IE, Dubin Flashcards
5 causes of NBTE
- RHD (10-35yo)
- Bicuspid valve (50-60)
- Calcific aortic stenosis (60-70)
- MV-Prolapse
- Marfan Syndrome
PPD greater than 10mm, think what?
Acute pericarditis, incarceration, coxsackie A or B
Dairy cattle, goats, etc. Think what disease and what organism?
Q-Fever, Coxiella burnetti (obligate intracellular proteobacteria).
HA, fever, joint pain, GI, atympocal pneumonia ot ARDS, think what?
Acute Q-fever
Chronic Q-fever can lead to what?
endocarditis.
Major causes of myocarditis: viral, bacterial, parasitic.
Viral - coxsackie
Bacteria - Borellia burdorferi
Parasitic - Trypanosome, babeosis
5 Predisposing factors to IE. Why?
All promote bacterial growth. 1. PRosthetic valve. 2. implant devices 3. Parenteral nutrition 4. Congenital heart defect 5/ Previous endocarditis
What Hx tips you off to IE?
Fever, chills, COUGH (right-side), orthopnea, night sweats, fatigue, weight loss
PE in IE (3)
MURMUR (changed or new)
Signs of HF, CVA signs
Lab findings in IE
ANEMIA (left side), increased WBC,
INCREASED SED RATE or CRP, hematuria, thrombocytopenia
ESR of 70+, think what?
cancer
Best imaging for IE
trans throacic (or esophageal) ECHOCARDIOGRAM
Painful, purple, (palpable) erythematous subcutaneous nodules on pads of fingers and toes.
Osler nodes.
Painless, hemorrhagic plaques on soles and palms.
Janeway Lesions
Thin, linear hemorrhage under nailbeds of fingers/toes.
Splinter hemorrhage
Retinal infarct with central pallor and surrounding hemorrhage.
Roth spot
Gran negative bugs that can cause IE.
Why dont they always show up on culture?
Haemophilum Actinobacilus Cardiobacterium Eikenella Kingella
SLOW growing
Tx for IE caused by Gram positive bugs.
Staph - naficillin
Strep - Penicillin G
Tx for IE caused by Gram negative bugs.
Ampicillin and cephriaxone
What situations warrent prophylaxis?
Person has: prosthetic valve, previous endocarditis, heart transplant, CHD (repaired CHD in past 6mo or residual defects or unrepaired cyanotic CHD)
Person HAVING: dental, tonsillectomy, adenoidectomy, surgery on infarcted skin
Major Jones criteria
J=joints=polyarteritis O=heart=carditis N=nodules=subcutanous E=erythematous marginatum S=Syndham Chorea
Minor Jones criteria
Fever, arthralgia, previous RF, APR (ESR), Prolonged PR interval on ECG.
What evidence of preceding strep infection can be found to meet Jones criteria?
ASO, Grp A Strep, Recent Scarlet Fever
What are the number of major/minor requirements for Jones Criteria?
What is this used to diagnose?
Acute RF
2 major
1 major, 2 minor
Evidence of preceding strep infection
What is this?
Persistent ST elevation in all leads, Retrosternal chest pain, night sweats, PPD10+mm.
Viral - Coxsackie
Pericarditis
