DSA- Cardiac Clinical Medicine Part 2 Flashcards
Acute infective endocarditis typically is due to?
What does it develop on?
1) Staph aureus
2) Normal heart valve endothelium
Subacute infective endocarditis typically is due to?
What does it develop on?
1) Streptococcus viridans and enterococcus
2) Damaged heart valve endothelium
Nonbacterial thrombotic endocarditis (Marantic endocarditis) is typically seen in patients with?
Nonbacterial verrucous endocarditis (Libman-Sacks endocarditis) is typically seen in patients with?
Both of theses conditions typically present with?
1) Metastatic malignancy
2) SLE
3) New cardiac murmur in setting embolic disease
What are some risk factors for infective endocarditis?
1) Older than 60
2) Male
3) IV drug use
4) Poor dentition
5) Structural heart disease
6) Implantable cardiac device
IV drug use typically presents with what sided endocarditis?
What is the most common cause of this?
1) Right sided endocarditis
2) Staph aureus
While less common what pathogen can cause infective endocarditis and is often associated with colon cancer or IBD?
Streptococcus bovis
How does infective endocarditis classically present?
1) Fever
2) New cardiac murmur
3) Vascular embolic events
What are some PE findings for infective endocarditis?
1) Petechiae
2) Splinter hemorrhages
3) Osler’s nodes (red, raised, painful lesions in distal extremities)
4) Janeway lesion (red, flat, painless lesions often on palms or finger)
5) Roth spots (retinal hemorrhages with white centers)
What is performed on a modified duke criteria in order to diagnose infective endocarditis?
1) Echocardiography
2) Blood cultures
What is the initial therapy for the treatment of infective endocarditis?
Vancomycin
Endocarditis prophylaxis is recommended for what high risk patients?
1) Hx of infective endocarditis
2) Hx of prosthetic heart valve replacement
3) Hx of cardiac valve repair with prosthetic material
4) Hx of Cardiac transplantation with valvular regurgitation
5) Congenital heart disease
6) Dental procedures
What are the most common causes of myocarditis?
1) Idiopathic
2) Viral infections
What are the most common viral pathogens that cause myocarditis?
1) Coxsackie B virus
2) HHV-6
3) Parvovirus
Definitive diagnosis of myocarditis is made on?
Endomyocardial biopsy
What symptoms are seen prior to developing myocarditis?
Fever, myalgias, respiratory or GI symptoms due to viral prodrome
What is cardiac tamponade?
What does it impair?
1) A life threatening accumulation of pericardial fluid that compresses the heart
2) Diastolic filling and decreases cardiac output
What does constrictive pericarditis result from?
What does it cause?
1) Results from a scarred, thickened, and frequently calcified pericardium
2) Constricts the heart which impairs cardiac filling and cardiac output
What are most cases of acute pericarditis due to in the developed world?
In the developing world?
1) Idiopathic or viral
2) TB
How is the chest pain characterized for acute pericarditis?
Where does it radiate?
What body position makes it worse?
What body position makes it better?
1) Sudden onset, retrosternal, and pleuritic
2) To trapezius ridge or neck
3) Lying flat
4) Sitting up and leaning forward
What is heard with acute pericarditis on auscultation?
Pericardial friction rub
What is the diagnostic criteria for acute pericarditis?
At least 2 of the 4 following criteria:
1) Pericarditis chest pain
2) Pericardial rubs
3) ST elevation and/or PR depression
4) Pericardial effusion
What ECG change is seen with acute pericarditis?
New widespread ST-segment elevation and/or PR segment depression
What is the classic presentation of cardiac tamponade?
Beck’s Triad:
1) Hypotension
2) Muffled heart sounds
3) JVD
What is heard with cardiac tamponade on auscultation?
Pericardial friction rub
What jugular venous waveform changes are seen with cardiac tamponade because of lack of right ventricular filling?
Absent y descent
What term associated with cardiac tamponade is characterized by abnormally large decrease in systolic blood pressure during inspiration?
Pulsus paradoxus
What ECG change is seen with cardiac tamponade?
Electrical alternans which is alternating amplitude of QRS complex in any lead
What is seen on CXR when diagnosing cardiac tamponade?
Enlarged cardiac silhouette (water-bottle sign)
What is found on PE for constrictive pericarditis?
1) Jugular venous distention
2) Pulsus paradoxus
3) Kussmaul’s sign (JVP fails to decrease with inspiration)
4) Pericardial knock (high pitched diastolic sound that results from abrupt cessation in ventricular filling)
What jugular venous changes are seen with constrictive pericarditis?
Prominent x and y descents
What is found on CXR for constrictive pericarditis?
Pericardial calcifications
What is the Tx for acute pericarditis?
NSAIDs (Indomethacin) and Colchicine
What is the Tx for cardiac tamponade?
Remove pericardial fluid with pericardiocentesis
What is the Tx for constrictive pericarditis?
Pericardiectomy
