ID of CV Flashcards
In a patient with subacute infective endocarditis, what lab and imaging should include in the work up?
Blood cultures x4 and TTE
Staphylococcus epidermidis is implicated for subacute endocarditis. what tests would confirm staphylococus epidermidis?
- blood culture revealing G+ cocci in clusters
- catalase positive
- coagulase negative
ABX prophylaxis is indicated for a patient who has had infective endocarditis or are at risk of endocarditis. what abx are used for patients who are allergic to penicillin?
Oral cephalexin hr before procedure
What is the best empiric treatment for a patient with acute infective endocarditis?
Vancomysin and ceftriaxone
In a patient with endocarditis, would their estimated sedimentation rate be elevated or decreased?
elevated
what microorganism is associated dental procedure related endocarditis?
Streptococcus viridans
Fever, decreased breath sounds, heart murmur at right sternal border (decrescendo-distolic), IV drug user, frequent STI, elelvated sedimentation rate, high WBCs, positive PPD, nodular infiltrates bilaterally on xray, all indicate _
R-sided infectious endocarditis (via IV drug use)
The nodular infiltrates thats seen in lung fields in an pt with endocarditis is usually due to _
septic emboli via tricuspid valve
The most likely organism of R-sided infectious endocarditis is _
Staph aureus
Differentiate between acute and subacute endocarditis
- Subacute = L side, slow onset, systemic symptoms, S. viridans, HACEK, enterococus are common causative agents.
- Acute = R sided thus affects Tri > Bi > aorta > pulm. fast onset, HIGH fever,SOB, pleuritic chest pain symptoms. S. aureus common cause
What are predispositions to infective endocarditis?
- Prosthetic valves
- implantable devices
- Parenteral nutrition tube
- Congenital heart disease(BAV, VSD, PDA, C of A)
- Previous endocarditis
- Structural heart disease
- Valvular heart disease rheumatic, MVP, aortic valve)
- Hemodialysis
- HIV
New murmur or changing murmur almost always indicates _
endocarditis
Dental procedures –> _sided endocarditis and the likely organism involved is _
Left.
Strep viridans
What are the major jone’s criteria for acute rheumatic fever?
- Carditis
- polyarthritis
- sydenham’s chorea
- Erythema marginatum
- Subcutaneous nodules
What the minor jones criteria for acute rheumatic fever?
- Fever
- arthralgia
- previous rheumatic fever or heart disease
- acute phase reactants
- prolonged P-R interval on EKG
When is prophylactic antibiotics for endocarditis indicated?
- prosthetic valve, previous endocarditis, Heart transplant, congenital defects
- going for dental procedure, tonsillectomy, adenoidectomy, or surgery on infected skin
What is the standard prophylactic medication? what if pt is allergic to penicillin?
Amoxicillin (oral), ampicillin, cefazolin, or ceftriaxone (if unable to take oral)
If allergic to penicillin or ampicilin then clindamycin, cephalexin, azithromycin or clarithromycin
If allergic to penicillin/ampicillin and unable to take oral med then caphalexin, ceftrixone or clindamycin
what are the most common gram negative endocarditis (besides in IV drug users)
HACEK organisms (Haemophilus, actinobacillus, cardiobaterium, eikenella, kingella)
What are the common treatments for gram positive endocarditis?
Strep = penicillin G Staph = Nafcillin
what are the 3 main causes of myocarditis?
- Coxsackie B viruses
- Trypanosomas (Chagas disease)
- Borrelia (lyme disease)
Pt presents with retrosternal chest pain that radiates to neck and L shoulder, cough and difficulty swallowing, night sweats, positive PPD, elevated CBC. what is the likely diagnosis?
- acute pericarditis secondary to TB
The most common infectious cause of pericarditis?
- Coxsakie viruses (Also Echovirus and flu)
In a patient with subacute endocarditis, what lab findings would support the diagnosis?
- Hematuria
- Proteinuria
- Blood culture + for coxiella, and others
- Increased ESR
- retinal hemorrhages
What’s needed to have met to diagnose IE according to Duke criteria?
One of the following
- 2 major criteria
- 1 major with 3 minor criteria
- 5 minor criteria
What’s considered a major criteria according to the Duke’s criteria for diagnosis of infective endocarditis?
- Positive blood culture with an infecting microorganism
2. Evidence of endocardial involvement via ECHO or signs or new valvular regurg
What’s considered a minor criteria according to the Duke’s criteria for diagnosis of infective endocarditis?
- Predisposition to IE such IV drug user, prosthetic valve etc
- Fever
- Vascular phenomena: emboli, infarcts, aneurysm, hemorrhage, janeway lesion
- Immunologic phenomenon: glomerulonephritis, osler nodes, roth spots rhematoid factor
- Microbiologic evidence: positive blood culture or serology titer that do not meet major criteria
a 28 year old male with recent URI presents with substernal chest pain that radiates to B/L shoulders. the pain is central in nature with associated diaphoresis and ever. Cardiac auscultation reveals a friction rub. what is the most likely diagnosis? and what is the classification of the causative agent?
Acute Pericarditis due to a viral infection, most likely coxsakie B virus, a member of picornavirus which is classified as +ssRNA naked icosahedral virus
Pleuritic chest pain can be relieved in what position?
Sitting upright and leaning forward
What is the treatment for acute pericarditis?
high dose ASA (steroids) and colchicine
What lab values can be monitored to ensure treatment effectiveness in a patient with acute pericarditis?
CRP (C-reactive protein)
Aside from viral, what are some other causes of pericarditis?
- Chronic kidney failure with uremia
- Neoplastic processes (hodgkin, mets, lymphomas)
- Dressler - most MI
- SLE
- Drug induced (PCN, clozpine, minoxidil)
- Radiation
- S/P invasive cardiac procedure
Inflammatory pericardial syndrome is diagnosed with at least 2 of which 4 criteria?
- Pericarditic chest pain
- Pericardial rubs
- New widespread ST elevation or PR depression
- pericardial effusion
Others: CRP, ESR, WBC, CT, CMR
