardiectomy (definitive)

35
Q

Abdominal Aortic Aneurysm is focal aortic dilation > 1.5cm. Where is the MC site for this condition?

What are some risk factors for AAA?

A

Infrarenal MC site

RF: Smoking!!!!, Male, Age >60, Caucasian

36
Q

Symptoms of an AAA

How about symptoms if ruptured?

A

Most asymptomatic; however, can have abdominal/flank pain, abdominal bruit, pulsatile abdominal mass

Ruptured: same as above, hypotension, syncope, flank ecchymosis

37
Q

Regarding diagnostics for AAA, what are the best options if…

-Stable
-Unstable
-Best test to monitor progression if asymptomatic

A

-Stable: CT with IV contrast
-Unstable: Bedside US
-Abdominal US if asymptomatic to monitor progression

38
Q

Explain the screening for abdominal aortic aneurysms

A

-One time abdominal US in men 65-75 who ever smoked

39
Q

Explain the treatment and monitoring for AAA based on size

A
  • 5.5 or more OR > 0.5cm expansion in 6 months = immediate surgery

->4.5: vascular surgeon referral

-4-4.5: US Q6 months

3-4cm: US Q12 months

40
Q

An aortic dissection, which is a tear through the innermost layer (the intima), has two types. Which type is the MC and associated with the highest mortality?

What are some risk factor associated with this condition?

A

-Ascending (MC) = highest mortality

RF: Hypertension**, Pregnancy, Men, Collagen disorders (Marfan, Ehler Danlos), Turner’s

41
Q

Symptoms of aortic dissection

Where is the pain in both types of this condition (it changes based on location).

A

-Sudden onset severe, ripping, knife-like chest pain radiating between scapulae
-Unequal BP in both arms = decreased peripheral pulses, > 20mmHg difference between arms

-Ascending: anterior CP
-Descending: interscapular pain

42
Q

Diagnostics for aortic dissection

A

-CT angiogram (GOLD), TEE
-CXR: Widened mediastinum

43
Q

Management for both types of aortic dissection

A

-Surgical: Proximal/Ascending (Stanford A)
-Medical: Distal/Descending (Stanford B)
–Labetolol with Sodium Nitroprusside (for HTN)
–Systolic BP rapidly lowered!

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