Cardiovascular Infections Flashcards
Describe the direction of blood flow in the heart
- Blood flows in from the superior and inferior vena cava to the right atrium
- From right atrium to right ventricle
- From right ventricle through the pulmonary artery to the lungs
- Blood becomes oxygenated in the lung
- Blood then flows from the lungs through the pulmonary veins into the the left atrium
- From left atrium to the left ventrcile
- From left ventricle to the aorta
What is the name of the valve that is located between the right atrium and right ventricle
Tricuspid valve
What is the name of the valve that is located between the left ventricle and left atrium
Mitral valve
What is the name of the valve that is located at the pulmonary artery
Pulmonary valve
What is the name of the valve at the aorta
Aortic valve
Which 3 coronary arteries is the heart of heart supplied by
Left anterioir descending coronary artery
Left circumflex artery
Right coronary artery
What are the 3 distint layers of the heart
- Pericardium
- Mycordium
- Endocardium
Which layer of the heart is the most outermost layer
Pericardium
What is the structure of the pericardium
Parietal pericardium
Pericardial cavity
Visceral pericardium
What is inflammation of the pericardium known as
pericarditis
What is inflammation of the myocardium known as
myocarditis
What is inflammation of the endocardium known as
Endocarditis
What are the causes of pericarditis
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)
What are the common organism that cause infective pericarditis
Virus
Bacteria
TB
What are the viral causes of pericarditis
Enterovirus Echovirus Adenovirus Mumps Hepatitis Varicella zoster virus Influenza HIV Parvovirus
What are the bacterial causes of pericarditis
Staphylococcus aureus
Streptococci
Pneumococci
Legionella
What are the signs and symptoms of pericarditis
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
What are the signs of pericarditis
Pericardial rube to the parietal layer rubbing against the visceral layer
Pulses paradoxes
Jugular venous distension
What are the investigations for pericardtits
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
What are the ECG changes that can occur in pericarditis
Pr elevation
Pr depression
ST depression
St elevation
What is the diagnostic criteria for pericarditis
In acute pericarditis you need 2/4 of:
- Pericarditic chest pain relieved by sitting forward
- Pericardial rub
- New widespread ST elevation or PR depresion
- Pericardial effusion
What is the incessant pericarditis
Lasting more than 4-6 weeks but less than 3 months
What is recurrent pericarditis
Recourring symptoms after symptom free period of 4-6 weeks
What is chronic pericarditis
Pericarditis lasting more than 3 months
What is the management of viral endocarditis
Symptoms relief by aspirin, NSAIDs, colchicine
What is the management for purulent (bacterial) pericarditis
Antibiotics
Pericardiocentesis (surgical drain) and fluid is sent to the lab to find the exact bug
What is the management for tb pericarditis
RIPE
Pericardiectomy- cutting out little windows
If there is myocarditis what will this affect
Cardiac mucle
Conduction pathway- can lead to cardiac failur or arrhythmia
What are the causes of myocarditis
Viral; adenovirus, enterovirus, SARS cov2
Autoimmune: SLE, gcs, takayasus arteritis
Iatrogenic: anthracycline
What is the presentation of myocarditis
Heart attack
Heart failure
Arrhythmia
What is the management of mycarditis
If viral: supportive
Treat cardiac failure
What is the commnest cause of myocarditis
Chagas disease
What are the other complications of chagas disease
Mega oesophagus
Megacolon
Myocarditis
What is the management of acute chagas disease
Antiprotozo drugs
What is the management for chronic chagas disease
Supportive
What is the presentation of chagas disease
If the bug bites aroud eye or lips it will cause a swelling
What are the risk factors (cardiac condition) for pericarditis
Congenital heart disease: biscupid valve, ventricular septal defect
Valvular heart disease: stenosism regurgitation
Prosthetic heart valve
Previous infective endocarditis
Rheumatic heart disease
What lifestyle puts people at risk for endocarditis
Iv drug use
What are the ways we can classify endocarditis
Acute
Subacute
What is acute endocarditis
Affects healthy normal valves Sudden Progressive High mortality Organism is usually staph aureus
What is subacute endocarditis
Occurs in pre-existing valve disease
Slowly progessive
High mortality
Organism is usually streptococci (coagulase negaitve e.g strep epidermidis)
What is another way to classify endocardtisi
Native valve endocarditis
Prosthetic valve endocardits
Intravenoud drug use endocarditis
What are the common organism in native valve endocarditis
S.aureus
Streptococci
Enterococcus
HACEK group
When can prosthetic valve endocarditis occur
Less than 2 months or more than 2 months post op
What is the commonest organism for iv drug use endocarditis
staph. Aureus
What is the pathogenesis of the infective endocarditis
- There is alteration of the valvular endothelium leading to deposition of platelets and fibrin
- Bacteria in the blood seed onto it leading to thrombotic vegetation
- On vegetation there is bacterial growth so more platelets and fibrin deposit
- This extends to the local structures e,g the chorda tendinae that holds the valves opens leading to endocarditis
What are the complications of endocarditis due to local spreaf
Heart failure
Valvular abscess
Pericarditis
What are the embolic complications that can occur in endocarditis
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
What are the symptoms of infective endocarditis
Fever
Night sweats
Malasie
Weight loss
What are the specific symptoms for emboli phenomena in infective endocarditis
Dyspnea with PE
Back pain with discitis
Fascial from with stroke
What are the signs of endocarditis
Fever with new murmur Roth spots Janeway lesions- non painful Osler nodes- painful red nodules Haematuria Splenomegay Splinter haemorrhage
What investigations can be done in endocarditis
Ecg Urine dip for haematuria Blood: FBC, UE, CRP Blood culture CXR Echocardiogram
What criteria is used to diagnose endocarditis
Modified duke criteria
What criteria needs to be met in the modified duke criteria for definite diagnosis if endocarditis
2 major criteria Or 1 major and 3 minor criteria Or 5 minor criteria
What is the management of endocarditis
For fever paracetamol
Surgery if uncontrolled infection: with large vegetation
Give iv antibiotics guided by blood culture result
