CV infections

Question 1

Bacteremia

Answer 1

the presence of bacteria in the bloodstream; may or may not be clinically significant.

Question 2

Transient Bacteremia

Answer 2

self-resolving in clients with no underlying illness, immune deficiency, or turbulent cardiac bloodflow.

Question 3

Primary bacteremia

Answer 3

nosocomial infection, also associated with IV drug use. direct inoculation of bacteria into the bloodstream.

Question 4

Secondary bacteremia

Answer 4

opportunistic infection. microorganisms causing infection at another site (eg. pneumonia) invade the bloodstream and disseminate via the circulation to other body areas (hematogenous spread)

Question 5

Sepsis

Answer 5

life-threatening organ dysfunction caused by a dysregulated host response to infection.

Question 6

Sepsis characteristics

Answer 6

• infection (suspected or confirmed)

- acute, life threatening organ dysfunction as defined by a sepsis related organ dysfunction assessment (qSOFA) tool

Question 7

qSOFA

Answer 7

quick sepsis-related organ failure assessment. measures respiratory, hepatic, CV, renal, CNS, and platelet aggregation.

Question 8

Endocardium

Answer 8

thin lining inside the chambers of the heart

Question 9

Myocardium

Answer 9

muscle tissue of the heart

Question 10

Pericardium

Answer 10

thin, double layered sac that encloses the heart.

Question 11

Rheumatic Fever

Answer 11

a rare complication of streptococcal pharyngitis (strep throat) infections. Caused by streptococcus pyogenes (GAS). most common in children ages 5-15 and adults in developing countries.

Question 12

a rare complication of streptococcal pharyngitis (strep throat) infections. Caused by streptococcus pyogenes (GAS). most common in children ages 5-15 and adults in developing countries.

Answer 12

inflammation of the heart valves, no active infection

symptoms of rheumatic fever

Question 13

Polyarthritis

Answer 13

large joints, lasting ~2-4 weeks

symptom of rheumatic fever

Question 14

Erythema marginatum

Answer 14

Rash of Rheumatic fever

Question 15

Chorea

Answer 15

abnormal involuntary movement disorder characteristic of rheumatic fever.

Question 16

Rheumatic Fever Treatment

Answer 16

anti-inflammatories, diuretics, and bedrest. prevent further attacks with antibiotics.

Question 17

Treatment for rheumatic fever with NO residual heart disease

Answer 17

Penicillin (IM) once monthly for a minimum of 10mo. or until 25 years old

Question 18

Treatment for rheumatic fever WITH residual heart disease

Answer 18

Penicillin (IM) once monthly until 40-45 years old, but often continued for life.

Question 19

Rheumatic heart disease

Answer 19

heart disease caused by rheumatic fever.

Question 20

rheumatic heart valve

Answer 20

clients with one are at an increased risk of complications associated with bacteremia. this increased risk is associated with turbulent bloodflow at the site of the damaged heart valve.

Question 21

Non-Bacterial Thrombotic Endocarditis (NBTE)

Answer 21

minor fibrin and platelet deposition can occur on the low pressure side of the damaged valve

Question 22

Why is transient bacteremia problematic?

Answer 22

because it gives the microbe a place to adhere, increasing the risk of infective endocarditis

Question 23

Endocarditis

Answer 23

infection and inflammation of the endocardium; commonly affects the mitral and aortic heart valves.

Question 24

subacute endocarditis

Answer 24

symptoms develop slowly; fatigue, malaise, fever, chills, anorexia, weight loss, back pain.
signs include new or changing heart murmur, peripheral manifestations.
associated with relatively non-virulent bacteria (ie. viridans streptococci)

Question 25

acute endocarditis

Answer 25

symptoms develop quickly; intense fever, shaking, chills, exhaustion. signs include new or changing heart murmur, peripheral manifestations, sepsis. associated with highly virulent bacteria (ie. staphylococcus aureus)

Question 26

Peripheral manifestations of endocarditis

Answer 26

splinter hemorrhages, conjunctiva petichiae, osler's nodes, roth's spots, and janeway lesions

Question 27

Osler's nodes

Answer 27

painful, raised, red lesions on hands and feet

Question 28

Roth's Spots

Answer 28

red spots with white centres on the retina

Question 29

Janeway Lesions

Answer 29

non-tender, small, erythematous lesions on the palms or soles of feet.

