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Clin Med II > endocarditis, pericarditis, tamponade > Flashcards

endocarditis, pericarditis, tamponade Flashcards

1
Q

aortic valve endocarditis

A
  • most common valve involved

- can have aortic abscess which would indicate worse prognosis

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2
Q

tricuspid valve endocarditis

A
  • most common in IVDU

- septic PE also assoc

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3
Q

bicuspid valve endocarditis

A
  • not as common

- can lead to aortic valve involvement

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4
Q

risk factors for endocarditis

A
  • age > 60
  • underlying valve disease
  • male sex
  • IVDU
  • pior valve surgery
  • poor dentition
  • prior hx of IE
  • intravascular device or cardiac implantable device
  • chronic hemodyalisis
  • HIV infection
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5
Q

what pts should get abx prophylaxis for endocarditis

A
  • prosthetic valves and/or repairs
  • hx of IE
  • unrepaired cyanotic congenital heart disease
  • repair of congenital heart disease with residual shunt or regurg
  • valve regurg d/t structurally abnormal valve in transplant heart
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6
Q

what procedures do you give prophylactic abx for endocarditis?

A
  • dental work
  • respiratory tract procedures
  • skin and soft tissue procedures
  • cardiac surgery with prosthetic material
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7
Q

what abx do you use for endocarditis prophylaxis

A
  • po amoxicillin
  • cephalexin, clindamycin, or macrolides if allergic to PCN
  • given as 1 time dose 1 hour prior to surgery
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8
Q

most common bacterial cause of endocarditis in native valves

A
  • staph aureus- usually acutely ill
  • viridans group streptococci
  • enterococci
  • coag neg staph
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9
Q

most common bacterial cause of endocarditis in prosthetic valves

A
  • s aureus within 2 mo of surgery

- strep after 2 mo

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10
Q

most common bacterial cause of endocarditis in IVDU

A
  • MRSA
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11
Q

si/sx of endocarditis

A
  • fever
  • new onset murmur
  • janeway lesions
  • osler nodes
  • roth spots
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12
Q

janeway lesions

A
  • nontender erythematous macules on palms and soles

- indicates endocarditis

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13
Q

osler nodes

A
  • tender subq nodules on pads of fingers and toes

- indicates endocarditis

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14
Q

roth spots

A
  • exudative erythematous hemorrhagic lesions of retina with pale center
  • indicates endocarditis
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15
Q

complications of endocarditis

A
  • most related to septic emboli
  • valve insufficiency and HF
  • neurologic complications i.e. embolic stroke
  • septic emboli- kidneys, spleen
  • PE associated with tricuspid valve endocarditis
  • metastatic infections
  • systemic immune reactions
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16
Q

diagnosis of endocarditis

A
  • check CBC with diff, chem 10, LFTs, UA
  • EKG- may show conduction abnormalities
  • blood cultures
  • echo- gold stnd
  • TTE first but most pts also need TEE
  • ct scan for spetic emboli
  • valve culture in OR
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17
Q

what is the duke criteria used for?

A
  • stratifies pt risk for endocarditis
  • definite IE
  • possible IE
  • rejected IE
  • used only for left sided native valve endocarditis
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18
Q

definite IE

A
  • 2 major
  • 1 major and 3 minor
  • 5 minor
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19
Q

possible IE

A
  • 1 major and 1 minor

- 3 minor

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20
Q

rejected IE

A
  • firm alternate dx
  • resolution of sx after < 4 days abx
  • no pathologic evidence of IE found in surgery or autopsy
  • clinical criteria for possible or definite not met
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21
Q

major duke criteria

A
  • 2 pos blood cultures or persistent bacteremia
  • endocardial involvement on echo
  • new regurg murmur
22
Q

minor duke criteria

A
  • presence of predisposing conditions- IVDU or prior valve issues
  • fever > 38
  • vascular phenomenon
  • immunologic phenomenon
  • pos blood culture not meeting major criteria
  • serologic evidence of acute infection
23
Q

medical management of endocarditis

A
  • get blood cultures before abx
  • empiric abx therapy
  • IV abx 4-6 weeks via PICC line
  • oral suppression for recurrent endocarditis or risk factors for recurrence
  • most cases medically managed
24
Q

surgical management of endocarditis

A
  • infectious cause must be removed unless hemodyn unstable
  • acute HF unresponsive to tx
  • infection unresponsive to medical tx 7-10 days
  • recurrent endocarditis
  • continued embolization despite medical mgmt
25
Q

