Endocarditis, Myocarditis and Pericarditis

Question 1

What is endocarditis infection of?

Answer 1

Heart endothelium

Question 2

What is a big factor in the bad prognosis of endocarditis?

Answer 2

Commonly diagnosed late

Question 3

What are the two types of presentations of endocarditis?

Answer 3

Acute or subacute

Question 4

What can it cause if bacteria gets in the bloodstream?

Answer 4

Septic shock and death

Question 5

What colour will a negative blood culture bottle be?

Answer 5

Blue

Question 6

What colour will a positive blood culture bottle be?

Answer 6

Yellow

Question 7

How many sets of blood cultures should you take?

Answer 7

3

Question 8

Heart valve abnormality is the main predisposing factor to endocarditis. How does this differ in the old and young?

Answer 8

Young- bicuspid valve

Old- calcification

Question 9

Apart from valve abnormalities, what are other predisposing factors to endocarditis?

Answer 9

IV drug user and IV lines

Question 10

What is the main diagnostic test for endocarditis? What should be done first and second?

Answer 10

ECHO- first trans-thoracic ECHO and if a second investigation is needed then use trans-oesophageal ECHO

Question 11

What is the presentation of acute endocarditis?

Answer 11

Overwhelming sepsis and cardiac failure

Question 12

What are the symptoms of a subacute presentation of endocarditis?

Answer 12

Fever, breathless, malaise, weight loss and tiredness

Question 13

What are signs of endocarditis?

Answer 13

New/changed murmur, clubbing, splinter haemorrhages, splenomegaly, Roth spots/Janeway lesions/Oslers nodes, haematuria

Question 14

Which of Osler’s nodes/Janeway lesions are painful?

Answer 14

Osler’s nodes

Question 15

What is the first stage of the pathogenesis of endocarditis?

Answer 15

Heart valve is damaged which causes turbulent blood flow over the roughened endothelium

Question 16

What happens when there is turbulent blood flow in endocarditis?

Answer 16

Platelets and fibrin are deposited

Question 17

What has to be present for an organism to vegetate in the heart valve?

Answer 17

Bacteraemia

Question 18

What happens when vegetations break off the heart valve?

Answer 18

They become lodged in the next capillary bed and cause haemorrhage or abscess

Question 19

What is the most common cause of endocarditis?

Answer 19

Staph. aureus

Question 20

What is the most common cause of hospital acquired endocarditis?

Answer 20

Staph. aureus

Question 21

Endocarditis following a recent dental procedure is most commonly caused by what?

Answer 21

Strep. viridans

Question 22

What does staph. epidermis commonly colonise?

Answer 22

IV lines

Question 23

Endocarditis within two months of prosthetic valve surgery is most commonly caused by what?

Answer 23

Staph. epidermis

Question 24

What organism is associated with colorectal cancer?

Answer 24

Strep. bovis

Question 25

What is another cause of endocarditis which is not a staph or strep organism?

Answer 25

Enterococcus

Question 26

Staph aureus is what type of organism?

Answer 26

Gram + cocci in clusters

Question 27

Staph epidermis is coagulase what?

Answer 27

Negative

Question 28

Strep viridans is the name for a group of organisms. This group are all what type of haemolytic?

Answer 28

Alpha

Question 29

What is the prophylaxis for endocarditis?

Answer 29

None

Question 30

What is the treatment for all patients with prosthetic valves or negative blood cultures?

Answer 30

Vancomycin and gentamycin IV, rifampicin PO 3-5 days later

Question 31

What is the treatment for native valve endocarditis?

Answer 31

Amoxicillin and gentamycin IV

Question 32

What is the treatment for PWID with endocarditis?

Answer 32

IV flucloxacillin

Question 33

How long are antibiotics for endocarditis given for?

Answer 33

4-6 weeks

Question 34

What is the treatment for staph aureus endocarditis?

Answer 34

Flucloxacillin IV

Question 35

What is the treatment for strep viridans endocarditis?

Answer 35

Benzylpenicillin and gentamycin IV

Question 36

What is the treatment for enterococcus endocarditis?

Answer 36

Amoxicillin/vancomycin and gentamycin IV

Question 37

What is the treatment for staph. epidermis endocarditis?

Answer 37

Vancomycin and gentamycin IV and rifampicin PO

Question 38

What side does endocarditis usually affect and what valves does this affect?

Answer 38

Left side- mitral/aortic valves

Question 39

What side and valve does endocarditis in PWID mostly affect?

Answer 39

Right side- tricuspid valve

Question 40

What is myocarditis?

Answer 40

Inflammation of the heart muscle

Question 41

Who is myocarditis most common in and what can it sometimes cause?

Answer 41

Young people- cause of sudden death

Question 42

What are some symptoms of myocarditis?

Answer 42

Fever, chest pain, SOB, palpitations

Question 43

What are signs of myocarditis?

Answer 43

Arrhythmias, cardiac failure

Question 44

What are the most common causes of myocarditis?

Answer 44

Enteroviruses- Coxsackie A and B, echovirus

Question 45

How is myocarditis diagnosed?

Answer 45

Viral PCR, throat swab and stool for enterovirus

Question 46

What is the treatment for myocarditis?

Answer 46

Supportive

Question 47

What often occurs with myocarditis?

Answer 47

Pericarditis

Question 48

What is the main feature of pericarditis?

Answer 48

Chest pain

Question 49

What type of organism usually causes pericarditis?

Answer 49

Normally viral, bacterial is less common

Question 50

When is pericarditis common?

Answer 50

Post cardio surgery

Question 51

What is the treatment for pericarditis?

Answer 51

Antimicrobials and drainage