Question 30

bacteremia risk factors

Answer 30

associated with injection drug users and people with central IVs in people with both normal and abnormal valves

Question 31

subacute infective endocarditis risk factors

Answer 31

people with abnormal heart valves, prosthetic valves, rheumatic valves, mitral valve prolapses, and congenitally abnormal valves

Question 32

Turbulent bloodflow

Answer 32

causes roughening of the endocardium that allows bacteria to adhere to the endocardium

Question 33

Complications of endocarditis

Answer 33

- persistent bacteremia and risk of seeding distant sites (risk of secondary infection, sepsis) - Tissue destruction (damage to heart valve, heart failure) - Fragmentation of Vegetation (CNS emboli, MI, stroke, vascular insufficiency, and necrosis) - Stimulation of antibodies (combine with bacterial antigens and form circulating immune complexes that deposit in kidneys or skin) - Recurrent infection (once you've had endocarditis, you're at a higher risk for getting in again d/t damaged heart valve)

Question 34

Duke Criteria

Answer 34

for endocarditis (need 2 major, 1 major + 3 minor, or 5 minor) MAJOR: 1. 2 positive blood cx with staph aureus, viridans strep, strep bovis/epidermidis, enterococci, GNRs, Candida (HACEK orgs are generally cx negative!) 2. abnormal echo (mass/vegetation, abscess, new partial detachment of prosthetic valve) MINOR: 1. fever >38 degrees 2. risk factors (IV drug use, structural heart disease, prosthetic valve, dental procedures involving bleeding, h/o endocarditis) 3. vascular findings (janeway lesions, septic pulmonary infarcts, arterial emboli, mycotic aneurysm, conjunctival hemorrhage) 4. immunologic findings (roth spots, osler's nodes, Glomerulonephritis) 5. micro findings (positive blood culture that doesn't meet major criteria)

Question 35

treatment of endocarditis

Answer 35

appropriate antimicrobial therapy (bactericidal) administered parenterally (long duration 4-6 weeks), valve replacement surgery in cases of severe AROs, severe valve dysfunction, recurrent embolism, or in cases of fungal endocarditis

Question 36

Prevention of endocarditis

Answer 36

Prophylactic antibiotic therapy in advance of surgical and dental procedures (ie. procedures associated with transient bacteremia)

Question 37

Myocarditis

Answer 37

inflammatory cardiomyopathy most often associated with a viral infection of the myocardium and infiltration of cardiac muscle by t-lymphocytes.

Question 38

Myocarditis causative pathogens

Answer 38

enteroviruses (coxsackie B), adenovirus, HSV, influenza, HIV.

Question 39

Myocarditis symptoms

Answer 39

Hx of recent flulike syndrome of fever, malaise, pharyngitis, tonsilitis, or upper respiratory tract infection. Sx of mild heart failure (fatigue, weakness, SOB, edema, palpitations, arrhythmias) Pain reported in those with concomitant pericarditis

Question 40

pediatric myocarditis

Answer 40

acute symptoms; cardiogenic shock and acute heart failure, sudden death

Question 41

adult myocarditis

Answer 41

progresses slowly- progressive heart failure and dilated cardiomyopathy

Question 42

coxsackie-adenovirus receptor (CAR)

Answer 42

a receptor in the heart myocytes that welcomes viral pathogens into the heart. the virus then attacks the heart, T-lymphocytes enter that are also filled with virus. the heart then makes more of these receptors, and the client becomes more ill. higher concentration in children than adults.

Question 43

Myocarditis treatment

Answer 43

same as for heart failure; ACE inhibitors, diuretics, beta-blockers. avoid NSAIDs (increased risk of mortality), induce fluid retention (d/t vasoconstriction of blood vessels in the kidneys), immunosuppressive therapy

Question 44

early resolution of myocarditis

Answer 44

complete recovery

Question 45

prolonged symptoms of myocarditis

Answer 45

permanent dilated cardiomyopathy, increased risk of heart attack and stroke, worsening heart failure, death, or need for cardiac transplantation.

Question 46

Pericarditis

Answer 46

inflammation of the pericardium. may coexist with myocarditis. viruses are the most causative pathogens (eg. entoviruses; coxsackie virus, echovirus) appears 2-3 weeks after "flu-like" symptoms

Question 47

Pericarditis symptoms

Answer 47

sharp, stabbing chest pain caused by rubbing of 2 layers of the pericardium. pain worsens when laying down, with deep breaths, swallowing, and coughing. pain improves with sitting upright or forward.

Question 48

Pericarditis diagnostic findings

Answer 48

abnormal heart sounds (pericardial rub), abnormal ECG, echocardiogram (appearance of fluid surrounding the heart)

Question 49

pericarditis treatment

Answer 49

- analgesics and anti-inflammatory drugs (NSAIDs or steroids) - antibiotics for bacterial causes - pericardial tamponade (tachycardia, SOB, increased RR and prominent neck veins): pericardiocentesis (drainage of pericardial fluid) - constructive paricarditis: pericardectomy (surgical removal of pericardium)