Endocarditis and Pericarditis

Question 1

Treatment for post MI Pericarditis?

Answer 1

Aspirin 650-1000mg qid for 7-10 days then taper over 4 weeks

Question 2

What drugs should you not use for post MI pericarditis?

Answer 2

Corticosteroids and NSAIDs because they delay healing

Question 3

First line treatment for non-MI related pericarditis?

Answer 3

NSAIDs for 2-4 weeks. Ibuprofen 600-800mg every 6-8 hours tapered over 4 weeks. Indomethacin 25-50mg TID tapered over 4 weeks

Question 4

Second line treatment for non-MI related pericarditis?

Answer 4

Aspirin 800mg q6-8 hours for 7-10 days, then taper over 3-4 weeks AND Colchicine 1-2mg on day 1 and then 0.5 to 1 mg/day for 3 months

Question 5

Dosing of Colchicine for patients?

Answer 5

> 70kg (154lbs): 0.5mg BID

Question 6

What should be used for refractory cases in non-MI pericarditis?

Answer 6

Prednisone 10mg PO qd for 1-2 weeks

Question 7

Side affects of colchicine?

Answer 7

Gastrointestinal upset and neutropenia, peripheral neuropathy. High doses can cause bone marrow damage and anemia.

Question 8

Initial empirical treatment for endocarditis?

Answer 8

Vancomycin 15-20mg/kg q8-12h IV AND Ceftriaxone 2g q24h IV OR Gentamicin 1mg/kg q8h IV or IM.

Question 9

Initial empirical treatment for endocarditis w/ a prosthetic valve?

Answer 9

Vancomycin 15-20mg/kg q8-12h IV AND Gentamicin 1 mg/kg q8h IV or IM AND Rifampin 300mg PO/IV q12h

Question 10

Treatment for Viridans Streptococcus or Streptococcus bovis? Penicillin Susceptible

Answer 10

Penicillin G or Ceftriaxone for 4 weeks OR Gentamicin AND (Penicillin G or Ceftriaxone) for 2 weeks OR Vanco for 4 weeks.

Question 11

Treatment for Viridans Streptococcus or Streptococcus bovis? Penicillin Intermediate Sensitivity

Answer 11

Gentamicin 2 weeks AND (Penicillin G or Ceftriaxone) 4-6 weeks OR Vanco 6 weeks

Question 12

Treatment for Viridans Streptococcus or Streptococcus bovis? Penicillin Resistant

Answer 12

Gentamicin AND (Penicillin G or Ampicillin) 4-6 weeks or Vanco 6 weeks

Question 13

Treatment for Coagulase negative Staphylcoccus? Oxacillin-susceptible

Answer 13

Nafcillin or oxacillin for 6 weeks AND Rifampin 300 mg IV/PO 6 weeks AND Gentamicin 1mg/kg q8h IV or IM 2 weeks

Question 14

Treatment for coagulase negative staphylococcus? Oxacillin-resistant

Answer 14

Vanco 6 weeks AND Rifampin 300mg IV/PO 6 weeks AND Gentamicin 1mg/kg q8h IV/IM 2 weeks

Question 15

Treatment for MSSA?

Answer 15

Same as for oxacillin susceptible coagulase negative staphylococcus

Question 16

Treatment for MRSA endocarditis?

Answer 16

Same as for oxacillin resistant coagulase negative staphylococcus

Question 17

Treatment for Enterococcus that is resistant to all 3

Answer 17

Gentamicin and (Ampicillin or Penicillin G) 4-6 weeks OR Gentamicin and Vanco 6 weeks

Question 18

Treatment for Enterococcus that is resistant to Gentamicin?

Answer 18

Steptomycin AND (Ampicillin or Penicillin G) 4-6 weeks or Streptomycin and Vanco 6 weeks

Question 19

Treatment for Enterococcus that is resistant to Penicillin?

Answer 19

Gentamicin and Ampicillin-Sulbactam for 6 week or more OR Gentamicin and Vanco for 6 weeks.

Question 20

Major cause of pericarditis in developing countries?

Answer 20

HIV or tuberculosis

Question 21

Most common cause of pericarditis

Answer 21

Viral. Common viruses: coxsackie virus A or B, echovirus, mumps, andenovirus, HIV, infectious mononucleosis, varicella, Hep B

Question 22

Common causes of bacterial pericarditis?

Answer 22

Steptococcus, pneumococcus, staphylococcus. Rare in age of antibiotics

Question 23

What are common drugs that cause pericarditis?

Answer 23

Hydralazine, procainamide, phenytoin

Question 24

Clinical manifestations for pericarditis?

Answer 24

Fever, pericardial friction rub, Ewarts sign (patch of dullness on auscultation beneath the angle of the left scapula

Question 25

Workup for pericarditis?

Answer 25

CBC, CMP, troponin I, ESR, CRP, blood culture if over 100.4 temp, ECG, CXR PA/lateral, echo. Possibly ANA, TB skin test, HIV serology, CT, Cardiac MRI

Question 26

What would you see on ECG for pericarditis?

Answer 26

PR depression, diffuse concave upward ST elevation, electrical alternans, if effusion present

Question 27

High risk individuals for pericarditis?

Answer 27

Fever > 100.4, cardiac tamponade, large pericardial effusion, immunosupression, anticoagulation, trauma, failed NSAIDs therapy after 7 days, elevated troponin

Question 28

Clinical signs for tamponade with pericarditis

Answer 28

Becks Traid (diffuse/ muffled heart sounds, JVD, hypotension), Tachycardia, Pulsus paradoxus (systolic BP drops more than 10 mm HG with inspiration

Question 29

Common bacteria that cause endocarditis?

Answer 29

Streptococcus (viridans strep most common), enterococcus, staphylococcus (s. aureus)

Question 30

Culture negative endocarditis that cause endocarditis?

Answer 30

HACEK, anaerobes, legionella, Libman-sacks, marantic, antiphospholipids

Question 31

Biggest cause of infection within first 2 months of surgery?

Answer 31

Coagulase negative staphylococci `

Question 32

Clinical manifestations of endocarditis?

Answer 32

Fever, new murmur, subungal “splinter hemorrhage”

Question 33

Exam findings for endocarditis?

Answer 33

Osler nodes ( red, raised lesions on hands and feet) Janeway lesions ( non-tender, small erythematous or hemorrhagic macular or nodular nodes on palms or soles of feet), Roth spots (retinal hemorrhages with white or pale centers)

Question 34

Labs to run for endocarditis?

Answer 34

CBC, Troponin I, ESR, CRP, UA, blood culture if over 100.3, ECG, CXR, Echo