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infection > Cardiovascular Infections > Flashcards

Cardiovascular Infections Flashcards

1
Q

Describe the direction of blood flow in the heart

A
  1. Blood flows in from the superior and inferior vena cava to the right atrium
  2. From right atrium to right ventricle
  3. From right ventricle through the pulmonary artery to the lungs
  4. Blood becomes oxygenated in the lung
  5. Blood then flows from the lungs through the pulmonary veins into the the left atrium
  6. From left atrium to the left ventrcile
  7. From left ventricle to the aorta
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2
Q

What is the name of the valve that is located between the right atrium and right ventricle

A

Tricuspid valve

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3
Q

What is the name of the valve that is located between the left ventricle and left atrium

A

Mitral valve

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4
Q

What is the name of the valve that is located at the pulmonary artery

A

Pulmonary valve

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5
Q

What is the name of the valve at the aorta

A

Aortic valve

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6
Q

Which 3 coronary arteries is the heart of heart supplied by

A

Left anterioir descending coronary artery
Left circumflex artery
Right coronary artery

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7
Q

What are the 3 distint layers of the heart

A
  1. Pericardium
  2. Mycordium
  3. Endocardium
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8
Q

Which layer of the heart is the most outermost layer

A

Pericardium

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9
Q

What is the structure of the pericardium

A

Parietal pericardium
Pericardial cavity
Visceral pericardium

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10
Q

What is inflammation of the pericardium known as

A

pericarditis

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11
Q

What is inflammation of the myocardium known as

A

myocarditis

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12
Q

What is inflammation of the endocardium known as

A

Endocarditis

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13
Q

What are the causes of pericarditis

A

Vascular: post myocardial infarction syndrome
Infective
Traumatic: accidental or iatrogenic such as needle
Autoimmune: SLE, RA, sarcoidosis, stills disease or vasculitis
Metabolic: uraemia
Iatrogenic
Neoplastic: malignancy
Amyloidosis

(VITAMIN A)

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14
Q

What are the common organism that cause infective pericarditis

A

Virus
Bacteria
TB

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15
Q

What are the viral causes of pericarditis

A 
Enterovirus
Echovirus
Adenovirus
Mumps
Hepatitis
Varicella zoster virus 
Influenza
HIV
Parvovirus
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16
Q

What are the bacterial causes of pericarditis

A

Staphylococcus aureus
Streptococci
Pneumococci
Legionella

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17
Q

What are the signs and symptoms of pericarditis

A

Substernal chest pain relieved by sitting forward, wose on inspiration and lying supine
Purulent (bacterial pericarditis): fever, dyspnea, and pain is less common
Tb pericardits: gradual onsent, fever, weight loos and night sweats

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18
Q

What are the signs of pericarditis

A

Pericardial rube to the parietal layer rubbing against the visceral layer
Pulses paradoxes
Jugular venous distension

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19
Q

What are the investigations for pericardtits

A 
Blood: WBC, CRP, troponin
ECG
Echocardiagram
CXR, ct, MRI
Pericardial fluid and tissue biopsy: pericardial fluid is sent for microbiology testing and histology to look for signs 
Microbiology test: serolgy for hiv, mumos, parvovirus, EBV pcr, CMV pcr, respiratory viral swab, ICGRA test, stool for enterovirus 
Vasculitis screen
Renal function test for uraemia 
TSH
Tumour markers
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20
Q

What are the ECG changes that can occur in pericarditis

A

Pr elevation
Pr depression
ST depression
St elevation

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21
Q

What is the diagnostic criteria for pericarditis

A

In acute pericarditis you need 2/4 of:

  1. Pericarditic chest pain relieved by sitting forward
  2. Pericardial rub
  3. New widespread ST elevation or PR depresion
  4. Pericardial effusion
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22
Q

What is the incessant pericarditis

A

Lasting more than 4-6 weeks but less than 3 months

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23
Q

What is recurrent pericarditis

A

Recourring symptoms after symptom free period of 4-6 weeks

24
Q

What is chronic pericarditis

A

Pericarditis lasting more than 3 months

25
Q

What is the management of viral endocarditis

A

Symptoms relief by aspirin, NSAIDs, colchicine

26
Q

What is the management for purulent (bacterial) pericarditis

A

Antibiotics

Pericardiocentesis (surgical drain) and fluid is sent to the lab to find the exact bug

