Endocarditis, Myocarditis, and Pericarditis Flashcards
how can endocarditis be classified?
infective, non-bacterial thrombotic, non-bacterial verrucous
what is the typical cause of acute infective endocarditis?
s. aureus (highly virulent)
what is the typical cause of subacute infective endocarditis?
less virulent bacteria like strep viridans or enterococcus
where does acute infective endocarditis occur?
develops on normal heart valve endothelium
where does subacute infective endocarditis occur?
on damaged heart valve endothelium
what is another name for non-infective thrombotic endocarditis?
marantic endocarditis
when is marantic endocarditis usually seen?
in patients with metastatic malignancy; at autopsy
what is another name for non-bacterial verrucous endocarditis?
Libman-Sacks endocarditis
when is Libman-Sack endocarditis typically seen?
in patients with SLE
how do patients with non-bacterial endocarditis typically present?
with a new cardiac murmur in setting of embolic disease
IV drug users are at risk for what type of endocarditis?
infective, right-sided endocarditis
what is the classic presentation of infective endocarditis?
fever, constitutional symptoms such as: anorexia, weight loss, night sweats; new cardiac murmur (typically regurgitation), vascular embolic events
what physical exam findings would you expect to see in a patient with infective endocarditis?
splenomegaly, petechiae, splinter hemorrhages, osler’s nodes, janeway lesion, roth spots
if you get a patient with infective endocarditis, how would you go about diagnosing them?
by using the modified duke criteria
what goes into the modified duke criteria?
echocardiography and blood cultures
what are the cardiac complications associated with infective endocarditis?
heart failure, perivalvular abscess, pericarditis
what are the general complications that infective endocarditis can lead to?
cardiac complications, metastatic infection, or renal complications
how do you treat and manage a patient with infective endocarditis?
empiric abx–> vancomycin; duration of antibiotics is calculated from the first day the blood cultures are negative so obtain blood cultures every 1-2 days until negative; typical IV abx duration is 4-6 weeks depending on type of infection
who is considered to be a high risk patient for endocarditis?
those with hx of infective endocarditis, hx of prosthetic heart valve replacement, hx of cardiac valve repair with prosthetic material, hx of cardiac transplantation with valvular regurgitation, and those with congenital heart dx; those with dental procedures
what are 3 examples of viruses that cause viral myocarditis?
coxsackie B virus, HPV 6, parvovirus
what are the clinical manifestations of myocarditis?
variable: subclinical disease to sudden cardiac death
most myocarditis patients present with one of 3 patterns, what are they?
new onset or worsening heart failure, cardiac conduction abnormalities, and acute MI like syndrome
how is definitive diagnosis of myocarditis made?
endomyocardial biopsy
how should you treat viral myocarditis?
ACEi/ARB, beta blockers, diuretics, aldosterone receptor blocker
how is the pericardium composed?
fibrous sac and a serous sac, which is further broken down into a parietal layer and a visceral layer
what are the two most common causes of acute pericarditis?
idiopathic or viral (developed world); undeveloped world: tuberculosis
how does acute pericarditis present?
many patients will report a viral prodromal illness that precedes the development of pericarditis; CP-pain is worse lying flat and relieved by sitting forward
what EKG changes would you expect to see in a patient with acute pericarditis?
new widespread ST-segment elevation and/or PR segment depression
what is the classic presentation of cardiac tamponade?
Beck’s triad: hypotension, muffled heart sounds, JVD; pericardial friction rub, jugular venous waveforms; pulsus paradoxus
what are the jugular venous waveforms seen in cardiac tamponade?
absent y descent because of lack of right ventricular filling (ventricle is compressed) by fluid
what is pulsus paradoxus seen in cardiac tamponade?
abnormally large decrease in systolic blood pressure during inspiration
what EKG changes would you expect to see in cardiac tamponade?
electrical alterans and low voltage QRS complexes
what is electrical alterans?
alternating amplitude of QRS complex in any lead (often in precordial leads)
how do you make the diagnosis of cardiac tamponade?
CXR: shows enlarged cardiac silhoutte; ecg; ECHO: large pericardial effusion present
