CIS Microbiology of Heart Disease--Hersh Flashcards
subacute vs acute Infective Endocarditis?
ACUTE:
- rapid onset (less than 7 days), toxic-appearing, super sick!!
- no underlying heart disease
- R more than L (Tri>Bi>aorta>pulmonary)
- S aureus
- SOB, high fever, chills, pleuritic chest pain, back pain
SUBACUTE:
- underlying heart disease
- gradual onset
- L more than R
- S viridans, HACEK, enterococcus
- low grade fever, anorexia, fatigue, N/V
IE- risk factors
- age older than 60; males
- IV drug use
- poor dentition
- predisposing conditions- valves!
signs of IE
- roth spots
- janeway lesions (painless- pams, soles)
- osler nodes (painful- fingers)
- splinter hemorrhages
workup for subacute IE?
-blood cultures x 3, TTE (transthoracic echocardiogram)
staph epidermidis
-G+ cocci in clusters, catalase positive, coagulase negative
what is empiric treatment?
-broad coverage! until you get cultures back
best empiric treatment for IE?
vancomycin and ceftriaxone!!
dental work- subacute IE- which organism?
-streptococcus viridans
duke criteria- major?
- positive blood culture
- electrocardiograph changes consistent with valvular disease
- new murmur
duke criteria- minor?
- prosthetic/abnormal vavle
- fever greater than 38 C
- immunologic phenomenon (GN, roth spots, osler nodes)
- vascular phenomenon (janeway lesions)
duke criteria- diagnosis
- 2 major criteria
- 1 major with 3 minor
- 5 minor
when to use antibiotic prophylaxis for IE?
- cardiac conditions with high risk of IE- dental procedures
- ampicillin!!
- if alleregic- cephalexin, clindamycin
empiric treatment for IE?
-vancomycin + ceftriaxone
enterococcus- where?
GI tract!
-grow on bile salts culture
treatment for tb acute pericarditis
- isoniazid
- rifampin
- ethambutol
- pyrazinamide
treatment for pericarditis
-aspirin + colchicine
treatment for pericarditis that doesnt respond to aspirin
-colchicine + high dose corticosteroids
most common cause of pericardiits?
-Coxsackie B (also Echovirus, flu
other causes of pericarditis
- uremia
- neoplastic processes
- Dressler- post MI
- SLE
- drug induced
- radiation
pericarditis- presentation
- anterior pleuritic chest pain (uremic pts- painless)
- fever
- pericardial rub (very specific!!)
- dyspnea
Coxsackie virus B- morphology
-ssRNA naked icosahedral virus
(smallest virus)- picornavirus!
used in acute pericarditis to follow progress?
CRP!!
pericarditis- EKG progression
- diffuse ST elevation in all leads!
- ST normalization
- inverted T waves
- return to baseline
treatment for patent foramen ovlae?
indomethacin
