Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology > Cardiology- Cardiac Infections > Flashcards

Cardiology- Cardiac Infections Flashcards

1
Q

Case 1
23 year HIV infected woman presents to casualty with c/o
Progressive peripheral edema
Abdominal swelling
Shortness of breath and fatigue

ROS reveals 1/12 of fever, night sweats and weight loss

On the basis of the history, what is the likely cause of this symptom complex?

A

TB pericarditis

Especially extrapulmonary TB (such as peritoneal TB), can cause fever, night sweats, weight loss, ascites, and fatigue.
Common co-infection in HIV patients due to immunosuppression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is pericarditis?

A

Pericarditis is inflammation of the pericardium, the fibrous sac surrounding the heart, often causing chest pain, pericardial friction rub, and ECG changes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are common causes of pericarditis?

A

Causes include viral infections (most common), bacterial infections, autoimmune diseases (e.g., lupus), post-myocardial infarction (Dressler’s syndrome), trauma, and uremia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the characteristic clinical features of acute pericarditis?

A

Pleuritic chest pain (worsened by deep inspiration, relieved by sitting up/leaning forward), pericardial friction rub, and diffuse ST-segment elevation on ECG.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a pericardial effusion?

A

A pericardial effusion is the abnormal accumulation of fluid in the pericardial cavity, which can compress the heart and impair its function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are common causes of pericardial effusion?

A

Causes include pericarditis, malignancy, trauma, post-surgery, uremia, and hypothyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the signs of a large pericardial effusion?

A

Distant or muffled heart sounds, distended neck veins, and a “water-bottle” shaped heart on chest X-ray.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is cardiac tamponade?

A

Cardiac tamponade is a life-threatening condition where fluid accumulation in the pericardium leads to increased pressure, restricting heart filling and reducing cardiac output.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the key clinical features of cardiac tamponade?

A

Beck’s triad: hypotension, distended neck veins (raised JVP), and muffled heart sounds. Pulsus paradoxus (exaggerated drop in blood pressure during inspiration) is also common.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the immediate treatment for cardiac tamponade?

A

The urgent treatment is pericardiocentesis, where fluid is drained from the pericardial sac to relieve the pressure on the heart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is constrictive pericarditis?

A

Constrictive pericarditis occurs when the pericardium becomes thickened and scarred, limiting the heart’s ability to expand and fill properly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the main causes of constrictive pericarditis?

A

Causes include chronic pericarditis, previous cardiac surgery, radiation therapy, infections (e.g., tuberculosis), and connective tissue disorders.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the key clinical features of constrictive pericarditis?

A

Features include right heart failure signs such as ascites, peripheral edema, hepatomegaly, and Kussmaul’s sign (elevated JVP that rises during inspiration).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is constrictive pericarditis treated?

A

Definitive treatment involves pericardiectomy, surgical removal of the thickened pericardium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Dressler’s syndrome?

A

Dressler’s syndrome, also known as post-myocardial infarction syndrome, is an autoimmune form of pericarditis that occurs weeks after a heart attack.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the clinical features of Dressler’s syndrome?

A

Features include fever, pleuritic chest pain, and a pericardial effusion, often with elevated inflammatory markers (ESR, CRP).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is Dressler’s syndrome treated?

A

Treatment includes NSAIDs for inflammation, corticosteroids in more severe cases, and colchicine to prevent recurrence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a pericardial rub?

A

A pericardial rub is a scratchy, grating sound heard during auscultation, caused by the friction between inflamed pericardial layers in pericarditis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How can you differentiate a pericardial rub from other heart sounds?

A

A pericardial rub has three components (systolic and two diastolic phases) and is best heard with the patient leaning forward, unlike pleural rubs or normal heart sounds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is pulsus paradoxus, and in which pericardial syndrome is it seen?

A

Pulsus paradoxus is an exaggerated drop in systolic blood pressure (>10 mmHg) during inspiration. It is commonly seen in cardiac tamponade.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is pulsus paradoxus detected clinically?