27
Q

What is the management for tb pericarditis

A

RIPE

Pericardiectomy- cutting out little windows

28
Q

If there is myocarditis what will this affect

A

Cardiac mucle

Conduction pathway- can lead to cardiac failur or arrhythmia

29
Q

What are the causes of myocarditis

A

Viral; adenovirus, enterovirus, SARS cov2
Autoimmune: SLE, gcs, takayasus arteritis
Iatrogenic: anthracycline

30
Q

What is the presentation of myocarditis

A

Heart attack
Heart failure
Arrhythmia

31
Q

What is the management of mycarditis

A

If viral: supportive

Treat cardiac failure

32
Q

What is the commnest cause of myocarditis

A

Chagas disease

33
Q

What are the other complications of chagas disease

A

Mega oesophagus
Megacolon
Myocarditis

34
Q

What is the management of acute chagas disease

A

Antiprotozo drugs

35
Q

What is the management for chronic chagas disease

A

Supportive

36
Q

What is the presentation of chagas disease

A

If the bug bites aroud eye or lips it will cause a swelling

37
Q

What are the risk factors (cardiac condition) for pericarditis

A

Congenital heart disease: biscupid valve, ventricular septal defect
Valvular heart disease: stenosism regurgitation
Prosthetic heart valve
Previous infective endocarditis
Rheumatic heart disease

38
Q

What lifestyle puts people at risk for endocarditis

A

Iv drug use

39
Q

What are the ways we can classify endocarditis

A

Acute

Subacute

40
Q

What is acute endocarditis

A 
Affects healthy normal valves 
Sudden
Progressive 
High mortality 
Organism is usually staph aureus
41
Q

What is subacute endocarditis

A

Occurs in pre-existing valve disease
Slowly progessive
High mortality
Organism is usually streptococci (coagulase negaitve e.g strep epidermidis)

42
Q

What is another way to classify endocardtisi

A

Native valve endocarditis
Prosthetic valve endocardits
Intravenoud drug use endocarditis

43
Q

What are the common organism in native valve endocarditis

A

S.aureus
Streptococci
Enterococcus
HACEK group

44
Q

When can prosthetic valve endocarditis occur

A

Less than 2 months or more than 2 months post op

45
Q

What is the commonest organism for iv drug use endocarditis

A

staph. Aureus

46
Q

What is the pathogenesis of the infective endocarditis

A
  1. There is alteration of the valvular endothelium leading to deposition of platelets and fibrin
  2. Bacteria in the blood seed onto it leading to thrombotic vegetation
  3. On vegetation there is bacterial growth so more platelets and fibrin deposit
  4. This extends to the local structures e,g the chorda tendinae that holds the valves opens leading to endocarditis
47
Q

What are the complications of endocarditis due to local spreaf

A

Heart failure
Valvular abscess
Pericarditis

48
Q

What are the embolic complications that can occur in endocarditis

A

Left side can embolise to the rest of body, right side can embolise to the lungs
Right side to lungs can cause multiple lung abscess
Left side to rest of body can go to spine to cause discitis

49
Q

What are the symptoms of infective endocarditis

A

Fever
Night sweats
Malasie
Weight loss

50
Q

What are the specific symptoms for emboli phenomena in infective endocarditis

A

Dyspnea with PE
Back pain with discitis
Fascial from with stroke

51
Q

What are the signs of endocarditis

A 
Fever with new murmur
Roth spots
Janeway lesions- non painful
Osler nodes- painful red nodules
Haematuria 
Splenomegay 
Splinter haemorrhage
52
Q

What investigations can be done in endocarditis

A 
Ecg
Urine dip for haematuria
Blood: FBC, UE, CRP
Blood culture
CXR
Echocardiogram
53
Q

What criteria is used to diagnose endocarditis

A

Modified duke criteria

54
Q

What criteria needs to be met in the modified duke criteria for definite diagnosis if endocarditis

A 
2 major criteria 
Or 
1 major and 3 minor criteria
Or 
5 minor criteria
55
Q

What is the management of endocarditis

A

For fever paracetamol
Surgery if uncontrolled infection: with large vegetation
Give iv antibiotics guided by blood culture result

infection (17 decks)

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