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Clinical Medicine II > Cardiology: Pericarditis/Endocarditis > Flashcards

Cardiology: Pericarditis/Endocarditis Flashcards

1
Q

An increased presence of pericardial fluid leading to inflammation of pericardial layers is known as…

A

pericardial effusion

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2
Q

Why is it not necessary to determine the etiology of pericarditis?

A

benign, self-limiting clinical course

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3
Q

Two most common causes of pericarditis are viral and idiopathic. What viruses are MC for viral pericarditis?

A

coxsackie and influenza

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4
Q

Pericarditis can be the 1st manifestation of…

A

underlying systemic disease

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5
Q

Pericarditis has what 4 major clinical manifestations?

A

chest pain

pericardial friction rub

ECG changes

New pericardial effusion

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6
Q

To diagnose pericarditis, how many of the 4 major clinical manifestations must be present?

A

2 of 4

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7
Q

What ECG changes are common in pericarditis?

A

new, widespread ST elevation

PR depression

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8
Q

On auscultation of the heart, you hear a scratchy, squeaky heart sound. What is this called?

A

pericardial friction rub

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9
Q

What type of chest pain is typically present in pericarditis?

A

sharp, pleuritic pain

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10
Q

95% of pericarditis presents with this sign…

A

sudden anterior chest pain

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11
Q

What makes the chest pain of pericarditis better?

A

sitting up and leaning forward

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12
Q

What makes the chest pain of pericarditis worse?

A

laying flat

inspiration

coughing/sneezing

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13
Q

What heart sound is highly specific to pericarditis?

A

pericardial friction rub

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14
Q

Where is pericardial friction rub best heard, and in what position?

A

left sternal border when sitting up and leaning forward

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15
Q

What percentage of pericarditis will occur with ECG changes like PR depression or ST elevation?

A

60%

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16
Q

What is the 1st diagnostic to asses for pericardial effusion?

A

echo

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17
Q

Beck’s triad for pericardial tamponade is…

A

hypotension

muffled heart sounds

JVD

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18
Q

A patient presents with the following:

BP 87/60

muffled heart sounds

profound JVD

what should you immediately suspect?

A

pericardial tamponade

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19
Q

What usually clues a clinician into a Dx of pericarditis?

A

sharp, retrosternal, pleuritic chest pain

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20
Q

What does the pericarditis workup consist of?

A

troponin, ESR, CRP, CBC

CXR

ECG

Echo

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21
Q

are abnormalities in blood work sensitive/specific to pericarditis?

A

no

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22
Q

If the dx isn’t apparent or etiology of pericarditis needs to be determined, what tests can be ordered?

A

TB test

ANA

HIV serology

contrast chest CT

Cardiac MRI

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23
Q

What patient with suspected pericarditis should get an ANA?

A

young woman w/ hx of rheum disorder

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24
Q

what are you looking for on contrast chest CT for pericarditis?

A

thickened pericardium/effusion

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25
Q

Who should get a cardiac MRI in pericarditis?

A

inconclusive echo, ongoing fever

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26
Q

CXR for pericarditis is typically normal, but if a significant effusion is present, what can be seen on X-ray?

A

enlarged cardiac silhouette

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27
Q

What is the primary method of managing pericarditis

A

manage underlying disorder and rest

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28
Q

What medications can be given for pericarditis and for how long?

A

NSAIDs, < 2 weeks

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29
Q

What can be added to NSAID treatment to mitigate GI issues?

A

proton pump inhibitor

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30
Q

Failure of NSAID therapy after 1 week suggests what?

A

non idiopathic/viral etiology

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31
Q

What can be given as an adjunct to NSAID therapy that reduces sxs and decreases rate of pericarditis recurrence?

A

colchicine

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32
Q

Under what three conditions can you consider glucocorticoids for pericarditis?

A

refractory to NSAIDs/Colchicine

pericarditis due to connective tissue disease, pregnancy, autoimmune, or uremic

contraindications to NSAID therapy

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33
Q

Glucocorticoids increase the risk of what?

A

recurrent pericarditis

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34
Q

What two surgical interventions can relieve cardiac tamponade?

A

pericardiocentesis

pericardiectomy/pericardial window

35
Q

What is used for guidance during pericardiocentesis?

A

US

36
Q

A surgical removal of a small part of pericardial sac allowing for continual drainage…

A

pericardial window

37
Q

Recurrent pericarditis occurs in ____ of patients…

A

1/3

38
Q

when does pericarditis typically recur…

A

weeks to months after

39
Q

recurrent pericarditis is NOT treated with ______

A

glucocorticoids

40
Q

What is the definitive tx for constrictive pericarditis?

