Endo/Pericarditis Flashcards by Wendy Pitts

Endocartitis definition?

inflamed lining of chambers and/or valves

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3 categories of Infective Endocartitis?

1) native valve
2) IV drug users
3) prosthetic valve

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Native valve endocartitis etiology?

strep, entero or staphylococci

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IV drug user endocartitis etiology?

1/2 staph aureus

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Prosthetic valve endocartitis etiology?

staph
G-
fungi

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Acute Infective Endocartitis etiology?

Regression?

(U) staph areus

rapid destruction
fatal <6wks w/o tx

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Subacute Bacterial Endocartitis etiology?

(U) viridans strep (normal mouth flora)

slower

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Infective Endocartitis epidemiology?

Up to 80% have predisposing cardiac lesion

(U) >60yo

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Infective Endocartitis presentation?

viral sxs
murmur
splenomegaly
arterial emboli
PETECHIAE (last 2-3 days)
focal neuro impairment
clubbing/splinter hemorrages

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Osler’s Nodes?

1/4 of Infective Endocartitis pt present w/:
PALPABLE, small, tender purple-red sub-q nodules on hands/feet,
tiny infarcts

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Roth’s Spots?

Some Infective Endocartitis pt present w/:

oval retinal hemorrh w/ pale center

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Janeway lesions?

Infective Endocartitis pt present w/:

small, NONTENDER hemorr macules on hands/feet

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Typical lab findings in Infective Endocartitis? (6)

\+ Blood culture
High sed rate
\+ anemia
\+ proteinuria
\+ rheumatoid factor
circulating immune complexes

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Duke diagnostic criteria for definitive Infective Endocartitis:

Pathologic

+ microorganisms
and + vegetation
or intracardiac abscess

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Duke diagnostic criteria for definitive Infective Endocartitis:

Clinical

2 major criteria
Or one major and 3 minor
or 5 minor

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Infective Endocartitis Major Criteria? (2)

1) Typical microorg from 2 separate blood cx

2) Endocardial involvement: + echo or new valvular regurge

Infective Endocartitis Minor Criteria? (6)

1) Heart condition or IV drug use
2) Fever >=100.4
3) Vascular phenom (emboil, hemorr, Janeway)
4) Immun phenom (glomnephritis, Osler, Roth, +RF)
5) Microbio evidence (one + blood cx)
6) Endocardiographic evidence (other than major criteria)

Infective Endocartitis tx?

Abx: sustained cidal [ ] confirmed by cx (U) 6wks

(P) surgery

Infective Endocartitis (valvular) surgery when?

CHF
Persistent or uncontrolled infection w/ abx
Recurrent emboli

Prophylaxis for IE, pre procedures?

amoxicillin, one 2gm dose

azythro for PCN allergies

Pericardial Disease definitons:

Acute
Subacute
Chronic

acute = 6mo

Pericarditis etiology:

Infectious? (4)

viral
pyogenic (bacterial)
TB
fungal

Pericarditis etiology:

Non-infectious? (4)

2º to acute MI
neoplasm
uremic
traumatic

Pericarditis etiology:

Hypersens/Autoimmune? (3)

Rheumatic fever
Collagen vascular (SLE, RA)
Drug-induced (procainamide)

Acute Pericarditis sxs?

Chest pain: severe, sharp Worse w/ lying down, cough, breathing Better sitting and leaning forward

Acute Pericarditis tests?

friction rub audible: med/high pitch loudest in inspiration EKG = widespread ST elev, T inver only after several days

Pericardial Effusion definition?

fluid build-up w/i pericardial space

Pericardial Effusion presentation?

Fluid increases space b/w wall and organs Ѧ: reduced friction rub reduced heart sounds

Pericardial Effusion diagnostic test of choice?

Echo

Pericardial Effusion (P) CXR and EKG findings?

CXR = elargment w/ water bottle appearance EKG = low voltage of QRS

Tamponade is?

compression that impairs filling due to increased fluid

Pericardial Effusion w/ Tamponade shows on EKG how?

Electrical alterans = | alternating size of QRS complexes

Pericardial Effusion w/ Tamponade causes (3)?

1) neoplasm 2) idiopathic pericarditis 3) uremia (renal failure)

Key features of tamponade? (3)

1) elevated intracardiac P = JVD 2) limited vent filling = paradoxical pulse 3) reduced cardiac output = hypotension

Paradoxical Pulse is? Caused by?

> 10 mmHg reduction in systolic BP during inspiration reduced pericardial space makes it so L vent can't expand against over-filled R vent -> temp reduced LV output

Acute Pericarditis tx?

underlying cause rest anti-inflm (asprin) for viral or idiopathic avoid anticoag