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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
What side does infective endocarditis normally affect in IV drug users?
Right
26
What does infective endocarditis often present as in IV drug users?
pneumonia
27
What is the prognosis for infective endocarditis in IV drug users like?
poor
28
What is the prognosis for infective endocarditis in IV drug users like?
poor
29
What is the general form of treatment of infective endocarditis?
High dose, frequent, IV antibiotics
30
Native value endocarditis treatment?
Benzylpenicillin & gentamicin
31
Prosthetic valve endocarditis treatment?
Vanomycin & gentamicin IV | valve replacement normally needed
32
Drug user endocarditis treatment?
Flucloxacillin IV
33
Staph aureus
Flucloxacillin IV
34
MRSA
Vanomycin & gentamicin IV
35
Viridans streptococci
Benzylpenicillin & gentamicin IV
36
Staph epidermidis
Vanomycin & gentamicin IV
37
Enterococcus sp.
Amoxicillin/ vanomycin/ gentamicin IV
38
How long are the antibiotics normally administered for?
4-6 weeks
39
How should the progress of an infective endocarditis patient be monitored?
Cardiac function Temperature Serum CRP
40
What 3 main things put people more at risk of contracting infective endocarditis?
Heart valve lesions Congenital heart defects Prosthetic heart valves
41
How can infective endocarditis be prevented?
Antibiotic prophylaxis in GI/ GU procedures if there is infection risk
42
Epidemiology of myocarditis?
Commonest in young people
43
Pathogenesis of myocarditis?
Mainly idiopathic
44
Symptoms of myocarditis?
Fever, chest pain, dyspnoea, fatigue, palpitations
45
Signs of myocarditis?
arrhythmias, cardiac failure, pyrexia
46
Main causes of myocarditis?
Enteroviruses (coxsackie A&B, echovirus and others)
47
Diagnosis of myocarditis?
viral culture (PCR) Throat swab/ stool for enteroviruses Throat swab/ serology for influenza
48
Treatment of myocarditis?
Treat the underlying cause
49
Pathogenesis of pericarditis?
Often occurs with myocarditis | Often secondary to virus (main), bactera, fungi or MI (dresslers)
50
Symptoms of pericarditis?
``` Chest pain: main feature, central, worse on lying flat, relieved on sitting up, worse on inspiration Pericardial rub Pericardial effusion Cardiac tamponade Fever ```
51
Diagnosis of pericarditis?
ECG - saddle shaped (concave) ST segment | Troponin levels raised
52
Treatment of infective pericarditis?
Supportive Analgesia Treat cause Try colchicine before steroids in relapse
53
Treatment of bacterial pericarditis?
Antibiotics + drainage
54
Features of constrictive pericarditis?
``` Rigid pericardium RHF symptoms (elevated JVP, Kussmaul's sign, soft diffuse apex, quiet heart sounds, third heart sound) ```
55
CXR features in constrictive pericarditis?
small heart, pericardial calcification
56
Treatment of constrictive pericarditis?
Surgical excision

Endocarditis, Myocarditis & pericarditis (1 decks)

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