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clinical medicine II > Carditis > Flashcards

Carditis Flashcards

1
Q

what is the most common cause of viral myocarditis

A

cocksackie B

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2
Q

viral myocarditis can lead go what three ways

A
  1. acute myocardial failure
  2. progression to dilated cardiomyopathy
  3. resolution
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3
Q

clinical presentation

  • S3, S4
  • mitral or tricuspid valve regurg
  • edema-hepative and peripheral
  • congestion-rales
  • low CO
A

myocarditis

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4
Q

what lab values are typically increased in myocarditis

A
  • BNP
  • troponin: may be increased
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5
Q

what will echo typically show in myocarditis

A
  • LV dilation
  • wall motion abnormalities
  • decreased systolic function
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6
Q

What presentations should you consider myocarditis

A
  1. unexplained cardiac abnormality such as CHF, shock, or arrhythmia
    • 20-50 yo typically
    • h/o viral illness
  2. acute LV dysfunction
  3. percarditis with biomarker elevation
  4. acute MI w/o h/o CAD and (-) angiogram
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7
Q

standard treatment of acute myocarditis

A
  • IVIG, steroids, plamapharesis
  • supportive care
    • oxygen
    • inotropes
    • diuretics
    • afterload reduction
    • anticoagulation
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8
Q

hat labs/tests would you order in workup for myocarditis

A
  • CXR
  • EKG
  • BNP, toponin
  • ECHO
  • MRI
  • possible biopsy
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9
Q

what are the three categories of infective endocarditis

A
  1. native valve endocarditis
  2. prosthetic valve endocarditis
  3. endocarditis in IV drug users
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10
Q

what organisms cause native valve endocarditis? what valves are commonly affected

A
  • streptococci, enterococci, staphylococci
  • normal mouth organisms
  • mitral and aortic valves
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11
Q

what organisms cause prosthetic valve endocarditis

A
  • 10-20% of endocarditis
  • staph species most common
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12
Q

what organisms cause IV drug abusers endocarditis? What valves are commonly affected

A
  • staph aureus
  • Right side valves (tricuspid and pulmonic)
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13
Q

acute bacterial endocarditis is usually caused from which bacteria

A
  • staph aureus
  • rapidly destructive
  • if untreated, fatal in < 6 weeks
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14
Q

subacute bacterial endocarditis is usually caused from which bacteria

A
  • viridans strep (nl mouth flora)
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15
Q

clinical presentation

  • previous normal valve
  • large bulky vegetation
  • IV drug user -> RF
  • rapid onset of fever or sepsis
  • splenomegaly and embolic events
A

acute bacterial endocarditis

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16
Q

clinical presentation

  • previous abnormal valve
  • small vegetation
  • slow onset of symptoms
A

subacute bacterial endocarditis

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17
Q

60-80% of people who get infective endocarditis have what

A
  • identifiable predisposing cardiac lesion
    • rheumatic valve lesion (25%)
    • congenital heart disease (10-20%)
    • mitral prolapse (10-33%)
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18
Q

>50% of cases with infective endocarditis are people in what age group

A

> 60 yo

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19
Q

what are some skin signs associated with infective endocarditis

A
  • petechiae
  • Osler’s nodes
  • Janeway lesions
  • splinter hemorrhages (pictured)
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20
Q

ocular signs of endocarditis

A
  • Roth spot (specific)
  • scleral hemorrhage
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21
Q

what should your history be geared toward if you suspect infective endocarditis

A
  • prior cardiac lesions
  • recent source of bacteremia
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22
Q

what can be found on a echocardiogram that is diagnostic for infective endocarditis

A
  • vegetation
    • if echo negative, do transesophageal echo
23
Q

treatment of IE

A
  • bactericidal Abx
    • duration: elimiate microorganisms growing within valvular vegetations
  • 4-6 weeks of high dose
  • often use indwelling central catheter
24
Q

indications for surgery in IE

A
  • staph infection -> more aggressive
  • IE +
    • CHF
    • persistent or uncontrolled infection (Sepsis)
    • recurrent emboli
    • vegetation > 1-2 cm in size
25
Q

antibiotic prophylaxis recommended in dental procedures or procedures involving respiratory tract or infected skin, tissues just under the skin, or musculoskeletal tissue

A
  • prosthetic cardiac valve
  • previous endocarditis
  • cardiac transplant recipients
  • congenital heart disease
    • wait 6 months if repaired
26
Q

what is given for antibiotic prophylaxis in dental, oral, respiratory, or esophageal procedures (adults)

A
  • amoxicillin 2g p.o. 1 hr before procedure
    • allergy?
      • azithromycin, cephalexin, or clindamycin
27
Q

differentiate between fibrous and serous pericardium

A
  • fibrous pericardium
    • fibrous sac
    • holds heart in position, seperates it from surroundind structures
  • serous pericardium
    • parietal layer : lines fibrous pericardium
    • visceral layer: line epicardium
28
Q

differentiate between acute, subacute, and chronic pericarditis?

