Endocarditits Myocarditis Pericarditis - Dr. Buchele

Question 1

Infective Endocarditis 2 types

Answer 1

Acute and Subacute

Question 2

Acute Infective Endocarditis

Answer 2

= from Staph Aureus (very virulent)
= on normal valve endothelium
= fatal in 6weeks if not treated

Question 3

Subacute Infective Endocarditis

Answer 3

= Staph viridans + Enterococcus
= on damaged heart valve endothelium
= longer then 6 weeks fatal if not treated

Question 4

Non-bacterial thrombotic endocarditis other name and what is it and when is it seen

Answer 4

Marantic Endocarditis

1. Sterile plt vegetation on valves
2. Usually during metastatic malignancy pts
3. Usually seen during autopsy
   - new murmur after MI

Question 5

Non-Bacterial Verrucous endocarditis other name and what is it and when does it happen

Answer 5

Libman-Sacks endocarditis

1. Sterile plt vegetation on valves
2. Usually in SLE pts
   - new murmur after MI

Question 6

Risks for infective endocarditis

Answer 6

1. Male
2. IV drug = right sided endocarditis , staph aureus**
3. Age
4. Past Hx
5. Poor dentition
6. Heart disease
7. Pacemaker or implantable cardio enter defibrillator
8. Hemodialysis
9. HIV

Question 7

How does infective endocarditis happen steps

Answer 7

1. Endothelial injury
2. Plt and fibrin adhere
3. Pathogen gains access to BS (from bacteremia)
4. Staph aureus can adhere to normal valve endothelium
5. Pathogen proliferated on valve
6. Embolization of vegetation particles and spreading of pathogens (MI, cerebral hemorrhage, meningitis, brain abscess, aneurysm

Question 8

Most common pathogens for endocarditis 5

Answer 8

1. Staph aureus
2. Strep viridans
3. Enterococci
4. Strep Bovis= from colon cancer or IBD usually **
5. HACEK : gram - bacilli that take time to grow so need to watch (Haemophilus, Actinobacillus, Cardiobacterium, Eiknella, Kingella) **

Question 9

Right sided endocarditis

Answer 9

Staph aureus from IV drug use

Question 10

SX of infective endocarditis

Answer 10

1. Fever
2. New murmur (usually regurg)
3. Constitutional sx : WL, night sweats
4. Vascular embolic event

Question 11

Physical exam findings for infective endocarditis 6

Answer 11

1. Petechiae
2. Splinter hemorrhages (on nail)
3. Oslers nodes : red raised painful lesions on distal extr like fingers
4. Janeway lesions : red flat painless lesions on palms or fingers from emboli
5. Roth spots : retinal hemorrhage with white center
6. Splenomegally

Question 12

How to DX infective endocarditis

Answer 12

Modified Duke Criteria
= Ecchocardiography (transthoracic and later transesophageal if cant see)
= Blood Cultures (must before ABs started)