A

Pulsus paradoxus is detected by measuring the blood pressure and noting the difference in systolic pressure between inspiration and expiration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is the diagnosis of TB pericarditis established

A
  1. Confirm the presence of a pericardial effusion

CXR
ECG
ECHO

  1. Confirm the tuberculous etiology

Rule out alternative causes
PUS
Uremia
Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Definitive diagnosis of TB pericarditis

A

Culture TB from pericardial fluid (low yield)

Granuloma on biopsy

Culture TB from sputum, lymph nodes etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Probable diagnosis of TB pericarditis

A

Lymphocytic exudate

High ADA or Gamma Interferon

If no access to pericardium

Rule out alternative causes of effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Complications of TB pericarditis

A

Tamponade

Severe heart failure

Constrictive Pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment of TB pericarditis in an HIV infected individual

A

Pericardiocentesis-particularly if any hint of hemodynamic instability

Anti Tuberculous therapy

No corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Treatment of TB in a non- HIV patient

A

Pericardiocentesis-particularly if any hint of hemodynamic instability

Anti Tuberculous therapy

Corticosteroids to reduce Constrictive pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Case 2

A 30-year-old presents to see you because she has been “sick” for 2/52
You take a brief history.

What information about your patient would make you concerned that your patient could have Infective endocarditis?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which of the following are not associated with a high risk for IE and why?

Dilated cardiomyopathy
VSD
Constrictive Pericarditis
Repaired Tetralogy of Fallot [TOF]
Ischemic Heart Disease with Hx of CABG

A

Not associated with high risk: Dilated cardiomyopathy, constrictive pericarditis, and ischemic heart disease with a history of CABG.
They don’t involve the valves of the heart

Associated with high risk: Ventricular septal defect (VSD) and repaired Tetralogy of Fallot (TOF).

Patients with abnormal native heart valves, prosthetic heart valves , certain congenital defects, patches, and conduits are at high risk for developing IE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is infective endocarditis?

A

Infective endocarditis (IE) is an infection of the endocardial surface of the heart, typically involving the heart valves, caused by bacteria, fungi, or other pathogens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are common risk factors for infective endocarditis?

A

Risk factors include pre-existing valvular heart disease, prosthetic heart valves, intravenous drug use (IVDU), previous infective endocarditis, and congenital heart disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the most common pathogens causing infective endocarditis?

A

The most common pathogens are Staphylococcus aureus, Streptococcus viridans, Enterococci, and coagulase-negative staphylococci. Fungi and other bacteria may also cause endocarditis, especially in immunocompromised patients or IVDU.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the pathophysiology of infective endocarditis?

A

IE begins with damage to the heart’s endocardial surface, allowing bacteria from the bloodstream to adhere and form vegetations on heart valves. These vegetations can cause local tissue destruction, systemic emboli, and immune complex deposition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the key clinical features of infective endocarditis?

A

Fever, heart murmur, fatigue, weight loss, and signs of embolic phenomena (e.g., petechiae, Janeway lesions, Osler’s nodes) are common clinical features.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are common embolic manifestations of infective endocarditis?

A

Embolic manifestations include Janeway lesions (painless erythematous lesions on palms and soles), splinter hemorrhages under the nails, Roth spots in the eyes, and infarcts in major organs (e.g., brain, kidneys, spleen).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are common immunological manifestations of infective endocarditis?

A

Immunological manifestations include Osler’s nodes (painful subcutaneous nodules on fingers or toes), Roth spots (retinal hemorrhages with pale centers), and glomerulonephritis.

37
Q

What criteria are used to diagnose infective endocarditis?

A

The Modified Duke Criteria are used, including major criteria (positive blood cultures, evidence of endocardial involvement on echocardiography) and minor criteria (fever, embolic events, predisposing heart condition, etc.).

38
Q

What are the major Duke Criteria for infective endocarditis?

A

The major criteria include:

Positive blood cultures with typical IE organisms from at least two separate cultures.

Echocardiographic evidence of endocardial involvement (vegetation, abscess, new valvular regurgitation).

39
Q

What are the minor Duke Criteria for infective endocarditis?

A

The minor criteria include:

Fever > 38°C.
Vascular phenomena (e.g., Janeway lesions, emboli).
Immunologic phenomena (e.g., Osler’s nodes, Roth spots).
Positive blood cultures not meeting the major criteria.

