Cardiology: Pericarditis/Endocarditis Flashcards
An increased presence of pericardial fluid leading to inflammation of pericardial layers is known as…
pericardial effusion
Why is it not necessary to determine the etiology of pericarditis?
benign, self-limiting clinical course
Two most common causes of pericarditis are viral and idiopathic. What viruses are MC for viral pericarditis?
coxsackie and influenza
Pericarditis can be the 1st manifestation of…
underlying systemic disease
Pericarditis has what 4 major clinical manifestations?
chest pain
pericardial friction rub
ECG changes
New pericardial effusion
To diagnose pericarditis, how many of the 4 major clinical manifestations must be present?
2 of 4
What ECG changes are common in pericarditis?
new, widespread ST elevation
PR depression
On auscultation of the heart, you hear a scratchy, squeaky heart sound. What is this called?
pericardial friction rub
What type of chest pain is typically present in pericarditis?
sharp, pleuritic pain
95% of pericarditis presents with this sign…
sudden anterior chest pain
What makes the chest pain of pericarditis better?
sitting up and leaning forward
What makes the chest pain of pericarditis worse?
laying flat
inspiration
coughing/sneezing
What heart sound is highly specific to pericarditis?
pericardial friction rub
Where is pericardial friction rub best heard, and in what position?
left sternal border when sitting up and leaning forward
What percentage of pericarditis will occur with ECG changes like PR depression or ST elevation?
60%
What is the 1st diagnostic to asses for pericardial effusion?
echo
Beck’s triad for pericardial tamponade is…
hypotension
muffled heart sounds
JVD
A patient presents with the following:
BP 87/60
muffled heart sounds
profound JVD
what should you immediately suspect?
pericardial tamponade
What usually clues a clinician into a Dx of pericarditis?
sharp, retrosternal, pleuritic chest pain
What does the pericarditis workup consist of?
troponin, ESR, CRP, CBC
CXR
ECG
Echo
are abnormalities in blood work sensitive/specific to pericarditis?
no
If the dx isn’t apparent or etiology of pericarditis needs to be determined, what tests can be ordered?
TB test
ANA
HIV serology
contrast chest CT
Cardiac MRI
What patient with suspected pericarditis should get an ANA?
young woman w/ hx of rheum disorder
what are you looking for on contrast chest CT for pericarditis?
thickened pericardium/effusion
Who should get a cardiac MRI in pericarditis?
inconclusive echo, ongoing fever
CXR for pericarditis is typically normal, but if a significant effusion is present, what can be seen on X-ray?
enlarged cardiac silhouette
What is the primary method of managing pericarditis
manage underlying disorder and rest
What medications can be given for pericarditis and for how long?
NSAIDs, < 2 weeks
What can be added to NSAID treatment to mitigate GI issues?
proton pump inhibitor
Failure of NSAID therapy after 1 week suggests what?
non idiopathic/viral etiology
What can be given as an adjunct to NSAID therapy that reduces sxs and decreases rate of pericarditis recurrence?
colchicine
Under what three conditions can you consider glucocorticoids for pericarditis?
refractory to NSAIDs/Colchicine
pericarditis due to connective tissue disease, pregnancy, autoimmune, or uremic
contraindications to NSAID therapy
Glucocorticoids increase the risk of what?
recurrent pericarditis
What two surgical interventions can relieve cardiac tamponade?
pericardiocentesis
pericardiectomy/pericardial window
What is used for guidance during pericardiocentesis?
US
A surgical removal of a small part of pericardial sac allowing for continual drainage…
pericardial window
Recurrent pericarditis occurs in ____ of patients…
1/3
when does pericarditis typically recur…
weeks to months after
recurrent pericarditis is NOT treated with ______
glucocorticoids
What is the definitive tx for constrictive pericarditis?
pericardiectomy
is pericardial constriction acute or chronic?
chronic
This condition is an acute pericarditis that also demonstrates myocardial inflammation.
myopericarditis
The workup for myopericarditis is similar to pericarditis, but what lab may be elevated?
troponin
this condition is the result of scarring and loss of pericardial elasticity that impairs cardiac filling.
constrictive pericarditis
what are two niduses for infection of endocarditis?
heart valves and pacemakers
This type of endocarditis presents with…
normal heart valves
commonly fatal if not tx w/in 6 weeks
rapidly destructive and deadly
acute IE
This type of endocarditis presents…
on damaged heart valves
indolent in nature
not usually fatal if treatment delayed
subacute
what makes the endocardium “sticky” enough to cause bacterial adhesion?
turbulent blood flow
what are the four most notable risk factors for IE?
age > 60
male
ivdu
poor dentition
What bacterial agent causes the majority of healthcare and ivdu IE?
staphylococci
What bacterial agents most commonly cause community acquired IE?
staph aureus
viridans streptococci
what are the two hallmark symptoms that should make you think of endocarditis?
fever of unknown origin and new cardiac murmur
what two cutaneous manifestations are present in endocarditis?
petechiae
splinter hemorrhage
What three physical exam findings are highly suggestive of IE?
janeway lesions
osler nodes
roth spots
nontender erythematous macules on palms and soles…micro abscess
janeway lesions
tender sub-q violacious nodules on pads of fingers and toes…microthrombi
osler nodes
exudative, edematous hemorrhagic lesions of retina with pale center…
roth spots
Janeway lesions are suggestive of acute or subacute IE?
acute
osler nodes are suggestive of acute or subacute IE?
subacute
in IE, septic emboli can shower through the body… complications of IE can often be the chief complaint. What are 4 common complications
cardiac
neuro
septic emboli
metastatic infection
this IE complication can occur as vertebral osteomyelitis, septic arthritis, etc…
metastatic infx
this IE complication can cause infarct of the kidneys, spleen, lungs and other vital organs…
septic emboli
What neuro complications can manifest in IE?
embolic stroke
hemorrhage
abscess
what cardiac complications can present as a result of IE?
valvular insufficiency
heart failure
A prolonged fever of unknown origin should immediately be suggestive of…
endocarditis
What are three diagnostic mainstays of IE?
clinical presentation
blood culture
echo
how many sets of blood cultures should be obtained?
3 sets to confirm results
where should venipuncture for blood cultures happen?
3 separate sites over 30-60 minutes
A pt. with negative blood cultures but persistent fever with one or more clinical findings should be suspected of having…
culture negative IE
what is the first diagnostic test that should be ordered for patients with suspected IE>
TTE
What is more sensitive for IE, TTE or TEE?
TEE
what type of antimicrobials are necessary for tx of IE, cidal or static or either?
cidal
For what patient with suspected IE should you delay empiric abx?
without acute sxs
What patient with IE should receive empiric abx and when?
acutely ill right after BCx drawn
who should you consult in cases of expected or observed IE complications?
CT surg, ID, cards
how can IE be monitored?
repeat blood cultures
What abx are given for native valve IE and for how long?
vanco for 4-6 weeks
for prosthetic valve IE, what does tx look like?
long, pathogen specific abx
surgical replacement
What is the most common indication for cardiac surgery in patients with IE?
heart failure
what is the most common cause of death in patients with IE?
heart failure
what two factors other than heart failure are associated with higher mortality from IE?
prosthetic valve IE and IV drug use IE
do GI/GU procedures require abx prophylaxis for IE?
no
What procedures require abx prophylaxis to prevent IE?
dental procedures
prosthetic heart valve
prior IE
congenital heart disease
procedure on infected skin or MSK tissue
