Endocarditis, Myocarditis, Pericarditis Flashcards
What are the 3 types of Endocarditis?
- Infective Endocarditis
- Non-bacterial Thrombotic Endocarditis
- Non-bacterial Verrucous Endocarditis
(–libmann Sachs)
Acute Infective Endocarditis develops on ____ heart valve endothelium
Normal
Subacute Infective Endocarditis develops on a ____ heart valve endothelium
Damaged
Non-bacterial Thrombotic and Verrucous Endocarditis are sterile platelet vegetations on cardiac valves. The patients present with?
New cardiac murmur or embolic disease
What are the main risk factors for Infective Endocarditis?
Older males
IV drug use
Poor dentition
Structural heart disease or implantable device
IV drug use leads to ____ sided Endocarditis
Right sided Endocarditis
What is the pathogenesis of Infective Endocarditis?
- Endothelial injury with platelets/fibrin adherence
- Pathogen gains access to blood
- Pathogen adheres to platelet/fibrin on valve surface
- Pathogen proliferates on endothelium
What is the pathogenesis of Infective Endocarditis?
- Endothelial injury with platelets/fibrin adherence
- Pathogen gains access to the blood
- Pathogen adheres to platelets/fibrin on valve surface
- Pathogen proliferates on endothelium
Acute Infective Endocarditis usually involves highly virulent pathogens like?
Staph. Aureus
Subacute Infective Endocarditis usually involves less virulent pathogens like?
Strep. Viridans
Enterococci
What are the clinical manifestations of Infective Endocarditis?
- Fever, malaise, night sweats, weight loss
- New cardiac murmur
- Splinter hemorrhages, janeway lesions, roth spots, osler nodes
- Vascular embolic events
What are the clinical manifestations of Infective Endocarditis?
- Fever, malaise, night sweats, weight loss
- New cardiac murmur
- Splinter hemorrhages, janeway lesions, osler nodes, roth spots on eye
- Vascular embolic events
With infective endocarditis, a new cardiac murmur can be heard. What is the usual type?
Regurgitation
What is the diagnostic measures for Infective Endocarditis?
Echocardiography (TTE) and blood cultures before antibiotics
Possible complications of Infective Endocarditis?
- Heart failure and pericarditis
- Metastatic infection/embolization
- Renal complications
What is the treatment for Infective Endocarditis?
- Infective disease consult – empiric antibiotics (vancomycin)
- Remove cardiac devices/surgery
Endocarditis prophylaxis is used for what type of patients?
High risk patients and relative procedures
What patients should receive Endocarditis Prophylaxis?
- History of Infective Endocarditis
- Prosthetic heart valve replacement/repair/etc.
- Congenital heart disease
What procedures should high risk patients have Endocarditis Prophylaxis for?
Dental procedures
Common causes of Myocarditis?
- Idiopathic
- Viral = Coxsackie B virus, Parvovirus B19, HHV6
What are 3 common viruses that cause Myocarditis?
- Coxsackie B virus
- Parvovirus B19
- HHV-6
Myocarditis involves a highly variable clinical presentation. It usually occurs after a?
Viral infection
Myocarditis involves a highly variable clinical presentation. What are the 3 most common patterns?
- New onset/worsening heart failure
- Conduction abnormalities
- Acute MI-like syndrome
Diagnostic test for Myocarditis?
Endomyocardial Biopsy
Diagnostic test for Myocarditis?
Endomyocardial Biopsy
Levels of WBC, ESR, CRP, Troponins and BNP for Myocarditis?
ELEVATED
Treatment for Myocarditis?
Treat the heart failure or conduction abnormalities
Describe the layering of the heart
- Endocardium
- Myocardium
- Visceral (serous) pericardium
- Pericardial sac
- Parietal (serous) pericardium
- Fibrous pericardium
What is pericarditis?
Inflammation of Pericardium
Serous fluid in pericardial sac
Pericardial effusion
Pericardial fluid that compresses the heart and impairs function
Cardiac tamponade
Scarred, thickened and calcified pericardium that impairs function
Constrictive pericarditis
What is the most common disorder involving pericardium?
Acute Pericarditis
It is not usually necessary to determine the cause of Pericarditis, but what are the most common causes in developed and undeveloped nations?
Developed - idiopathic/viral
Undeveloped - Tuberculosis
Symptoms of Pericarditis – describe chest pain?
Chest pain - sharp and pleuritic (worse with inspiration)
– Chest pain is worse with lying down and better when sitting up and leaning forward
Symptoms of Pericarditis – describe chest pain?
Chest pain - sharp and pleuritic (worse with inspiration)
– Chest pain worse with lying down and better when sitting up and leaning forward
What is heard on auscultation with Pericarditis?
Friction rub
ECG changes with Pericarditis?
PR segment depression and/or ST elevation
ECG changes with Pericarditis and the treatment?
PR segment depression and/or ST elevation
– NSAIDs and Colchicine
Treatment for Pericarditis?
NSAIDs and Colchicine
