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Oxygen supply and exchange > Endocarditis, pericarditis, myocarditis, and vasculitis > Flashcards

Endocarditis, pericarditis, myocarditis, and vasculitis Flashcards

1
Q

how to measure lactate levels

A

by taking a blood gas

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2
Q

what are the septic six

A 
give high flow oxygen 
take blood cultures
give IV antibiotics 
give a fluid challenge - crystalloid 
measure lactate 
measure urine output
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3
Q

what does CURB-65 stand for

A

CURB-65 = Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older.

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4
Q

when do you use the CURB-65 score

A

The CURB-65 calculator can be used in the emergency department setting to risk stratify a patient’s community acquired pneumonia.

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5
Q

risk factors for pneumonia

A
  • Elderly/young children, underlying respiratory disease such as asthma or COPD,

immunosuppression/HIV (every person presenting with pneumonia should have an HIV test), and co-morbidities such as heart disease.

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6
Q

signs and symptoms of typical pneumonia

A 
fever 
productive cough 
discoloured sputum 
SOB 
pleuritic chest pain 
high RR 
low oxygen sats 
crackles/bronchial breathing on examination

Clinical features of an atypical pneumonia tend to be more constitutional, low grade fever, malaise, headaches, myalgia, cough.

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7
Q

difference between typical and atypical pneumonia

A

Symptoms of atypical pneumonia tend to be milder and more persistent than those of typical pneumonia, which appear suddenly, and cause a more serious illness. Atypical pneumonia requires different antibiotics than typical pneumonia, which is commonly caused by the bacteria Streptococcus pneumonia.

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8
Q

3 clinical signs of a PE

A

Shortness of breath. This symptom typically appears suddenly and always gets worse with exertion.
Chest pain. You may feel like you’re having a heart attack. …
Cough. The cough may produce bloody or blood-streaked sputum.

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9
Q

how do we manage pneumonia

A

Management of pneumonia is supportive with fluids and supplemental oxygen alongside antibiotics. Initially broad-spectrum corresponding to trust guidelines before narrowing once blood cultures/sensitivities are back.

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10
Q

4 steps in the pathophysiology of pneumonia

A

consolidation
red hepatisation
grey hepatisation
resolution

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11
Q

what is consolidation in pneumonia and when does it occur

A

Occurs in the first 24 hours

Cellular exudates containing neutrophils, lymphocytes and fibrin replaces the alveolar air

Capillaries in the surrounding alveolar walls become congested

The infection spreads to the hilum and pleura fairly rapidly; pleurisy occurs

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12
Q

red hepatisation and when does it occur

A

Occurs in the 2-3 days after Consolidation

Lungs become hyperaemic (the increase of blood flow to different tissues in the body); alveolar capillaries are engorged with blood

Fibrinous exudates fill the alveoli

This stage is characterised by presence of many erythrocytes, neutrophils, desquamated epithelial cells, and fibrin within the alveoli

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13
Q

what is grey hepatisation and when does it occur

A

Occurs in the 2-3 days after Red Hepatisation

This is an avascular stage
The lung appears grey-brown because of fibrinopurulent exudates, disintegration of red cells, and hemosiderin(a protein compound that stores iron in your tissues)

The pressure of exudates in the alveoli causes compression of the capillaries
Leukocytes migrate into the congested alveoli

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14
Q

what is hemiosiderin

A

a protein compound that stores iron in your tissues

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15
Q

what is resolution

A

Characterised by resorption and restoration of the pulmonary architecture

A large number of macrophages enter the alveolar spaces

Phagocytosis of the bacteria-laden leucocytes occurs

Consolidation tissue re-aerates and the fluid infiltrate causes sputum
Fibrinous inflammation may extend to and across the pleural space, causing a rub heard by auscultation, and it may lead to resolution or to organisation and pleural adhesions

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16
Q

You are an FY2 working in ED. Paramedics bring in a 36 year old male who was found passed out on a bench. They report he is pyrexial, tachycardic and hypotensive.

The facts - acutely unwell, IVDU patient, septic, raised inflammatory markers, systolic murmur on examination.

A

Top differential acute bacterial endocarditis.
Other concerns are PE, pneumonia, bacterial cellulitis, compounding by overdose and intoxication, underlying HIV infection.

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17
Q

endocarditis

A

inflammation of the inner lining of the heart

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18
Q

for endocarditis how many blood cultures should you take

A

3 cultures from 3 different sites

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19
Q

what should you use to treat infective endocarditis

and for how Long

A

vancomycin and gentamicin ( trust guidelines) - broad spectrum antibiotics

6 weeks

20
Q

what can you use to diagnose this

A

ECHO - diagnostic, either transthoracic(TTE) or transoesophageal(TOE). Transthoracic is more common and more easily accessible, but often a diagnosis of bacterial endocarditis cannot be made or excluded on a TTE, so a transoesphageal is needed to rule it in/out.

