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Cardio > Endocarditis, Myocarditis, Pericarditis > Flashcards

Endocarditis, Myocarditis, Pericarditis Flashcards

1
Q

Classifications of Endocarditis:

Typically due to S Aureus infection of heart valve
Fatal in <6 weeks if untreated

A

Acute infectious endocarditis

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2
Q

Classifications of Endocarditis:

Typically due to S Viridans or Enterococcus infection of heart valve
Fatal in >6 weeks if untreated

A

Subacute infectious endocarditis

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3
Q

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

A

Non-bacterial thrombotic endocarditis

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4
Q

Classifications of Endocarditis:

Sterile platelet vegetations on heart valves
Typically seen in pt with SLE

A

Non-bacterial verrucous endocarditis

aka Libman-Sacks endocarditis

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5
Q

The following are risk factors for what disease?

Older age
Male
IVDU
Poor dentition
Structural heart disease
Implanted cardiac device
A

Infective endocarditis

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6
Q

Pathogenesis of infective endocarditis

A
  1. Endothelial injury w/ adherence of platelets
  2. Introduction of bacteria to the blood
  3. Bacteria adhere to platelet-fibrin nidus
  4. Proliferation, embolization and hematogenous spread

*S. Aureus can infect normal heart valve endothelium

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7
Q

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)

A

Infective endocarditis

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8
Q

Diagnostic criteria for infective endocarditis

A

Modified Duke Criteria

Based on echocardiography, blood cultures

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9
Q

Complications of infective endocarditis

A
  • Heart failure, pericarditis, perivalvular abscess
  • Metastatic infection
  • Renal complications (due to embolization)
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10
Q

Infective endocarditis treatment and management

A
  • Obtain ID consult
  • Start Vancomycin, then tailor to specific bug after culture (ISDA guidelines)
  • Remove cardiac devices
  • Consider surgical consult
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11
Q

Indications for infective endocarditis prophylaxis

A
  • 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
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12
Q

Common causes of myocarditis

A
  • Idiopathic

- Infectious: Coxsackie B, Parvovirus, HHV-6

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13
Q

Viral myocarditis pathogenesis

A
  1. Virus infects myocytes
  2. T-cells work to clear viral infection, loss of tolerance to myocardial cells
  3. Cell mediated myocyte damage
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14
Q

Diagnosis?

Recent viral infection (fever, myalgias, etc.)

New onset or worsening heart failure
or
Cardiac conduction abnormality
or
Acute MI-like syndrome
A

Viral myocarditis

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15
Q

Diagnosis of myocarditis

A

Endocardial biopsy

*also imaging (ischemia, arrhythmia, etc) and lab testing (leukocytosis)

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16
Q

Treatment and management of viral myocarditis

A

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

17
Q

Major causes of pericardial disease

A
  1. Idiopathic
  2. Infectious (mainly viral)
  3. Noninfectious (autoimmune, malignancy, cardiac, trauma, metabolic, radiation, drugs)
  • in developed world: idiopathic or viral
  • in developing world: TB
18
Q

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

A

Acute pericarditis

19
Q

Diagnostic features of pericarditis

A

ST elevations and PR depression on ECG

*definitive cause of acute pericarditis is not needed because it has a benign course for most pts

20
Q

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

A

Cardiac tamponade

21
Q

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

A

Constrictive pericarditis

*difficult to differentiate from restrictive cardiomyopathy

22
Q

Treatment for acute pericarditis

A
  • NSAIDs (indomethacin) until resolution, then taper

- Colchicine for 3 months

Cardio (18 decks)

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