Endocarditis, Myocarditis and Pericarditis Flashcards
What is endocarditis infection of?
Heart endothelium
What is a big factor in the bad prognosis of endocarditis?
Commonly diagnosed late
What are the two types of presentations of endocarditis?
Acute or subacute
What can it cause if bacteria gets in the bloodstream?
Septic shock and death
What colour will a negative blood culture bottle be?
Blue
What colour will a positive blood culture bottle be?
Yellow
How many sets of blood cultures should you take?
3
Heart valve abnormality is the main predisposing factor to endocarditis. How does this differ in the old and young?
Young- bicuspid valve
Old- calcification
Apart from valve abnormalities, what are other predisposing factors to endocarditis?
IV drug user and IV lines
What is the main diagnostic test for endocarditis? What should be done first and second?
ECHO- first trans-thoracic ECHO and if a second investigation is needed then use trans-oesophageal ECHO
What is the presentation of acute endocarditis?
Overwhelming sepsis and cardiac failure
What are the symptoms of a subacute presentation of endocarditis?
Fever, breathless, malaise, weight loss and tiredness
What are signs of endocarditis?
New/changed murmur, clubbing, splinter haemorrhages, splenomegaly, Roth spots/Janeway lesions/Oslers nodes, haematuria
Which of Osler’s nodes/Janeway lesions are painful?
Osler’s nodes
What is the first stage of the pathogenesis of endocarditis?
Heart valve is damaged which causes turbulent blood flow over the roughened endothelium
What happens when there is turbulent blood flow in endocarditis?
Platelets and fibrin are deposited
What has to be present for an organism to vegetate in the heart valve?
Bacteraemia
What happens when vegetations break off the heart valve?
They become lodged in the next capillary bed and cause haemorrhage or abscess
What is the most common cause of endocarditis?
Staph. aureus
What is the most common cause of hospital acquired endocarditis?
Staph. aureus
Endocarditis following a recent dental procedure is most commonly caused by what?
Strep. viridans
What does staph. epidermis commonly colonise?
IV lines
Endocarditis within two months of prosthetic valve surgery is most commonly caused by what?
Staph. epidermis
What organism is associated with colorectal cancer?
Strep. bovis
What is another cause of endocarditis which is not a staph or strep organism?
Enterococcus
Staph aureus is what type of organism?
Gram + cocci in clusters
Staph epidermis is coagulase what?
Negative
Strep viridans is the name for a group of organisms. This group are all what type of haemolytic?
Alpha
What is the prophylaxis for endocarditis?
None
What is the treatment for all patients with prosthetic valves or negative blood cultures?
Vancomycin and gentamycin IV, rifampicin PO 3-5 days later
What is the treatment for native valve endocarditis?
Amoxicillin and gentamycin IV
What is the treatment for PWID with endocarditis?
IV flucloxacillin
How long are antibiotics for endocarditis given for?
4-6 weeks
What is the treatment for staph aureus endocarditis?
Flucloxacillin IV
What is the treatment for strep viridans endocarditis?
Benzylpenicillin and gentamycin IV
What is the treatment for enterococcus endocarditis?
Amoxicillin/vancomycin and gentamycin IV
What is the treatment for staph. epidermis endocarditis?
Vancomycin and gentamycin IV and rifampicin PO
What side does endocarditis usually affect and what valves does this affect?
Left side- mitral/aortic valves
What side and valve does endocarditis in PWID mostly affect?
Right side- tricuspid valve
What is myocarditis?
Inflammation of the heart muscle
Who is myocarditis most common in and what can it sometimes cause?
Young people- cause of sudden death
What are some symptoms of myocarditis?
Fever, chest pain, SOB, palpitations
What are signs of myocarditis?
Arrhythmias, cardiac failure
What are the most common causes of myocarditis?
Enteroviruses- Coxsackie A and B, echovirus
How is myocarditis diagnosed?
Viral PCR, throat swab and stool for enterovirus
What is the treatment for myocarditis?
Supportive
What often occurs with myocarditis?
Pericarditis
What is the main feature of pericarditis?
Chest pain
What type of organism usually causes pericarditis?
Normally viral, bacterial is less common
When is pericarditis common?
Post cardio surgery
What is the treatment for pericarditis?
Antimicrobials and drainage