40
Q

What are the key treatment principles for infective endocarditis?

A

Treatment includes prolonged intravenous antibiotics (typically 4-6 weeks), guided by blood culture results. Surgical intervention may be necessary for valve replacement or in cases of uncontrolled infection or complications.

41
Q

What is the typical antibiotic regimen for infective endocarditis caused by Staphylococcus aureus?

A

For methicillin-sensitive S. aureus (MSSA), use nafcillin or oxacillin. For methicillin-resistant S. aureus (MRSA), use vancomycin or daptomycin.

42
Q

What antibiotics are used for infective endocarditis caused by Streptococcus viridans?

A

Penicillin G or ceftriaxone, often combined with gentamicin, are used for S. viridans.

43
Q

What are the indications for surgery in infective endocarditis?

A
  • Heart failure due to valvular dysfunction.
  • Fungal or resistant infections.
  • Uncontrolled infection or abscess formation.
  • Recurrent embolic events despite antibiotics.
  • Prosthetic valve endocarditis.
44
Q

What are common complications of infective endocarditis?

A

Complications include heart failure, systemic emboli (stroke, renal infarction), abscess formation, valvular damage, and conduction abnormalities (e.g., heart block).

45
Q

Who requires prophylaxis for infective endocarditis before dental or surgical procedures?

A

Prophylaxis is recommended for patients with high-risk conditions such as prosthetic heart valves, previous infective endocarditis, congenital heart disease, and heart transplant recipients with valvulopathy.

46
Q

What is the recommended antibiotic for endocarditis prophylaxis before dental procedures?

A

Amoxicillin 2 g orally 1 hour before the procedure. If allergic to penicillin, alternatives like clindamycin or azithromycin are used.

47
Q

What is the prognosis for infective endocarditis?

A

Prognosis depends on the underlying cause, the presence of complications, and promptness of treatment. Mortality rates can be as high as 20-25%, especially in cases involving Staphylococcus aureus or in those with prosthetic valves.

48
Q

Symptoms of infective endocarditis

A

FEVER
NIGHT SWEATS
RIGORS
WEIGHT LOSS
MALAISE
ARTHRALGIA
PALLOR

49
Q

To confirm infective endocarditis what two tests should be done

A
  1. Echocardiography
  2. Blood culture
    - Central to the diagnosis and treatment
  • Whenever you entertain IE always remember to take blood cultures before empiric therapy with antibiotics
  • 3 sets one hour apart from different sites
50
Q

Which organism commonly causes infective endocarditis (IE) from the oropharynx?

A

Streptococcus viridans

51
Q

What is the portal of entry into the bloodstream for Streptococcus viridans in infective endocarditis?

A

The portal of entry is typically through dental procedures, poor oral hygiene, or oral trauma, allowing bacteria from the mouth to enter the bloodstream.

52
Q

Which organism commonly causes infective endocarditis (IE) from the gastrointestinal tract?

A

Enterococci (specifically Enterococcus faecalis) are common pathogens causing IE from the gastrointestinal tract.

53
Q

What is the portal of entry into the bloodstream for Enterococci in infective endocarditis?

A

The portal of entry is typically through gastrointestinal or genitourinary procedures or infections, such as manipulation of the bowel or urinary tract.

54
Q

Which organism associated with the gastrointestinal tract commonly causes infective endocarditis (IE)?

A

Streptococcus bovis (also known as Streptococcus gallolyticus) is linked to IE.

55
Q

What is the portal of entry into the bloodstream for Streptococcus bovis in infective endocarditis?

A

The portal of entry is often from the colon, and its presence in the bloodstream may be associated with colonic malignancy or polyps.

56
Q

Which skin organism commonly causes infective endocarditis (IE)?

A

Staphylococcus aureus is the most common skin organism responsible for IE, especially in intravenous drug users.

57
Q

What is the portal of entry into the bloodstream for Staphylococcus aureus in infective endocarditis?

A

The portal of entry is typically through skin breaches (e.g., IV drug use, central line insertion, skin infections, or surgical wounds).

58
Q

Which coagulase-negative organism from the skin can cause infective endocarditis (IE)?

A

Coagulase-negative staphylococci (CoNS), particularly Staphylococcus epidermidis, can cause IE.

