Hersh CIS Flashcards
acute pericarditis diagnostic criteria
2 of following 4
pericarditic chest pain
pericardial rubs
new widespread ST elevation or PR depression on ECG
pericardial effusion
recurrent pericarditis
recurrence of pericarditis after first episode and symptom free for 4-6 weeks or longer
duke criteria major
Bacterial blood culture positive
ECG ID of valve change
New murmur
antibiotic prophylaxis IE
amoxicillin
what are janeway lesions
painless non tender lesions on palms and soles
do not blanch
what are the gram positive bacterias
staph, strep (coccus)
bacillius, clostridium (spore forming rods)
listeria, corynebacterium (non spore forming rods)
pericarditis presentation
anterior pleuritic chest pain
-uremic pts generally painless
fever
pericardial rub
dyspneas
heart side affected in Acute IE
R>L
tri>Bi>aorta>Pulm
empiric treatment IE
vancomycin and ceftriaxone
in regards to antibiotic prophylaxis of person getting future dental procedures for a person who has history of endocarditis
-pt with penicillin allergy
oral cephalexin
could also give amoxicillin, clindomyocin
risk factors for infective endocarditis
over 60
male
iv drug use
poor dentition
people with CF that have endocarditis
pseudomonas infection
what is the best empiric treatment for suspected endocarditis
vancomycin and ceftriaxone
-staph can be methocillin and penicillin resistant
PPD interpretation HIV positive recent contact with active TB pt nodular or fibrotic changes on chest x ray organ transplant
greater than or = to 5 mm is positive test
predisposing factors for IE
structural heart disease, valve disease, CHD, prostethic heart valves previosus IE intravasuclar device hemodialysis HIV
symptoms of acute IE
high fever, chills sob arthralgias/myalgias ab pain pleuritic chest pain ack pain
what test would you run if you are suspicious of endocarditits
transthoracic echocardiogram - non invasive, can pick up on vegetations
TEE- is good for acute bacterial endocarditis or any kind of carditis, can see posterior struictures of the heart, but invasive and have to sedate pts
EKG progression of pericarditis
diffuse ST elevation–>ST normalization–> inverted T wave–>return to baseline
staph epidermidids
affects what
virulance factor
urease and coag
treatments
affects prostattic valves–>endocarditis
produces biofilm to help stick to surfaaces (dextran)
urease +
coag -
treat with vancomycin
incessant pericarditits
pericarditis lasting for over 4-6 weeks but less than 3 months without remission
chronic pericarditis
pericarditis lasting for over 3 months
treatment for pericarditis
ASA and colchicine
duke criteria minor
FIVE PM
Fever
Immuno phenom: GN, osler nodes, roth spots, RF
Vacular lesions: janeway lesions
ECG findings consistent with endocarditis
Predisposing heart lesions and IV drug use
Microbiological evidence including single culture positive for unusual organism
symptoms of subacute IE
low grade fevere anorexia arthralgia/myalgia ab pain fatigue
test for mycobacteria (TB)
AFB stain
ziel-Neelsen stain
red rods
oslers nodes
painful lesions on fingers and tips of fingers
more likely to get TB with CD count under what
500
IF CD count below 200 then ____
AIDS
orthomyxovirus (flu) structure
single stranded 8 segmented RNA virus
heart side affected subacute IE
L>R
what are roth spots
retinal hemmhorages
antibiotic prophylaxis IE: allergic to penicillin or ampicllin and unable to take oral med
cephalexin
ceftriaxone
clindamycin
give IV
treatment for pericarditis caused by TB
RIPE
Rifampin
isonizid
pyrazinamide
ethambutol
positive IE with DUKE criteria
2 major met
1 major and 3 minor
5 minor
strep viridans
dextran mitral valve catalase neg a hemolytic subacute endocarditits
treatment for pericarditis without response to high dose aspirin and colchincine
high dose corticosteroids and colchicine
antibiotic prophylaxis IE: allergic to penicillin or ampicilin
cephalexin
clindamycin
azithromycin
clarithromycin
enterococcus faceilis
lives in GI tract
can get infection with chrons diseasse, GI surgery, uclercholisits
resistant to Abs
-treat with linezoid or tigecylince
PPD interpretation
-recent arrivals from high prevalence countries
IV drug users
high risk lab employees
children under 4
greater than or equal to 10mm = positive
what do you order with pericarditis to track treatment
CRP
staph aureus
virulance factor
coag and catalse
protein A
catalase + and coagulase +
effects tricuspid valve
what can be elevated in infection and inflammaotry processes
CRP
etiology of pericarditis
coxsackie B
echovirus
flu
what key player in IE grows on sodium chloride and bile salts
enterococcus
antibiotic prophylaxis IE: can’t take oral
ampicillin or cefazolin or ceftriaxone
pericarditis and EKG
ST intervals are elevated in all leads (above isoelectric line)
Pr is a little dipped down
does increased or decreased ESR suppor diagnosis of subacute endocarditis
increased
PPD interpretation
-persons with no known risk factors for TB
greater than or equal to 15 mm = positive