A

pericardiectomy

41
Q

is pericardial constriction acute or chronic?

A

chronic

42
Q

This condition is an acute pericarditis that also demonstrates myocardial inflammation.

A

myopericarditis

43
Q

The workup for myopericarditis is similar to pericarditis, but what lab may be elevated?

A

troponin

44
Q

this condition is the result of scarring and loss of pericardial elasticity that impairs cardiac filling.

A

constrictive pericarditis

45
Q

what are two niduses for infection of endocarditis?

A

heart valves and pacemakers

46
Q

This type of endocarditis presents with…

normal heart valves

commonly fatal if not tx w/in 6 weeks

rapidly destructive and deadly

A

acute IE

47
Q

This type of endocarditis presents…

on damaged heart valves

indolent in nature

not usually fatal if treatment delayed

A

subacute

48
Q

what makes the endocardium “sticky” enough to cause bacterial adhesion?

A

turbulent blood flow

49
Q

what are the four most notable risk factors for IE?

A

age > 60

male

ivdu

poor dentition

50
Q

What bacterial agent causes the majority of healthcare and ivdu IE?

A

staphylococci

51
Q

What bacterial agents most commonly cause community acquired IE?

A

staph aureus

viridans streptococci

52
Q

what are the two hallmark symptoms that should make you think of endocarditis?

A

fever of unknown origin and new cardiac murmur

53
Q

what two cutaneous manifestations are present in endocarditis?

A

petechiae

splinter hemorrhage

54
Q

What three physical exam findings are highly suggestive of IE?

A

janeway lesions

osler nodes

roth spots

55
Q

nontender erythematous macules on palms and soles…micro abscess

A

janeway lesions

56
Q

tender sub-q violacious nodules on pads of fingers and toes…microthrombi

A

osler nodes

57
Q

exudative, edematous hemorrhagic lesions of retina with pale center…

A

roth spots

58
Q

Janeway lesions are suggestive of acute or subacute IE?

A

acute

59
Q

osler nodes are suggestive of acute or subacute IE?

A

subacute

60
Q

in IE, septic emboli can shower through the body… complications of IE can often be the chief complaint. What are 4 common complications

A

cardiac

neuro

septic emboli

metastatic infection

61
Q

this IE complication can occur as vertebral osteomyelitis, septic arthritis, etc…

A

metastatic infx

62
Q

this IE complication can cause infarct of the kidneys, spleen, lungs and other vital organs…

A

septic emboli

63
Q

What neuro complications can manifest in IE?

A

embolic stroke

hemorrhage

abscess

64
Q

what cardiac complications can present as a result of IE?

A

valvular insufficiency

heart failure

65
Q

A prolonged fever of unknown origin should immediately be suggestive of…

A

endocarditis

66
Q

What are three diagnostic mainstays of IE?

A

clinical presentation

blood culture

echo

67
Q

how many sets of blood cultures should be obtained?

A

3 sets to confirm results

68
Q

where should venipuncture for blood cultures happen?

A

3 separate sites over 30-60 minutes

69
Q

A pt. with negative blood cultures but persistent fever with one or more clinical findings should be suspected of having…

A

culture negative IE

70
Q

what is the first diagnostic test that should be ordered for patients with suspected IE>

A

TTE

71
Q

What is more sensitive for IE, TTE or TEE?

A

TEE

72
Q

what type of antimicrobials are necessary for tx of IE, cidal or static or either?

A

cidal

73
Q

For what patient with suspected IE should you delay empiric abx?

A

without acute sxs

74
Q

What patient with IE should receive empiric abx and when?

A

acutely ill right after BCx drawn

75
Q

who should you consult in cases of expected or observed IE complications?

A

CT surg, ID, cards

76
Q

how can IE be monitored?

A

repeat blood cultures

77
Q

What abx are given for native valve IE and for how long?

A

vanco for 4-6 weeks

78
Q

for prosthetic valve IE, what does tx look like?

A

long, pathogen specific abx

surgical replacement

79
Q

What is the most common indication for cardiac surgery in patients with IE?

A

heart failure

80
Q

what is the most common cause of death in patients with IE?

A

heart failure

81
Q

what two factors other than heart failure are associated with higher mortality from IE?

A

prosthetic valve IE and IV drug use IE

82
Q

do GI/GU procedures require abx prophylaxis for IE?

A

no

83
Q

What procedures require abx prophylaxis to prevent IE?

A

dental procedures

prosthetic heart valve

prior IE

congenital heart disease

procedure on infected skin or MSK tissue

Clinical Medicine II (31 decks)

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