endocarditis, pericarditis, Rheumatic fever Flashcards
Native Valve endocarditis
Strep. viridans, staph aureus, entercocci
IV drug users endocarditis
S. aureus, tricupsid valve most affected
Prosthetic valve endocarditis
S. aureus, gram (-), fungi
osler nodes
painful, violascous red lesions of fingers, toes, feet
janeway
painless red lesion of palms and soles
Roth spots
exudative lesions of retina
how do dx endocarditis
3 blood cultures 1 hr apart, echo, TEE (helpful to see what valves are involved), Duke Criteria
presence of vegetation is diagnositc
Duke Criteria major criteria
two + blood cultures of a typical causative microorganism, echo evidence showing a new valvular regurge
Duke Criteria minor criteria
predisposing factor, fever higher than 100.4, vascular phenomena (embolic dz, pulm infarction), immunologic phenomena, positive blood culture
tx of endocarditis
gentamicin + ceftriaxone or vanco
Rheumatic Heart Disease
immune response 2-3 wks after B hemolytic strep throat
most affected valve of RHD?
mitral, then aortic (2/3 may have chronic valvular change)
typical lesion of RHD?
perivascular granuloma w/ vasculitis
Jones Criteria Major?
carditis, erythema marginatum, subcutaneous nodules, chorea, polyarthritis
Jones Criteria Minor?
fever, polyarthralgias, reversible prolongation of PR interval, rapid ESR, C-reactive protien
RHD tx?
bed rest, salicylates (ASA), IM PCN
RHD tx for PCN alergic
erythromycin
what are some ways pelple can get endocarditis?
direct intravascular contaminations from bacteremia- dental, upper respiratory, urologic, and lower GI porcedures
what are some clinical features of endocarditis?
fever (can be absent in the elderly), nonspecific sx (cough, dyspnea, arthralgias, back or flank pain, GI complaints)
-pallor and splenomegaly, strokes and emboli may occur
what do almost 90% of endocarditis pts have ?
stable murmur, but this may be absent in right-sided infections
when is antibiotic prophylaxis recommended w/ invasive dental work or surgical procedures?
pt with prosthetic valves, previous IE, some congenital heart conditions, some acquireed valve diorsder, hypertrophic cardiomyopathy and cardiac trasnplant recipeitns w/ vavulopathy
what is the antibiotic prophylaxis drug of choice?
amoxicillin
what are some pericardial disorders?
acute pericarditis, perciardial effusion, or pericardial tamponade
what is the most common cause of acute pericarditis?
idiopathic or due to viral infxn
what are some other causes of acute pericarditis?
bacterial infxn,autoimmune or conncective tissue dz, neoplams, radiation theraphy, chemo, drug toxicity, cardiac surrgery, or myxedema
what population is percarditis most common?
men and those younger than 50
what can a pericardial effusion be secondary to?
pericarditis, uremia, or cardiac trauma
what is cardiac tamponade?
when fluid compromises cardiac filling and impairs cardiac ouput
what is the primary presenting sx of acute pericarditis?
sharp, pleuritic substernal radiating chest pain often relieved by sitting upright and leaning forward
what is characteristic of PC?
cardiac friction rub
how do constrictive pericarditis pts present?
slowly progressive dyspnea, fatigue, weakness, accompanied by edema, hepatomeglay, and ascites
how do pericardial effusions present?
+/- pain, cough dyspnea
how does cardiac tamponade present?
tachycardia, tachypnea, narrow pulse pressure, JVD. pulses paradoxus
what is pulses paradoxus?
an abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mmHg. When the drop is more than 10 mmHg, it is referred to as pulsus paradoxus. Pulsus paradoxus is not related to pulse rate or heart rate and it is not a paradoxical rise in systolic pressure.
etect beats on cardiac auscultation during inspiration that cannot be palpated at the radial pulse.[1] It results from an accentuated decrease of the blood pressure, which leads to the (radial) pulse not being palpable and may be accompanied by an increase in the jugular venous pressure height (Kussmaul’s sign). As is usual with inspiration, the heart rate is slightly increased,[2] due to decreased left ventricular output.
dx studies for pericarditis
CBC
cXR or echo- extent of effusion or pericardial clcification
what would an EKG show in pericarditis?
diffuse ST-segment elevation
what would an EKG show in effusion?
nonspecific T-wave changes and low WRS
what is electrical alternans?
onsecutive, normally-conducted QRS complexes alternate in height.
the heart swings backwards and forwards within a large fluid-filled pericardium
massive pericardial effusions
tx of pericarditis?
if pt is in hemodynamic compromise, do a pericardiaocentesis
may need a pericardial window
inflammatory percarditis tx?
NSAIS or steroids
constrictive pericarditis?
pericardectomy
aortic aneurysm
weakness and subsequent dilation of vessel wall: genetic defect or atherosclerotic
what ist he most common cause of aortic aneurysms?
artherosclerosis
but other causes include:
- syphilis
- GCA
- vasculitis
- trauma
- Marfan
- Ehlers-Danlos
who is most likely to have AA?
elderly males
what is the classic patient presentation of AA
elderly male smoker w/ CAD, ephysema, and renal impairment
what ere ist he most common place for AA?
abdominal (90%)
thoracic (105)
s/sx of A AA
asx
pulsating abdominal mass, sometimes accompanied by abdmonal or back pain
what is also present in 25% of pts with AA
renal or lower extremity occlusive dz
what are sx of thoracic AA?
asx
substernal, back, or neck pain, dyspnea, stridor, cough
-hoarseness, sx of superior vena cava syndrome
what is superior vena cava syndrome?
swelling and flushing of pts head/ neck
what are severe sx of AA
ripping or tearing CP
AAA rupture sx
severe back, abdominal, or flank pain, hypotension and shock
what is the dx study of choice for AAA?
Abdominal US
what is the current screening recommendation of rAA
single abdominal US fo men older than 65 you who have ever smoked (must be followed by contrast CT)
what is the dx study of choice for TAA
CT/ MRI
Rheumatic fever?
systemic immune response occuring usually 2-3 wks after B hemolytic streptococcal pharyngitis
what part o the body does rheumatic fever most commonly affect?
heart, joint, skin, CNS
what pt population is most lkely to get rheumatic fever?
recent immigrants; kids 5-15yo
what is rheumatic valve dz?
either self-limited or can lead to progressive deformity of the valve
what is the typical lesion of rheumatic valve dz?
perivascular granuloma w/ vasculitis
what is the most common valve involved in rheumatic valve dz
mitral, followed by aortic then tricuspid
what are the requirements for dx of rheumatic fever?
two major or one majore and two minors of the jones critera
what are the major criteria?
carditis erythema marginatum subcutaneous nodules, chorea polyarthritis
what are the minor criteria?
fever, polyarthralgia, reversible PR prolongations, increased ESR, or CRP
tx of Rheumaticfever?
IM PCN
ASA, corticosteroids
how can RFever be prevented
early tx of strep
benzathine PCN every 4 weeks is a common prophylactic regimen