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RRCCPA Clin Med Exam 4 > Infections of Cardiology (Exam 4) > Flashcards

Infections of Cardiology (Exam 4) Flashcards

1
Q

What is myocarditis?

A

Focal or diffuse inflammation of the myocardium. Most cases are infectious and often follow a URI.

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2
Q

What is the most common cause of myocarditis in the US?

A

Viral (adenovirus, coxsackie virus, parvovirus B19, HIV, CMV)

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3
Q

What are some other causes of myocarditis?

A

Bacteria (Brucellosis, strep pneumo, Legionella, Staph, Strep, Mycoplasma)
OR
Fungus (Candida, Aspergillus)

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4
Q

Symptoms of myocarditis.

A

Acute heart failure without previous symptoms.
Pleural/pericardial pain
Tachycardia

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5
Q

Diagnostic studies of myocarditis.

A

EKG: Nonspecific ST changes, ventricular ectopy

Chest XR: often shows cardiomegally

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6
Q

Treatment of myocarditis

A

If bacterial or fungal, treat with antimicrobial.
Treat symptoms of HF
Transplant

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7
Q

What is pericarditis?

A

Infection/inflammation of the pericardium. Often occurs in conjunction with myocarditis.

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8
Q

Causes of pericarditis?

A

Same as myocarditis.
Viral (adenovirus, coxsackie virus, parvovirus B19, HIV, CMV)
Bacteria (Brucellosis, strep pneumo, Legionella, Staph, Strep, Mycoplasma)
Fungus (Candida, Aspergillus)

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9
Q

Symptoms of pericarditis?

A

Chest pain, symptoms of myocarditis (Heart failure, tachycardia)

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10
Q

Physical exam finding consistent with pericarditis?

A

Will be able to auscultate a rub.

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11
Q

What is endocarditis?

A

Infection of the endocardial surfaces of the heart valves.

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12
Q

What patient populations are at higher risk for endocarditis?

A

IV drug users
Pt’s after prosthetic valve replacement
History of rheumatic fever
Male: female ratio 2: 1

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13
Q

Most common bacteria involved with endocarditis?

A

Strep Viridans, Staph, Gram negative rods, Enterococci

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14
Q

Most common causes of native valve endocarditis?

A

Acute usually do to Staph or Group B Strep

Subacute usually alpha hemolytic strep (strep Viridans)

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15
Q

Most common cause of prosthetic valve endocarditis?

A

Occurs within 60 days of replacement: Staph and Candida

Occurs later than 60 days after replacement: staph and alpha hemolytic strep

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16
Q

What valve is most often infected in IV drug users?

What bacteria is most commonly responsible?

A

Tricuspid valve.

Most commonly Staph Aureus (60%)

17
Q

Physical exam findings consistent with endocarditis?

A

New heart murmur or worsening of an old murmur. Peripheral stigmata (splinter hemorrhages, Osler nodes, Janeway lesions, Roth spots), embolic findings

18
Q

Symptoms of endocarditis

A

Fever and chills most common

Others include anorexia, weight loss, night sweats, headache, myalgias, SOB

19
Q

What are Osler nodes?

A

Painful raised lesions on hands and feet

20
Q

What are Janeway lesions?

A

Flat, painless, purple lesion on hands or feet

21
Q

What are Roth spots?

A

Retinal hemorrhages with white or pale centers

22
Q

What diagnostics might you order if you suspect endocarditis?

A

Echocardiogram -60% sensitive
Transesophageal echocardiogram- 90% sensitive
Blood cultures, CBC, ESR(elevated in 90% of cases)

23
Q

If you highly suspect endocarditis, yet blood cultures are negative, what might you order?

A

Serologies for chlamydia, q fever, bartonella, fungal culture, and HACEK culture.

24
Q

What are HACEK organisms?

A

HACEK stands for the bacteria that are slow growing.

Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

25
Q

How do you use the Duke Criteria?

A

Use the Duke Criteria to diagnose endocarditis. A patient must meet either 2 major criteria, 1 major and 3 minor criteria, or 5 minor criteria.

26
Q

What are the major Duke Criteria?

A

Blood culture positive from 2 separate cultures consistent with organisms that cause IE.
Positive echocardiogram.

27
Q

What are the minor Duke Criteria

A 
Predisposition for IE
Fever
Vascular phenomena (peripheral stigmata)
Immunologic phenomena
Microbiologic evidence
Echo results showing valve thickening without vegetation
28
Q

Does this patient meet Duke Criteria?

One positive blood culture growing Eikenella and a positive echocardiogram?

A

No! Patient must have 2 separate cultures in order to meet the major criteria.

29
Q

Does this patient meet Duke Criteria?

Blood cultures pending. Positive echocardiogram. Fever, Osler nodes, and the patient has hx of rheumatic fever.

A

Yes, this patient has 1 major and 3 minor criteria(Fever, vascular phenomena, and predisposition for IE).

30
Q

What antibiotics would you use to treat a patient with IE before you have culture results?

A

Vancomycin and Cephtriaxone are used for empiric treatment

31
Q

What might you use for IE caused by strep and why?

A

Penicillin and gentamycin, because they work synergistically

32
Q

What antibiotic would you use for IE caused by MSSA?

A

Nafcillin

33
Q

What antibiotic would you use for an infection of a prosthetic valve and why?

A

Daptomycin 6mg/kg. It is effective against biofilms.

34
Q

How long do you treat for IE?

A

At least 2 weeks, 6 weeks if blood cultures are negative.

35
Q

Last resort treatment?

A

Surgery

36
Q

What valve(s) is most likely to be infected in a patient with peripheral stigmata?

A

Left sided valves: Aortic or mitral. Emboli get stuck in capillaries of hands and feet causing splinter hemorrhages, Janeway lesions, Osler nodes

37
Q

What valve(s) is most likely to be infected in a person with PE’s.

A

Right sided valves: tricuspid or pulmonic

Emboli break off and get stuck in capillaries of lungs causing PE’s.

38
Q

What might you consider if a pt has IE due to enterococci?

A

Consider GI tract as source, rule out colon cancer.

39
Q

What is the most commonly infected valve?

What is the least common?

A

Most common: Mitral

Least common: Pulmonic

RRCCPA Clin Med Exam 4 (20 decks)

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