IDIS Flashcards
___ are the most common cause of pericarditis
Viruses
- Coxsackie A/B and echo
- serous fluid NOT purulent
Acute purulent pericarditis is caused by ___
Bacteria
___ causes chronic pericarditis
Mycobacterium tuberculosis
Presentation of tuberculous pericarditis
Fever
Pericardial friction rub
Primary seeding from lungs, sternum, spine
+ PPD test
- fluid smear for AFB
Large volume effusions with mononuclear cells
Tuberculous pericarditis
Clinical presentation of pericarditis
- Pain-sharp/stabbing, radiates, relieved by sitting up and leaning forward
- Pericardial effusion, clear, straw-colored
- Friction rub (pathognomonic), heard during expiration but corresponds to heart beat, scratching/grating sound
Dx of pericarditis if it is a purulent disease
Pericardiocentesis
ECG findings for pericarditis
Widespread ST elevations
Depressed PR segments
Infectious causes of myocarditis in North America and Europe
Coxsackie B virus Echo virus Adeno virus B19V and HHV6 on the rise *most common is B19V *in the rest of the world it is T. cruzi (South America) and C. diphtheriae
Coxsackie B and Adenovirus bind to ____ on myocytes
CAR
Viral myocarditis causes disruption of the ____ complex
Dystrophin-sarcoglycans
The acute phase of viral myocarditis lasts ____ and the subacute phase lasts ___
A few days
A few weeks to several months
The chronic phase of viral myocarditis is characterized by ___
Myocardial remodeling and development of DCM
Myocarditis is the most common cause of death in ___
Diphtheria
You should consider ___ when a young person develops unexplained heart failure, chest pain, or arrhythmias
Myocarditis
The most common symptom of myocarditis is ___
Chest pain
___ is a common cause of myocarditis (and is the cause of Chagas’ disease)
Trypanosoma cruzi
Sudden cardiovascular collapse and shock
Requires aggressive intervention with inotropic agents
Fulminant myocarditis
Echo of patient with myocarditis shows ___
Chamber enlargement and diminished ventricular contractility
Dx of myocarditis
Endomyocardial bx
- acute: necrosis and evidence of degenerative (not seen in chronic)
- both: >14 leukocytes/mm^2
Criteria for Chagasic Myocarditis:
- Hx of residence in endemic area
- Serology + for T. cruzi
- Compatible clinical syndrome
- No evidence of another cardiac disorder
Infective endocarditis is usually ____ and primarily affects the ____
Bacterial
Cardiac valves
Most common predisposing factor for IE in developed nations
Mitral valve prolapse
IE
Patients with hx of IV drug use or health care contact
Most virulent pathogen
S. aureus
Imp. in prosthetic valve endocarditis
CONS?
S. aureus
IE after dental work
- HACEK (culture negative)
- Viridans strep:
- S. sanguis
- S. mutans
- S. mitis
HACEK bacteria account for 5% of IE cases
Haemophilus Aggregatibacter Cardiobacterium Eikenella Kingella
Presentations specific to myocarditis but not seen in pericarditis
Elevated troponin I and T
Most common fungal pathogens associated with IE
- Aspergillus (rarely found in blood cultures)
2. Candida (blood cultures +)
Acute vs subacute endocarditis
- acute: symptoms develop quickly, may be fatal in <6 weeks
- sub-acute: slow, worsens for 1 yr before fatal
In IV drug users, the structure most likely to develop vegetations is
Tricuspid valve
*in others it is the mitral and aortic valve
-mitral>aortic>tricuspid>pulmonary
Factors that determine complication and time course of endocarditis
Type of pathogen and its virulence
Immune status of the patient
Valve involved
Endocarditis
Rapid onset (hours to days)
High fever
Rigors
Acute
Endocarditis Symptoms within 2 weeks Dx takes about 6 weeks Low back pain, fever, chills, night sweats Fatigue, anorexia, weakness
Sub-acute
Endocarditis
What is seen with both acute and sub-acute?
Murmurs Roth spots (flame shape on retina) Petechia Splinter hemorrhages Janeway lesions Oslers nodes Splenomegaly Sudden loss of peripheral pulse
Dx endocarditis
Lab values
Anemia
Increase ESR and CRP
Abnormal urinalysis