A
  1. acute: < 6 weeks duration
    • most common
  2. subacute: 6 wks-6 mon
  3. chronic: > 6 mon

**may be characterized as serous, fibrinous (pictured), adhesive or constrictive

29
Q

clinical presentation

  • severe, pleuritic, shap chest pain aggravated by breathing, coughing, position change
  • pain is relieved by sitting up and leaning forward
  • pain is intensified by lying supine
A

acute pericarditis

30
Q

what is the most characteristic physical exam finding in acute pericarditis

A

pericardial friction rub

  • high/medium pitch, scratching grating
  • loudest during inspiration
31
Q

what EKG findings are consistent with acute pericarditis

A

widespread elevation of ST segments

  • usually with reciprocal deprssion in aVR and V1
32
Q

treatment of acute percarditis with viral or idiopathic etiology

A
  • anti-inflammatory meds
    • Aspirin 600-900 mg QID
    • other NSAID, eg Indomethacin
    • may need steroids
  • **Avoid anticoagulants
33
Q

What is constrictive pericarditis

A
  • result of scarring and consequent loss of normal elasticity of pericardial sac
  • pericardium becomes inelastic -> inability to adapt to volume changes
  • results in ventricular interdependence
34
Q

what is the big difference between constrictive pericarditis to restrictive cardiomegaly

A
  • constrictive pericarditis: cardiac filling is impaired by extrinsic or external force
  • restrictive CM: cardiac filling is impaired by intrinsic force
35
Q

what happens to blood flow in heart during inspiration in normal pericardium

A
  • during inspiration -> decreased intrathoracic pressure -> inc. venous return to right heart -> increased rt heart size -> increased pericardial size; left heart filling is not impaired
36
Q

what happens to blood flow in heart during inspiration in constrictive pericardium

A
  • normal inspiratory decrease in intrathoracic pressure is not transmited to heart chamber -> pericardium does not expand to accommodate increase in Rt heart size from venous return
  • reduction in LV fillings, septum shifts into LV and further impairs LV filling
  • stroke volume and CO are impaired
37
Q

common causes of constrictive pericarditis

A
  1. idiopathic or viral 40-50%
  2. post-surgery
  3. post-radiation (hodgkin’s, breast CA)
38
Q

What are the common signs/symptoms associated with constrictive pericarditis

A
  1. fluid overload: peripheral edema to anasarca
  2. diminished cardiac output in response to exertion/exercise
    1. fatigue
    2. DOE
39
Q

physical exam

  • increased JVP (JVD)
  • pericardial knock
  • pulsus paradoxius
  • kussmaul’s sign - increased JVP with inspiration
A

constrictive pericarditis

40
Q

CXR findings consistent with constrictive pericarditis

A

calcifications

41
Q

treatment of constrictive pericarditis

A

pericardiectomy

42
Q

what is pericardial effusion? what appearance will be on CXR and EKG?

A
  • build-up of fluid within pericardial space
  • CXR: “water bottle” appearance
  • EKG: low voltage of QRS (QRS < 0.5 mV)
  • friction rub may disappear and heart sounds may become faint
43
Q

what is the diagnostic test of choice for pericardial effusion

A

echocardiogram

44
Q

acute pericarditis can cause what kind of pericardial effusion

A
  • viral - serous
  • bacteria - purulent
45
Q

renal failure with uremia can cause what kind of pericardial effusion

A

serous usually

46
Q

What analysis is done on fluid extracted from pericardial effusion

A
  • gram stain, bacterial and fungal culture
  • cytology
  • ARB stain and mycobacterial culture and PCR
47
Q

treatment of pericardial effusion

A
  1. if no evidence of hemodynamic compromise -> no immediate intervention
  2. severe -> percardial fluid drainage
  3. in reality, since may be related to pericarditis, treat with NSAIDS or steroids and judicious diuresis
48
Q

what is pericardial tamponade

A
  • when pericardial fluid accumulates in an amount sufficient to cause serious obstruction to inflow of blood into the ventricles
49
Q

what are the three most common causes of pericardial tamponade

A
  • neoplasia
  • idiopathic pericarditis
  • uremia - renal failure
50
Q

what is electrical alternans? It supports what diagnosis

A
  • alternating size of QRS complexes
  • a finding in effusion with tamponade
51
Q

What is Beck’s Triad and what condition does it describe

A
  1. distended neck veins (elevated JVD)
  2. distant heart sounds (muffled)
  3. hypotension

**pericardial tamponade

52
Q

what is paradoxical pulse

A
  • > 10mmHg reduction in systolic BP during inspiration
    • may be detected as reduced pulse during inspiration
  • LV output is temporarily reduced during inspiration since both ventricles are w/in confines of the reduced pericardial space
53
Q

treatment of cardiac tamponade

A
  • oxygen, IV fluids, T+C, CXR/ECHO (do not send to radiology)
  • DO NOT give pain medications, sedate, or intubate
  • ECHO guided pericardiocentesis, only sedate once fluids hooked up and ready to decompress

clinical medicine II (8 decks)

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