Infections of the heart

Question 1

Infective causes of pericarditis

Answer 1

Viruses such as coxsackie, echovirus, CMV, herpes, HIV. Bacteria such as staph, pneumococcus, streptococcus, haemophilus and M.tuberculosis

Question 2

Drug causes of pericarditis

Answer 2

Anthracycline chemotherapy, hydralazine, isonizid, methyldopa, phenytoin, penicillins

Question 3

Clinical features of pericarditis

Answer 3

Chest pain which is usually pleuritic and worse lying flat, fever, pericardial friction rub

Question 4

ECG changes seen in pericarditis

Answer 4

Widespread saddle ST elevation and PR depression.

Question 5

Diagnosis of pericarditis

Answer 5

ECG, raised troponin, echo and angiogram

Question 6

Causes of pericarditis

Answer 6

Lung/breast cancer, lymphoma, radiation, HF, Dressler’s syndrome, SLE, RA, sarcoidosis, vasculitis, renal failure, hypothyroidism, IBD, ovary stimulates

Question 7

Infection causes of myocarditis

Answer 7

Viral is most common - coxsackie, adenovirus, parovirus, enterovirus, HIV, EBV, Hep A and C, Diptheria, Chaga’s disease

Question 8

Auto-immune causes of myocarditis

Answer 8

SLE, sarcoidosis, scleroderma, Churg-strauss, kawasaki, granulomatosis with polyangitis, thyrotoxicosis, polymyositis

Question 9

Signs and symptoms of myocarditis

Answer 9

Cardiac-type chest pain, fatigue, palpitations, HF symptoms, sudden unexplained cardiac death, HF signs

Question 10

ECG changes in myocarditis

Answer 10

non-specific but such as ST and T wave changes, ectopic beats and arrhythmias

Question 11

Diagnosis and investigations into myocarditis

Answer 11

Troponin is elevated, ECHO shows ventricular dysfunction, cardiac MRI shows inflammation, endomyocardial biopsy via cardiac catherterisation

Question 12

First line treatment of pericarditis

Answer 12

idiopathic or viral is exercise restriction and NSAIDs. Colchicine adjuvant used in caution with patients suspected of renal or hepatic impairment

Question 13

Second line treatment of pericarditis

Answer 13

Corticosteroids for those unable to toelerate or refractory to NSAIDs, and non-viral cause. Bacteria causes treated with IV antibiotics and pericardiocentesis

Question 14

Complications of pericarditis

Answer 14

Cardiac tamponade, pleural effusions, constrictive pericarditis

Question 15

Management of myocarditis

Answer 15

Curing underlying cause, managing complications and avoiding strenuous exercise

Question 16

Risk factors for infective endocarditis

Answer 16

Age >60, males, IV drug users, poor dental factors, co-morbid conditions such as valve disease, congenital heart disease, intravasc disease, HIV and haemodialysis

Question 17

Infective cause of IE

Answer 17

Staph aureus, strep viridans, enterococci, strep bovis, fungi, coagulase negative staph

Question 18

Symptoms of infective endocarditis

Answer 18

Fever, anorexia, weight loss, headache, myalgia, arthralgia, night sweats, abdo pain, cough, pleuritic chest pain

Question 19

Complications of infective endocarditis

Answer 19

Heart failure, neurological complications, embolic complications, infection

Question 20

Clinical signs of infective endocarditis

Answer 20

Murmurs, janeway lesions, oslers nodes, roth spots, microscopic haematuria, glomerulonephritis, splinter haemorrhages, PR prolongation or coomplete AV block

Question 21

How many blood investigations are needed for suspected infective endocarditis

Answer 21

3 sets of bloods taken at different times from different sites

Question 22

Investigations into suspected endocarditis

Answer 22

ECG, CXR, LFT, FBC, UE, CRP

Question 23

What is the first line imaging investigation for IE

Answer 23

Transthoraccic echo

Question 24

What is the most sensitive diagnostic test for IE

Answer 24

Transoesophageal ECHO

Question 25

Management of IE

Answer 25

Long term IV antibiotics, initially broad spec then more specific. May need surgery if aortic root abscess

Question 26

What are the components of major Duke's criteria

Answer 26

Blood cultures positive for typical microorganisms from 2 cultures. ECHO positive for IE such as vegetation or abscess, PET-CT abnormal prosthetic valve, cardiac CT paravalvular lesions

Question 27

What are the components of minor Duke's criteria

Answer 27

Predisposition for IE, fever >38 degrees, vascular phenomena, immunological phenomena, microbial evidence

Question 28

Diagnosis of IE from Duke's criteria

Answer 28

Two major criteria One major and three minor criteria All 3 minor criteria

Question 29

What is Duke's criteria

Answer 29

Way to diagnose infective endocarditis

Question 30

What is cardiac tamponade

Answer 30

Accumulation of fluid, blood, purulent exudate or air in the pericardial space raises the intra pericardial pressure.

Question 31

Effect of cardiac tamponade on cardiac output

Answer 31

Diastolic filling is reduced so reduces cardiac output

Question 32

Symptoms of cardiac tamponade

Answer 32

SOB, tachycardia, confusion, chest pain, abdominal pain

Question 33

Signs of cardiac tamponade

Answer 33

Beck's triad - hypotension, quiet heart sounds, raised JVP

Question 34

Management of stable patients with cardiac tamponade

Answer 34

Surgical drainage

Question 35

Management of unstable patients with cardiac tamponade

Answer 35

Pericardiocentesis