59
Q

What is the portal of entry for Coagulase-negative Staphylococci in infective endocarditis?

A

The portal of entry is often from medical devices such as prosthetic valves, catheters, or pacemakers, where CoNS can colonize and enter the bloodstream.

60
Q

Which organism from the uro-genital tract can cause infective endocarditis (IE)?

A

Neisseria gonorrhoeae, the bacteria responsible for gonorrhea, can cause infective endocarditis, although this is rare.

61
Q

What is the portal of entry into the bloodstream for Neisseria gonorrhoeae in infective endocarditis?

A

The portal of entry is through the uro-genital tract during disseminated gonococcal infection.

62
Q

Which organism from the uro-genital tract can cause infective endocarditis (IE)?

A

Group B Streptococcus (Streptococcus agalactiae) is associated with IE, particularly in pregnant women or newborns.

63
Q

What is the portal of entry into the bloodstream for Group B Streptococcus in infective endocarditis?

A

The portal of entry is often via the uro-genital tract, commonly during childbirth or urogenital infections.

64
Q

Finding on investigation on a patient with infective endocarditis

A

Full blood count: 80% anemia (normochromic/ cyctic)

ESR, CRP: elevated

Serum biochemistry: urea, creatinine and electrolytes

Urine: hematuria casts, proteinuria

Immunology: immune complexes positive, rheumatoid factor positive, complement low

65
Q

Modified Duke Criteira

A
  1. Microbiological evidence.
  2. Echo evidence of a vegetation
  3. New valve regurgitation
  4. Predisposing condition
  5. Fever >38
  6. Microbiological evidence not meeting major criteria
  7. Elevated inflammatory markers
  8. Embolic phenomena (splenomegaly, stroke etc)
  9. Immunological phenomena(, splinter hemorrhages, GN, Roth spots + rheumatoid factor complement consumption)
  10. Suspicious echo

2 major
OR
1 major + 3 minor
OR
5 minor

66
Q

Cardiac complications of endocarditis

A

1-Severe valve regurgitation.

2- Heart Failure

3-Heart Block

4-Abscess formation

67
Q

Extra cardiac complications of infective endocarditis- Neurological

A

Mycotic aneurysms
Embolic stroke
Meningitis
encephalitis

68
Q

Extra cardiac complications of infective endocarditis- Renal

A

Glomerulonephritis
Embolic infarction

69
Q

Extra cardiac complications of infective endocarditis- Metastatic

A

Septic emboli with
Abscess formation
Spleen, brain, kidney

70
Q

Extra cardiac complications of infective endocarditis- Musculoskeletal

A

Arthralagia
Arthritis
Lumbar back ache
Limb ischemia

71
Q

Principles of treatment of infective endocarditis

A
  1. IDENTIFY THE ORGANISM
    1. ADEQUATE ANTIBIOTIC (I.V.) IN APPROPRIATE DOSE FOR A PROLONGED PERIOD (WEEKS).
    3.  ENSURE THAT BACTERICIDAL LEVELS ARE ACHIEVED. 

    4.  OBSERVE CAREFULLY DURING AND AFTER TREATMENT FOR COMPLICATIONS.

        5.   MONITOR METICULOUSLY AFTER TREATMENT TO ENSURE INFECTION ERADICATED.
72
Q

When should you consider surgical cure for your patient?

A

Signs of infection not resolving despite Rx with appropriate ABX

Refer to an expert if any cardiac, or extra-cardiac complication

73
Q

Prevention of infective endocarditis

A

Regular tooth brushing, dental floss or other plaque removing devices should be encouraged and recommended to all susceptible patients, and where available/affordable, regular visits to an oral hygienist

74
Q

Anti- biotic prophylaxis

A

Prosthetic valves

Previous infective endocarditis

Complex congenital heart disease:
- Cyanotic congenital heart disease without surgical repair, or those with residual defects, shunts or conduits
- Congenital heart disease with complete repair with prosthetic material up to 6 months post procedure
- Persisting residual defect despite intervention

Those with Rheumatic Valvular disease

75
Q

Regarding TB pericarditis, which of the following is NOT recommended in HIV infected patients?