21
Q

what is an echo

A

An echocardiogram, or “echo”, is a scan used to look at the heart and nearby blood vessels. It’s a type of ultrasound scan

22
Q

IE typically develops on the valvular surfaces of the heart, which have sustained endothelial damage secondary to turbulent blood flow. As a result, platelets and fibrin adhere to the underlying collagen surface and create a prothrombotic milieu. Bacteraemia leads to colonisation of the thrombus and perpetuates further fibrin deposition and platelet aggregation, which develops into a mature infected vegetation.

Patients who develop native valve endocarditis in the absence of intravenous drug use commonly present with viridans group streptococci, enterococci, or staphylococci, with other pathogens being less frequent. Intravenous drug users often present with right-sided valvular involvement and are more likely to haveS aureus, streptococci, gram-negative bacilli, or polymicrobial infections.

Acute IE is usually associated with what organism

A

Staphylococcus aureus

23
Q

what are the causes of IE

A 
Lots of different bacterial causes 
Strep Viridans
Staphylococcus aureus
Enterococci
Coagulase-negative staphylococci
Haemophilus parainfluenzae
Fungal (less common)
24
Q

risk factors for IE

A 
Artificial heart valves
previous IE
intracardiac devices such as implantable defibrillators
chronic rheumatic heart disease
age-related degeneration of valves
IVDU
immunosuppression
recent dental procedure
25
Q

symptoms of acute IE

time period

A

develops over days to weeks

characterised by fevers, tachycardia, fatigue and progressive damage to cardiac structures

26
Q

subacute IE symptoms

time period

A

develops weeks to months
patients will complain of vague constitutional symptoms - low grade fever, weight loss, fatigue , night sweats and appetite loss

27
Q

what is dukes criteria

A

The Duke criteria are a set of clinical criteria set forward for the diagnosis of infective endocarditis. For diagnosis the requirement is: 2 major and 1 minor criterion or. 1 major and 3 minor criteria or. 5 minor criteria.

28
Q

signs on examination of IE

A

Osler nodes - painful
laneway lesions
splinter haemorrhages
moths sports on fundoscopy

29
Q

what blood are raised in pericarditis

A

CRP and troponin

in this heart sound heard like stepping on snow

30
Q

in pericarditis what would you see on an ECG

A

wide spread ST elevation and PR depression

31
Q

what is pericarditis

A

Inflammation of the pericardium. Over 90% is idiopathic/viral related (coxsackie, EBV, Mumps, CMV, varicella, HIV, Parvovirus) - often patients will have had preceding URTIs.

32
Q

causes of pericarditis

A

viral - cosackie

Systemic autoimmune disordersSystemic immune responses (Post-MI, cardiac surgery, radiotherapy)Bacterial/fungal/parasiticNeoplasticUraemicDrug related

33
Q

who is more likely to get pericarditis

A

males

aged 20-50

34
Q

risk factors for pericarditis

A

cardiac surgery
transmural MI
systemic autoimmune disorders

35
Q

what is a transmural MI

A

A transmural myocardial infarction refers to a myocardial infarction that involves the full thickness of the myocardium

36
Q

symptoms of pericarditis

on auscultation what do you here

A 
sharp pleuritic chest pain 
radiating pain to trapezius ridges ( phrenic nerve innervates the pericardium and trapezius ridges) 
relieved when leaning forward 
worse on lying down 
not related to exercise 
not relieved by GTN

pericardial rub on auscultation - like treading on snow

37
Q

how to manage pericarditis

A

in community with NSAIDS as well as management of underlying cause

38
Q

one complication of pericarditis is a large pericardial effusion how do we manage this

A

drained with pericardiocentesis

39
Q

myocarditis

A

Myocarditis is an inflammation of the heart muscle (myocardium).

INFLAMMATION OF THE MYOCARDIUM IN THE ABSENCE OF THE PREDOMINANT ACUTE OR CHRONIC ISCHAEMIA CHARACTERISTIC OF CORONARY ARTERY DISEASE

40
Q

causes of myocarditis

A

infectious cause invading the myocardium
local and systemic immunological activation
humoral activating causing local inflammation and anti-heart antibody production and further myonecrosis

41
Q

causes of myocarditis

A

viral related - adenovirus
cocaine
SLE and sarcodisosis

42
Q

who is most likely affected in myocarditis

A

under 50 years of age

43
Q

symptoms of myocarditis

A 
chest pain
SOB 
syncope 
fatigue 
palpitations 
can cause arrhymias , cardiac failure and dilated cardiomyopathy
44
Q

what disease can myocarditis be confused with

A

acute coronary syndrome - CAG to rule out

45
Q

ecg changes associated with myocarditis

A 
ECG changes
Most common = sinus tachy with non specific ST segment/T wave changes
QRS / QT prolongation
Diffuse T wave inversion
Ventricular arrhythmias
AV conduction defects
Widespread ST changes - pericarditis
46
Q

management of myocarditis

A

Supportive - conventional heart failure therapy to stabilise - ACE-i, diuretics, vasodilators, beta-blocker (once not acutely decompensated), spironolactone.

Treat underlying cause (e.g autoimmune - steroids)

47
Q

vasculitis

A

Inflammation of blood vessels

Categorised by size of vessels and ANCA association

Often have generalised symptoms, with a few specific ones for each condition

Many impact the kidneys and lungs

Oxygen supply and exchange (24 decks)

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