Infection Flashcards
Risk factors of infective endocarditis
Previous episode of infective endocarditis
rheumatic valve disease (30%)
prosthetic valves
congenital heart defects
intravenous drug users (IVDUs, e.g. typically causing tricuspid lesion)
Signs of infective endocarditis
splinter haemorrhages
new/worsening murmur (rare)
janeway lesions
Oslers nodes
Symptoms of infective endocarditis
fever/night sweats malaise anorexia weakness arthralgia headache SOB chest pain
Investigations in suspected infective endocarditis
FBC, CRP, U&Es Urinalysis ECG Echo Blood cultures: 3 separate at spike of fever prior to antibiotics therapy from different locations
What might you seen in urinalysis in infective endocarditis
RBC casts
WBC casts
proteinuria
pyuria
What may you see on ECG as infective endocarditis progresses
prolonged PR interval
non-specific ST/T wave abnormalities
AV block
What might you see on Echo in infective endocarditis
valvular mobile vegetations
What is the management of infective endocarditis
- supportive
- empirical antibiotic therapy
- surgery to debride infected tissue/valves
What are the complications of infective endocarditis
- congestive heart failure
- systemic emboli
- anterior mitral valve vegetation
- valvular rupture
What is Acute rheumatic fever
- Autoimmune disease that may occur following group A streptococcal throat infection
- Can affect joints, heart, brain, and skin.
What are the common features of Rheumatic fever
- Joint pains
- Sore throat/scarlet fever
- Malaise
- Fever
- Chest pain/murmur/palpitations
- SOB
- Pericardial rub
Risk factors for rheumatic fever
- poverty
- overcrowded living
- FH/genetic susceptibility
- HLA association
Investigations when considering Rheumatic fever
- FBC, CRP/ESR, U&Es
- Blood cultures
- ECG: prolonged PR
- Echo: valvular dysfunction (mitral or aortic)
- throat culture
What pathogen usually causes rheumatic fever
beta-haemolytic streptoccocal A
What is the treatment of rheumatic fever
- Antibiotics - benpen
- If arthritis NSAIDs
- secondary prophylaxis
- valvular surgery
which valve is most commonly affected in rheumatic heart disease
mitral
aortic
What is pericariditis
inflammation of the pericardium
What are the RF for pericardits
- Male
- 20-50
- Transmural MI
- cardiac surgery
- neoplasm
- uraemia or on dialysis
- bacterial infection
- systemic auto-immune disorders
Which bacteria is usually involved in bacterial pericarditis
Mycobacterium tuberculosis.
Classic triad of symptoms for pericarditis
- chest pain - pleuritic
- pericardial rub
- ECG changes
( fever, malaise)
What ECG changes may you find in pericarditis
upwards concave ST-segment elevation globally with PR depressions
What investigations for pericarditis
- ECG
- troponins
- pericardial fluid/blood cultures
- ESR/CRP
- U&Es - ureas
WHat may you see on CXR in pericarditis
Normal or water bottle cardiac silhouette
Differentials of pericarditis
- MI
- PE
- Pneumonia
- Pneumothorax
- costochondritis
Management of pericarditis
- Pericariocentesis?
- NSAIDs
- PPI
- Coclchicine - improves response
- ABX if purulent
- exercise restriction
Complication of pericarditis
pericardial effusion with or without tamponade
Prognosis pericarditis
Acute idiopathic pericarditis: self-limited disease in 70%- 90% with no significant complications or recurrence. Purulent pericarditis is uniformly fatal if untreated and has a mortality of 40% with treatment.
