Clinical Approach To Endocarditis Mycarditis, Pericarditis Flashcards
Endocarditis epidemiology and risk factors
Incidence is approximately 10-15/100,000
Male predominant (3:2)
Older patients (>60yrs)
Prosthetic valves, immunosupression, Bacteremia, Poor oral hygiene and IV drug use are common causes
Cardiac risk factors for endocarditis
Prior infective endocarditis
Prosthetic valves (10-20% of cases)
Implantable defibrillators/pacemakers
History of valvular diseases
History of congenital heart disease
Non-cardiac risk factors for endocarditis
IV drug use
- often seen in heroin abuse
Being on an IV catheter for extended periods of time (increases potential by 12x fold)
Immunosuppressed populations
- includes organ transplants, RA, chronic glucocorticoid therapies, psoriasis and cancer
Recent dental or surgical procedure
Clinical symptoms of Endocarditis
Chills
Anorexia
Malaise
Headache
Myalgia
Arthralgia
Night sweats
Fever
Ab pain
Dyspena
Irritating and sustained coughing
Tooth or pleuritic pain
Clinical signs for endocarditis
FEVER (most common 90%)
New cardiac murmurs (2nd most common @ 85%)
Splenomegaly (20-50%)
Petechiae (20-40%)
Osler nodes
Roth spots
Janeway lesions
Splinter hemorrhages
Endocarditis evaluation steps
1) take a history
2) do physical exam
3) obtain blood cultures and CBC
4) echocardiograph to determine where the endocarditis is
5) chest radiography
Duke criteria for endocarditis diagnosis
Definitive IE If any of the following is present:
1) 2 major criteria
2) i major and 3 minor criteria
3) 5 minor criteria
Possible IE if:
1) presence of 1 major and 1 minor criteria
2) presence of 3 minor criteria
Major criteria for the duke criteria of endocarditis
Positive blood cultures for any of the following
1) staph A
2) viridans streptococcus
3) HÁČEK
4) coxiella Burnetii w/ IgG antibody titer >1:800
Echo cardio gram
1) vegetation is seen
2) access is seen on the valves
Valvular regurgitation that is new (new murmur)
Minor criteria for the duke criteria of endocarditis
IV drug use or has a prosthetic heart valve/lesion that is old
Fever
History of Hemorrhages, Janeway lesions or mycotic aneurysms
Presence of Osler nodes, Roth spots and/or high rheumatoid factor
Acute vs chronic myocarditis
Inflammation of the myocardium that presents with heart failure symptoms
- <3 months = acute
- > 3 months = chronic
Etiologies of myocarditis
Viral (most common)
Bacterial (2nd cause)
Trypanosoma cruzi (Chagas’ disease)
- common in South America
- benzinadazole is the 1st line Tx
Sarcoidosis
Giant cell myocarditis
Eosinophilic myocarditis
oftne goes hand-in-hand w/ pericarditis
Clinical myocarditis symptoms
Chest pain
Excessive fatigue/ exercise intolerance
Unexplained sinus tachycardia
Nonleathal arrhythmias
CHF
Hepatomegaly
Tachypnea
SCD (usually this is postmortem)
Evaluation of Myocarditis
1) history and physical exam
2) electrocardiography
- tachycardia
- QRS and QT elongation
- diffuse T wave inversions
- non specific ST changes
3) echocardiography
4) serum troponin levels (shows cardiac cell death)
5) CK-BM levels, ESR and CRP levels
6) Cardiovascular magnetic resonance and biopsy
- 100% confirms but is very invasive so not used often
Pericarditis etiology
Viral (more common in developed)
Bacterial (in developing countries, TB is the more common cause)
Uremia (most common altogether)
Neoplasms
Post-cardiac injury (Dressler syndrome)
Secondary to myocarditis
Is male dominant and often presents w/ nonischemic chest pain
How to treat pericarditis
90% of pericarditis is idiopathic
Most common treatment is
- aspirin (not in trauma patients)
- NSAIDs (Not in MI )
Infections confirmed
- antibiotics to the organism
Aortic dissections or MI
- surgery and aspirin
Uremia
- dialysis