normal pericardial fluid

A
  • 15-50 ml

- made up of mostly plasma

26
Q

acute pericarditis

A
  • less than 2 weeks

- often viral

27
Q

noninfectious causes of acute peridcarditis

A
  • metastasis, radiation
  • autoimmune disorders
  • metabolic disorders
  • trauma
  • drugs- penicillins
  • idiopathic
  • dressler’s syndrome
28
Q

what is dressler’s syndrome

A
  • post MI -> irritation of pericaridum
29
Q

subacute pericarditis

A
  • greater than 2 weeks
30
Q

common causes of subacute pericarditis

A
  • Tb
  • dressler’s syndrome
  • radiation
31
Q

clinical presentation of pericarditis

A
  • pleuritic chest pain
  • dyspnea
  • recent illness
  • know carcinoma, autoimmune disorders, recent MI, or cardiac surgery
32
Q

PE findings for pericarditis

A
  • pericardial friction rub*
  • fever, malaise
  • if bacterial pt will look very ill
  • neoplastic cause is usually painless and presents with hemodyn instability
33
Q

EKG changes associated with pericarditis

A
  • diffuse ST elevations
34
Q

treatment for pericarditis

A
  • ASA 1-2 weeks
  • NSAIDs 2-3 weeks, usually indomethacin or ibuprofen
  • if resistant or recurrent tx with steroid
  • Dressler’s syndrome- colchicine X 3 months +/- NSAIDs
  • mostly treated as outpatient
35
Q

admission for pericarditis

A
  • fever > 100.4
  • subacute course
  • tamponade
  • large pericardial effusion
  • immunosuppressed
  • anticoagulation
  • acute trauma
  • fail to improve with OP tx
  • elevated cardiac enzymes
36
Q

complications of pericarditis

A
  • constrictive pericarditis

- tamponade

37
Q

constrictive pericarditis

A
  • inflammation -> chronic thickened, fibrotic adherent pericardium
  • restricts diastolic filling
  • chronically elevated venous pressures
  • poor prognosis
38
Q

causes of constrictive pericarditis

A
  • radiation in thorax
  • cardiac surgery
  • viral pericarditis
  • Tb
  • histoplasmosis
39
Q

clinical presentation of constrictive pericarditis

A
  • slow and progressive onset dyspnea, fatigue, weakness
  • chronic edema, ascites
  • prior pericarditis, MI, radiation, or cardiac surgery
40
Q

PE findings of constrictive pericarditis

A
  • elevated JVD
  • kussmaul sign
  • pericardial knock
  • hepatic congestion
  • afib
41
Q

diagnostic tests for constrictive pericarditis

A
  • CXR may show pericardial calcifications
  • thickening > 4 mm on CT or MRI
  • echo- thickened pericardium and septal bounce
  • cardiac cath
42
Q

treatment for constrictive pericarditis

A
  • diuretics
  • refer to cardiology
  • pericardiectomy
43
Q

pericardial effusion

A
  • accumulation of fluid > 15-50 mL
44
Q

clinical presentation of pericardial effusion

A
  • may be asymptomatic esp if chronic
  • chest pain, dyspnea, cough
  • recent pericarditis, carcinoma, cardiac surgery, MI or illness
  • pericardial friction rub*
  • muffled heart sounds*
45
Q

diagnostic tests for pericardial effusion

A
  • CXR may show widened mediastinum if large effusion
  • EKG- low voltage or electrical alternans
  • echo- gold std
46
Q

treatment of pericardial effusions

A
  • if small can observe with serial echos
  • if mod-lg effusion do pericardiocentesis, pericardial drain placement
  • recurrent- pericardial window
47
Q

tamponade

A
  • accumulation of fluid in pericardial space that causes significant change in hemodynamics
  • restricts venous return and ventricular filling
  • complication of pericardial effusions based on how fast effusion accumulates
48
Q

acute tamponade presentation

A
  • life threatening*
  • death
  • cardiogenic shock, hypotension, tacycardia
  • dyspnea, tachypnea
  • chest pain
  • elevated JVD
  • muted heart sounds
  • decreased urine output and end organ perfusion
49
Q

beck’s triad of tamponade

A
  • hypotension
  • elevated JVD
  • muffled heart sounds
50
Q

pulsus paradoxus

A
  • occurs in tamponade

- greater than 10 mm decline in systolic pressure during inspiration d/t impaired LV filling

51
Q

diagnosis of tamponade

A
  • echo

- any RV compression is considered tamponade

52
Q

treatment of tamponade

A
  • emergent pericardiocentesis
  • if s/p cardiac surgery then reopen sternotomy
  • if trauma or surgery related pericardial drain is sometimes left in place

Clin Med II (16 decks)

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