Endocarditis, Myocarditis, Pericarditis Flashcards
Classifications of Endocarditis:
Typically due to S Aureus infection of heart valve
Fatal in <6 weeks if untreated
Acute infectious endocarditis
Classifications of Endocarditis:
Typically due to S Viridans or Enterococcus infection of heart valve
Fatal in >6 weeks if untreated
Subacute infectious endocarditis
Classifications of Endocarditis:
Sterile platelet vegetations on heart valves
Typically seen in pts with metastatic malignancy
Typically presents as new murmur in setting of embolic disease
Non-bacterial thrombotic endocarditis
Classifications of Endocarditis:
Sterile platelet vegetations on heart valves
Typically seen in pt with SLE
Non-bacterial verrucous endocarditis
aka Libman-Sacks endocarditis
The following are risk factors for what disease?
Older age Male IVDU Poor dentition Structural heart disease Implanted cardiac device
Infective endocarditis
Pathogenesis of infective endocarditis
- Endothelial injury w/ adherence of platelets
- Introduction of bacteria to the blood
- Bacteria adhere to platelet-fibrin nidus
- Proliferation, embolization and hematogenous spread
*S. Aureus can infect normal heart valve endothelium
Diagnosis?
Fever (>38C)
Constitutional symptoms (anorexia, malaise, night sweats)
New cardiac murmur
Vascular embolic events
Splinter hemorrhages
Osler’s nodes (painful red lesions in distal extremities)
Roth spots (retinal hemorrhage with white center)
Infective endocarditis
Diagnostic criteria for infective endocarditis
Modified Duke Criteria
Based on echocardiography, blood cultures
Complications of infective endocarditis
- Heart failure, pericarditis, perivalvular abscess
- Metastatic infection
- Renal complications (due to embolization)
Infective endocarditis treatment and management
- Obtain ID consult
- Start Vancomycin, then tailor to specific bug after culture (ISDA guidelines)
- Remove cardiac devices
- Consider surgical consult
Indications for infective endocarditis prophylaxis
- Hx of infective endocarditis
- Hx of prosthetic valve repair or replacement
- Hx of heart transplant with valve regurgitation
- Congenital heart disease
- Dental procedures
- Typically oral Amoxicillin before procedure
- Prophylaxis not necessary prior to GI/GU procedures unless known infection present
Common causes of myocarditis
- Idiopathic
- Infectious: Coxsackie B, Parvovirus, HHV-6
Viral myocarditis pathogenesis
- Virus infects myocytes
- T-cells work to clear viral infection, loss of tolerance to myocardial cells
- Cell mediated myocyte damage
Diagnosis?
Recent viral infection (fever, myalgias, etc.)
New onset or worsening heart failure or Cardiac conduction abnormality or Acute MI-like syndrome
Viral myocarditis
Diagnosis of myocarditis
Endocardial biopsy
*also imaging (ischemia, arrhythmia, etc) and lab testing (leukocytosis)
Treatment and management of viral myocarditis
Treat heart failure if present (ACEi, ARB, B blockers, Aldosterone receptor blocker, LV assist device, ECMO, transplant)
Anti-arrhythmic as needed
Transcutaneous or transvenous pacing if bradycaric
Major causes of pericardial disease
- Idiopathic
- Infectious (mainly viral)
- Noninfectious (autoimmune, malignancy, cardiac, trauma, metabolic, radiation, drugs)
- in developed world: idiopathic or viral
- in developing world: TB
Diagnosis?
Sudden onset, sharp, retrosternal, pleuritic chest pain
Pain relieved by sitting up and leaning forward
Pain worsened by laying down
Pericardial friction rub on auscultation
Acute pericarditis
Diagnostic features of pericarditis
ST elevations and PR depression on ECG
*definitive cause of acute pericarditis is not needed because it has a benign course for most pts
Diagnosis?
Chest pain, dyspnea, fatigue, tachy
Beck’s triad: hypotension, muffled heart sounds, JVD
Pericardial friction rub
Absent y descent on JV waveforms
Pulsus paradoxus (decrease in SBP on inspiration)
Alternating or low amplitude QRS on ECG
Enlarged cardiac silhouette on CXR
Cardiac tamponade
Diagnosis?
Peripheral edema, abdominal swelling, ascites, effusions
Fatigue, exercise intolerance
Prominent x and y descents on JV waveform
JVD
Pulsus paradoxus (SBP increases on inspiration)
Kussmaul’ sign (JVP fails to decrease on inspiration
Pericardial knock (high pitched diastolic sound)
Pericardial calcifications on CXR
Constrictive pericarditis
*difficult to differentiate from restrictive cardiomyopathy
Treatment for acute pericarditis
- NSAIDs (indomethacin) until resolution, then taper
- Colchicine for 3 months
