Cardiovascular infections

Question 1

What is pericarditis?

Answer 1

An increase in fluid/ inflammation between the parietal and visceral pericardium.

Question 2

What are the causes of pericarditis?

Answer 2

Surgical sieve

Vascular - Dressler’s syndrome

Infection - Coxsackie A, B, Echovirus, Adenovirus, Mumps, Hepatitis,Varicella, S. aureus, Strep, TB

Trauma

Autoimmune - sarcoidosis, Still’s disease

Metabolic - Sarcoidosis, uraemia

Idiopathic or illicit drugs

Neoplasm

Amyloidosis

Question 3

What are the main viral infections of pericarditis?

Answer 3

CAME

Coxsackie A and B

Adenovirus

Mumps

Echovirus and enterovirus

Question 4

What are the main causes of purulent pericarditis?

Answer 4

S. aureus

Streptococus

TB - fever, weight loss and night sweats

Question 5

What are the signs of pericarditis?

Answer 5

Substernal chest pain relieved by sitting forward and can lead to heart failure.

Low grade fever

Three main signs

1. Rub
2. Pulsus paradoxus
3. Venous distension

Question 6

How is pericarditis treated?

Answer 6

Viral is normally self limiting

Analgesics: To reduce pain, inflammation and fever.

Ibuprofen . Naproxen

Colchicine

Question 7

What are caises of myocarditis?

Answer 7

The exact cause is not known but most commonly due to infection which reaches the heart muscle. The possible causes include:

Viral infections caused by adenovirus, hepatitis B and C, parvovirus and herpes simplex virus

Bacterial infections caused by staphylococcus, streptococcus

Fungi-yeast infection such as candida, aspergillum, histoplasma

Certain medicines (antibiotics) such as penicillin, sulfonamide

Chemicals such as carbon monoxide or radiations

Other diseases such as lupus, wegener’s granulomatosis, takayasu’s arteritis

Infection from parasites such as trypanosome cruzi and toxoplasma

Question 8

What are the signs of Chagas disease?

Answer 8

Megacolon

Megaoesophagus

Question 9

What is infective endocarditis?

Answer 9

Infective endocarditis is an infection of the inner surface of the heart, usually the valves. Signs and symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count.

Question 10

What are signs of endocarditis?

Answer 10

Splinter haemorrhages

Osler nodes

Janeway lesions

Roth spots in the eye

Question 11

Who is affected by infective endocarditis?

Answer 11

Between 0.5-1 in 1000 people

Any age

Males more at risk

20% mortality

Pre-existing valvular disease.

Question 12

What are the risk factors of infective endocarditis?

Answer 12

heart valve disease (biscupid valve)

having prosthetic valves

hypertrophic cardiomyopathy

injecting drugs

fungal endocarditis

procedure related

Question 13

What is the difference between native and artificial valve for IE?

Answer 13

Question 14

What is the difference between acute and subacute IE?

Answer 14

Question 16

What is most common site of endocarditis for IVDU

Answer 16

S aureus

Tricuspid valve IE

Mixed flora pseudomonas

Question 17

What normally causes IE and bowel cancer?

Answer 17

Strep bovis

Question 18

What is HACEK?

Answer 18

Question 19

What is Duke’s criteria?

Answer 19

Question 20

What is first line for echocardiagram?

Answer 20

TTE, then TOE

Question 21

What tests must be done for endocarditis?

Answer 21

Bedside - urine dip (haematuria), ECG

Bloods - cultures

CXR

Echo - TTE, then TOE

Question 22

How should you treat endocarditis?

Answer 22

No antibiotics until you speak to consultant

Paracetemol

Surgery

Question 23

What are the symptoms of endocarditis?

Question 24

What are the complications?

Answer 24

heart failure

absecesses

pericardial effusion

pulmonary emboli

Question 25

What is the basic pathogenesis of endocarditis in 3 steps?

Answer 25

1. Fibrin and platelets

2, Seeding of bacteria

3. Tissue damage