Endocarditis, Pericarditis, Tamponade Flashcards
infection of the endocardial surface of the heart, most commonly the valves
infective endocarditis
what 2 organisms usually cause infective endocarditis?
staph
strep
what heart structure is most commonly affected by community acquired infective endocarditis?
mitral valve
what heart structure is most commonly affected by infective endocarditis due to IV drug use?
tricuspid valve
a patient presents with fever, murmur, petechiae, osler/janeway lesions, splinter hemorrhages, weight loss, cough, and splenomegaly. what are they likely experiencing?
infective endocarditis
what criteria is used to diagnose infective endocarditis?
modified duke criteria
what would an echo of a patient with infective endocarditis, show? (3)
vegetations
new regurg
abscess
what is the test of choice to diagnose infective endocarditis?
transthoracic echocardiogram
what are the treatment steps for a stable patient suspected of infective endocarditis?
admit
await blood culture before antibiotics
what are the treatment steps for an unstable patient suspected of infective endocarditis?
admit
begin empiric antibiotics after blood culture sample is taken
what antibiotic can be used as empiric therapy for infective endocarditis?
vancomycin
a patient’s blood culture for infective endocarditis comes back as strep positive. what antibiotic therapy should be given?
IV penicillin G
a patient’s blood culture for infective endocarditis comes back as staph positive. what antibiotic therapy should be given? (2)
IV nafcillin
IV cefazolin
a patient’s blood culture for infective endocarditis comes back as resistant staph. what antibiotic therapy should be given?
vancomycin
what are 2 antibiotic alternatives if a patient is allergic to penicillin?
ceftriaxone
vancomycin
when is surgical treatment indicated for infective endocarditis? (2)
mod-severe heart failure
unavailable antimicrobial therapy for specific organism
what medication can be used as prophylaxis for surgical procedures of infective endocarditis?
amoxicillin
what are 3 symptoms to indicate acute pericarditis?
pleuritic chest pain
ECG changes
pericardial friction rub
what position makes pleuritic chest pain worse? better?
laying down
leaning forward
what would an ECG of acute pericarditis show?
diffuse ST elevations
what would a CXR of acute pericarditis show?
large effusion
when should an echo be URGENTLY ordered for acute pericarditis?
if tamponade is suspected
what cardiac enzyme may be elevated in acute pericarditis?
troponin
what is the goal of therapy for acute pericarditis? (2)
pain relief
resolve inflammation
what treatment regimen is indicated for viral or idiopathic acute pericarditis?
colchicine (3 mo) + NSAIDS (2 wks)
what treatment regimen is indicated acute pericarditis in post MI patients?
colchicine + aspirin
what treatment can be considered for acute pericarditis if symptoms are refractory to NSAIDS/ASA and colchicine?
steroids (prednisone)
what 2 meds should be avoided in post MI patients?
NSAIDS
steroids
in increased amount of pericardial fluid, over 250 ml
pericardial effusion/tamponade
a patient presents with dyspnea, dysphagia, hoarseness, hiccups, and atypical chest pain. what are they likely experiencing?
pericardial effusion
a patient presents with hypotension, JVD, muffled heart tones, atypical chest pain, and tachycardia. what are they likely experiencing?
pericardial tamponade
an ECG shows flat T waves and low voltage. what is this?
pericardial effusion
an ECG shows electrical alternans and low voltage. what is this?
pericardial tamponade
what is the management for a mild pericardial effusion that is asymptomatic?
frequent observation with serial echos
what is the treatment for moderate to severe pericardial effusions that are symptomatic?
pericardiocentesis / percutaneous catheter drain
what is the last resort treatment of pericardial effusions?
pericardiectomy
what diagnostic is used to directly measure intracardiac and intrapericardial pressures in tamponades?
cardiac catheterization
inflammatory signs suggests what diagnosis?
acute idiopathic pericarditis
large effusion without inflammatory signs or tamponade suggests what diagnosis?
chronic idiopathic pericardial effusion
tamponade without inflammatory signs suggests what diagnosis?
malignant effusion
