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Endocarditis, Myocarditis & pericarditis > Endocarditis, Myocarditis & Pericarditis > Flashcards

Endocarditis, Myocarditis & Pericarditis Flashcards

1
Q

Define sepsis

A

Bacteria in the blood

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2
Q

Why can blood cultures be unreliable?

A

Easy contamination - skin contaminants

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3
Q

Strep pneumonia often indicates?

A

Pneumonia or meningitis

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4
Q

E coli/ Klebsiella/ cloakrooms often indicate?

A

Urniary tract/ GI infection

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5
Q

Staph aureus often indicates?

A

Skin/ wound infection
Bone/ joint infection
Endocarditis

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6
Q

Commonest coagulase -ve staph
Often a skin contaminant
Known to infect prosthetic material

A

Staph epidermidis

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7
Q

Fever = new murmur

A

Endocarditis until proven otherwise

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8
Q

Majority of people with infective endocarditis patients are from what age group?

A

> 50 years old

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9
Q

Predisposing factors for infective endocarditis?

A

Heart valve abnormalities (stenosis, post rheumatic fever, congenital heart disease)
Prosthetic heart valves
IV drug users
Intravascular lines

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10
Q

Brief pathogenesis?

A

Valve damage, turbulent blood flow, platelet/ fibrin deposition, bacteraemia (dental work?), microbial vegetation, breaking off of the vegetation, this lodges in a capillary bed, abscess or haemorrhage

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11
Q

Infective endocarditis more commonly effects which side of the heat?

A

Left side of the heart

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12
Q

Infective endocarditis more commonly effects which valves?

A

mitral and aortic

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13
Q

4 common causative organisms of infective endocarditis?

A

Staph aureus
Viridans streptococci
Enterococcus sp.
Staph epidermidis

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14
Q

Two classes of atypical causative organisms of infective endocarditis?

A

Gram -ve

Fungi

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15
Q

2 presenting symptoms of acute endocarditis?

A

Cardiac failure presentation, severe sepsis

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16
Q

5 subacute presentation of endocarditis?

A 
Fever
Malaise
Weight loss
Breathlessness
Tiredness
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17
Q

Clinical signs of subacute infective endocarditis?

A

Fever, clubbing, new/ changed murmur, splinter haemorrhages, Microscopic haematuria, splenomegaly, Roth spots, Janeway lesions, Oslers nodes

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18
Q

Describe oslers nodes

A

Sore, red lesions

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19
Q

Describe Janeway lesions

A

Small, non-tender, red, non-hemorrhagic lesions on palms/ soles of feet

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20
Q

How should blood cultures be taken to diagnose infective endocarditis?

A

3 sets from different sites at the peak of fever BEFORE any antibiotics

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21
Q

Other diagnostic techniques for infective endocarditis?

A

U&Es - haematuria
CXR - cardiomegaly
ECG - long PR intervals at regular intervals

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22
Q

Which type of ECHO should be used diagnostically for infective endocarditis?

A

transoesophageal

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23
Q

What is the normal time and cause of early prosthetic valve infective endocarditis?

A

At the time of surgery

Staph aureus or Staph epidermidis

24
Q

Time and causes late infective endocarditis?

A

Years after valve insertion

co-incidental infection, could be many types of organisms

25
Q

What side does infective endocarditis normally affect in IV drug users?

26
Q

What does infective endocarditis often present as in IV drug users?

27
Q

What is the prognosis for infective endocarditis in IV drug users like?

28
Q

What is the prognosis for infective endocarditis in IV drug users like?

29
Q

What is the general form of treatment of infective endocarditis?

A

High dose, frequent, IV antibiotics

30
Q

Native value endocarditis treatment?

A

Benzylpenicillin & gentamicin

31
Q

Prosthetic valve endocarditis treatment?

A

Vanomycin & gentamicin IV

valve replacement normally needed

32
Q

Drug user endocarditis treatment?

A

Flucloxacillin IV

33
Q

Staph aureus

A

Flucloxacillin IV

34
Q

MRSA

A

Vanomycin & gentamicin IV

35
Q

Viridans streptococci

A

Benzylpenicillin & gentamicin IV

36
Q

Staph epidermidis

A

Vanomycin & gentamicin IV

37
Q

Enterococcus sp.

A

Amoxicillin/ vanomycin/ gentamicin IV

38
Q

How long are the antibiotics normally administered for?

39
Q

How should the progress of an infective endocarditis patient be monitored?

A

Cardiac function
Temperature
Serum CRP

40
Q

What 3 main things put people more at risk of contracting infective endocarditis?

A

Heart valve lesions
Congenital heart defects
Prosthetic heart valves

41
Q

How can infective endocarditis be prevented?

A

Antibiotic prophylaxis in GI/ GU procedures if there is infection risk

42
Q

Epidemiology of myocarditis?

A

Commonest in young people

43
Q

Pathogenesis of myocarditis?

A

Mainly idiopathic

44
Q

Symptoms of myocarditis?

A

Fever, chest pain, dyspnoea, fatigue, palpitations

45
Q

Signs of myocarditis?

A

arrhythmias, cardiac failure, pyrexia

46
Q

Main causes of myocarditis?

A

Enteroviruses (coxsackie A&B, echovirus and others)

47
Q

Diagnosis of myocarditis?

A

viral culture (PCR)
Throat swab/ stool for enteroviruses
Throat swab/ serology for influenza

48
Q

Treatment of myocarditis?

A

Treat the underlying cause

49
Q

Pathogenesis of pericarditis?

A

Often occurs with myocarditis

Often secondary to virus (main), bactera, fungi or MI (dresslers)

50
Q

Symptoms of pericarditis?

A 
Chest pain: main feature, central, worse on lying flat, relieved on sitting up, worse on inspiration
Pericardial rub
Pericardial effusion
Cardiac tamponade
Fever
51
Q

Diagnosis of pericarditis?

A

ECG - saddle shaped (concave) ST segment

Troponin levels raised

52
Q

Treatment of infective pericarditis?

A

Supportive
Analgesia
Treat cause
Try colchicine before steroids in relapse

53
Q

Treatment of bacterial pericarditis?

A

Antibiotics + drainage

54
Q

Features of constrictive pericarditis?

A 
Rigid pericardium
RHF symptoms (elevated JVP, Kussmaul's sign, soft diffuse apex, quiet heart sounds, third heart sound)
55
Q

CXR features in constrictive pericarditis?

A

small heart, pericardial calcification

56
Q

Treatment of constrictive pericarditis?

A

Surgical excision

Endocarditis, Myocarditis & pericarditis (1 decks)

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