A. NSAIDs (non-steroidal anti-inflammatory drugs)
B. Pericardiocentesis
C. Anti-TB therapy
D. Corticosteroids

A

D. Corticosteroids

76
Q

Which of the following is NOT a complication of infective endocarditis?

A. Heart block
B. Pericardial effusion
C. Glomerulonephritis
D. Meningitis

A

B. Pericardial effusion

77
Q

Which of the following is NOT associated with a high risk for infective endocarditis?

A. Intravenous drug use
B. Prosthetic valves
C. Ischaemic heart disease
D. Congenital heart disease

A

C. Ischaemic heart disease

78
Q

Which of the following will yield a probable diagnosis of TB pericarditis in suspected cases?

A. High ADA (adenosine deaminase)
B. TB culture from sputum or lymph nodes
C. Caseous granuloma on pericardial tissue biopsy
D. TB culture from pericardial fluid

A

A. High ADA (adenosine deaminase)

79
Q

In which procedure is antibiotic prophylaxis against infective endocarditis recommended?

A. Local anaesthetic injections in non-infected tissue
B. Placement of removable prosthodontics or orthodontic appliance or braces
C. Treatment of superficial dental caries
D. Procedures requiring manipulation of the gingival or per-apical region of the teeth

A

D. Procedures requiring manipulation of the gingival or per-apical region of the teeth

80
Q

What is the recommended antibiotic prophylaxis regimen for infective endocarditis in a patient without penicillin allergy?

A. Amoxicillin 2 grams orally 60 minutes before procedure
B. Ceftriaxone 500mg intravenously 60 minutes before procedure
C. Amoxicillin 3 grams orally 30 minutes before procedure
D. Ceftriaxone 1 gram intravenously 30 minutes before procedure

A

A. Amoxicillin 2 grams orally 60 minutes before procedure

81
Q

Which of the following does NOT form part of the major Modified Duke’s Criteria in the diagnosis of infective endocarditis?

A. Echo evidence of a vegetation
B. New valvular regurgitation
C. Positive blood culture
D. Predisposing cardiac condition

A

D. Predisposing cardiac condition

82
Q

To make a diagnosis of infective endocarditis using Modified Duke’s Criteria which of the following is INCORRECT?

A. 1 major and 1 minor criterion needed
B. 2 major criteria needed
C. 5 minor criteria needed
D. 1 major and 3 minor criteria needed

A

A. 1 major and 1 minor criterion needed

83
Q

Which of the following is NOT suggestive of a massive pericardial effusion on ECG?

A. T wave inversion in the precordial leads
B. Electrical alternans
C. Low QRS voltage
D. Sinus tachycardia

A

A. T wave inversion in the precordial leads

84
Q

What is the definitive investigation for the diagnosis of pericardial effusion?

A. Chest X-ray
B. Holter ECG
C. ECG (electrocardiogram)
D. Echocardiogram

A

D. Echocardiogram

85
Q

Which of the following is the LEAST likely cause of fibrinous stranding seen on echocardiography?

A. Uraemic pericarditis
B.
Staphylococcus aureus pericarditis

C. Streptococcus pneumoniae pericarditis
D. Lupus pericarditis

A

D. Lupus pericarditis

86
Q

Which of the following is NOT suggestive of pericarditis on ECG?

A. S1Q3T3 phenomenon
B. PR depression in the precordial leads
C. Sinus tachycardia
D. Diffuse ST segment elevation in the precordial leads

A

A. S1Q3T3 phenomenon

87
Q

Which of the following does NOT form part of the minor Modified Duke’s Criteria in the diagnosis of infective endocarditis?

A. Embolic phenomena
B. Elevated inflammatory markers
C. Fever
D. Weight loss

A

D. Weight loss

88
Q

Which of the following signs is MOST COMMONLY found in patients with TB pericarditis?

A. Pyrexia
B. Hypotension
C. Amphoric breath sounds
D. Palpable pulsus paradoxus

A

A. Pyrexia

89
Q

Which of the following is NOT a common complication of TB pericarditis?

A. Pulmonary embolism
B. Cardiac tamponade
C. Severe heart failure
D. Constrictive pericarditis

A

A. Pulmonary embolism

Cardiology (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions