Endocarditis, Myocarditis, Pericarditis

Question 1

Infective Endocarditis Acute and Subacute causes

Answer 1

Acute: S. Aureus vegetations on NORMAL Valve
Subacute: S. Viridans and Enterococci on DAMAGED valve

Question 2

Non-bacterial thrombotic endocarditis

Answer 2

Sterile platelet vegetations on valves

Usually due to metastatic malignancy

Question 3

Non-Bacterial verrucous endocarditis

Answer 3

aka Libman-Sacks

SLE

Question 4

Risk factors for Infective Endocarditis

Answer 4

Age>60
Male
IV drug use (Right-sided endocarditis)
Poor dentition 
Structural Heart Dz
Cardiac Devices

Question 5

Patients with colon cancer or IBD are at a higher risk of infective endocarditis due to what organism?

Answer 5

S. Bovis

Question 6

HACEK group of infective endocarditis causing organisms

Answer 6

Haemophilus
Actinobacillus
Cardiobacterium
Eiknella
Kingella

Question 7

PE findings of Inf. Endocarditis

Answer 7

Fever
New murmur
Osler nodes
Splinter Hemorrhages
Janeway lesions 
Roth spots

Question 8

Steps to diagnose Inf. Endocarditis

Answer 8

Use Modified Duke Criteria

1. Trans Thoracic ECHO
2. Trans Esophageal if high suspicion with negative TTE

Question 9

First line treatment of Inf. Endocarditis

Answer 9

IV Vancomycin

Question 10

When should Endocarditis Prophylaxis be used?

Answer 10

Hx of:

1. IE
2. Prosthetic heart valve replacement
3. Cardiac valve repair
4. Transplant with Regurge
5. Dental Procedures

Amoxicillin 2g 30-60m prior

Question 11

What is the 3rd leading cause of death in athletes?

Answer 11

Myocarditis (random fact)

Question 12

Causes of Myocarditis

Answer 12

1. Idiopathic

2. Viral

Question 13

3 primary viruses that cause myocarditis

Answer 13

1. Coxsackie B
2. HHV6
3. Parvo

Question 14

3 patterns of myocarditis

Answer 14

1. New onset and/or worsening HF
2. Conduction Abnormalities
3. Acute MI like syndrome

Question 15

Lab findings indicating Myocarditis

Answer 15

1. Leukocytosis
2. Elevated ESR and CRP
3. Troponin Elevated
4. Elevated BNP

Question 16

Treatment of Myocarditis

Answer 16

1. ACEi
2. B-blockers
3. Diuretics as needed
4. HF (LVAD)

Question 17

2 layers of the Pericardium

Answer 17

1. Outer Fibrous Sac

2. Serous Sac: Parietal and Visceral

Question 18

Classifications of Pericarditis

Answer 18

1. Pericarditis- acute, subacute, chronic, recurrent
2. Pericardial Effusion- fluid in sac
3. Cardiac Tamponade- fluid compresses heart impairing diastolic filling
4. Constrictive Pericarditis- Scarred, thickened pericardium

Question 19

What is the main cause of pericarditis in developing nations?

Answer 19

TB

Question 20

PE findings in Pericarditis

Answer 20

1. Retrosternal CP
2. Pleuritic pain (worse on inspiration)
3. Worse when supine
4. Friction Rub

Question 21

ECG finding in pericarditis

Answer 21

ST segment elevation with PR segment depression

Question 22

Beck’s Triad for Cardiac Tamponade

Answer 22

1. Hypotension
2. Muffled heart sounds
3. JVD

Question 23

What is Pulsus Paradoxus

Answer 23

Drop in Systolic pressure >10mmHg during inspiration

Question 24

ECG changes in Cardiac Tamponade

Answer 24

1. Electrical Alternans- alternating amplitude of QRS

2. Low amplitude QRS

Question 25

Jugular Venous Waveform changes seen in Cardiac Tamponade

Answer 25

absent Y descent: impaired ventricular filling

Question 26

Symptoms associated with constrictive pericarditis

Answer 26

Volume overload: Edema, Anasarca, ascites, etc.
DOE
JVD
Kussmaul’s sign- JVP doesn’t decrease with inspiration

Question 27

Treatment for Constrictive pericarditis

Answer 27

pericardiectomy

Question 28

Treatment for Cardiac Tamponade

Answer 28

Pericardiocentesis