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Midterm (AGPC 4) > Cardiovascular Infections > Flashcards

Cardiovascular Infections Flashcards

1
Q

What is endocarditis?

A

Infection of the valves

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2
Q

Risk factors for endocarditis

A
  1. Bacteremia (IV drug users, intravenous catheters)

2. Structural heart disease (prosthetic valve, severe stenosis or regurgitation)

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3
Q

Endocarditis Pathogen: Subacute infection: days-weeks

A

Streptococcal spp (streptococcus viridians and streptococcus bovis)

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4
Q

Endocarditis Pathogen: Acute infection: hours-days

A

Staphylococcus auerus

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5
Q

Streprococcal Spp

A

subacute onset of low grade fever, fatigue, murmur due to slow valve destruction

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6
Q

Staphylococcus Aureus

A

acute onset due to high grade fever, shaking, chills, murmur due to rapid valve destruction

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7
Q

Endocarditis Presentation

A

fever/ night sweats

new or worsening murmur

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8
Q

Endocarditis to right side valves

A

lung emboli (presents as pneumonia)

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9
Q

Endocarditis to left side valves

A

embolic stroke, MI, retinal emboli, renal emboli, Janeway lesions, Osler nodes, splinter hemorrhages

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10
Q

Janeway lesions

A

non-painful

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11
Q

Osler nodes

A

painful

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12
Q

Best Initial workup for Endocarditis

A

Blood cultures- necessary to establish diagnosis

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13
Q

Tests for diagnosis of Endocarditis

A
  1. Blood cx: Initial test (95% sensitive). Necessary to establish the diagnosis.
  2. TTE: Initial imaging test. 60-70% sensitivity for vegetations. Visualization of vegetations is necessary for diagnosis. Negative TTE will require to perform TEE
  3. TEE: Useful for establishing diagnosis if initial TTE is negative. 95%-100% sensitive. Maybe initial test for patients with prosthetic valve
  4. ECG: Non-specific changes. Do not require for diagnosis
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14
Q

What is needed for Dx of Endocarditis?

A

Positive Blood Cultures + Vegetation on ECHO

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15
Q

How to establish Dx of Endocarditis if Blood Cx are negative?

A

fever(+), risk factors (+) embolic phenomena + vegetation on ECHO

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16
Q

Endocarditis Treatment

A
  • Empiric coverage with intravenous Vancomycin (staph spp. including MRSA) + Ampicillin (strep spp.). Gentamycin can be added for synergism
  • Change abx based on sensitivity when culture results are available
  • X 4-6 weeks IV antibiotics
  • Surgery for ruptured valve and embolism (large vegetations)
17
Q

When to give prophylaxis for endocarditis?

A

significant valvular defect + risk for bacteremia

  1. Significant Valvular defect: prosthetic valve, previous endocarditis, unrepaired/partially repaired cyanotic defect (tetralogy of Fallot)
  2. Risk of bacteremia: dental work with blood (extraction, root canal, dental cleaning), respiratory tract procedures with blood (biopsy, tonsillectomy)
18
Q

Recommended Prophylaxis for Endocarditis

A

Amoxicillin / Clindamycin (single dose before procedure)

19
Q

Pericarditis

A

infection/inflammation of pericardium

20
Q

Causes of pericarditis

A

idiopathic, infection (viral-coxsackie virus), autoimmune (lupus),
malignancy (Hodgkin’s lymphoma, lung cancer), metabolic causes (uremia), Trauma (chest trauma)

21
Q

Pericarditis: Clinical Presentation

A 
POSITIONAL pain (relieved by sitting forward)
PLEURITIC pain (deep inspiration)
friction rub (disappears with pericardial effusion)
22
Q

Best Initial Dx Test for Pericarditis

A

ECG- shows diffused ST elevations and PR depressions on multiple leads

23
Q

Pericarditis Tx

A
  • NSAIDS w/ or w/o Colchicine
  • Steroids if insufficient response to NSAIDS
  • Resolves in 2-6 wks
24
Q

Tests for Pericarditis

A
  1. ECG: Initial test. Done to r/o myocardial ischemia. ECG maybe non-specific in pericarditis or show diffused ST elevations and PR depressions
  2. ECHO: TO R/O PERICARDIAL EFFUSION and tamponade. Pericarditis w/o effusion- normal ECHO
  3. Inflammatory markers: Non-specific, likely elevated
  4. Viral cultures: Rarely change the treatment
  5. Chest x-ray: Normal
25
Q

Intensity of the murmurs

A
  • Grade 1- faint (S1 and S2 is louder than a murmur)
  • Grade 2 - quiet (S1 and S2 = murmur)
  • Grade 3 – moderately loud (murmur is louder than S1 and S2)
  • Grade 4 – loud with palpable thrill
  • Grade 5 – very loud, with thrill. Maybe heard with a stethoscope is partly off the chest
  • Grade 6- very loud, with thrill. Maybe heard with a stethoscope entirely off the chest
26
Q

Systolic Murmurs

A
  1. Aortic Stenosis - radiates to the neck

2. Mitral Regurgitation - radiates to axilla

27
Q

Aortic Stenosis

A

Symptoms: Angina, Syncope, Dyspnea
Signs: systolic murmur at 2nd right intercostal space radiating to neck. S4 is common

28
Q

Mitral Regurgitation

A

Symptoms: dyspnea (CHF)
Signs: systolic murmur at apex radiating to axilla

29
Q

Diastolic Murmur

A
  1. Aortic Regurgitation

2. Mitral Stenosis

30
Q

Aortic Regurgitation

A

Causes: infarction, ischemia, infection
Symptoms: Dyspnea (CHF)
Signs: diastolic murmur at sternal border, widened pulse pressure, S3 common

31
Q

Mitral Stenosis

A

Causes: infection (RHD)
Symptoms: dyspnea, palpitations
Signs: low pitch diastolic rumble at apex, A-fib
Typical in young pt, pregnant pt

32
Q

Hypertrophic Obstructive Cardiomyopathy (HOCM)

A
  • no blood flow during systole between LV and aorta
    Symptoms: syncope during exercise, sudden death
    Signs: harsh systolic murmur radiates to carotid, heard best at right/left sternal border. GETS LOUDER WITH STANDING / VALSALVA
33
Q

Innocent Murmurs

A
  • due to increased blood flow
  • NO STRUCTURAL PATHOLOGY
  • physical activity, fever, anemia, hyperthyroidism, pregnancy
  • Grade 1-3, no thrill
  • always SYSTOLIC
  • SOFTER with standing and Valsalva
  • NO RADIATION beyond precordium
  • always ASYMPTOMATIC
  • common in children and young adults
  • OBSERVE AND RE-EVALUATE
34
Q

Pathologic Murmurs

A
  • STRUCTURAL PATHOLOGY
  • DIASTOLIC, holosystolic or continuous
  • GRADE >3
  • RADIATING beyond precordium
  • associated with SYMPTOMS
  • EVALUATE WITH TTE FIRST

Midterm (AGPC 4) (6 decks)

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