Infectious Diseases Flashcards by Costanza Cascio

what are main causes of infectious cardiac disease?

implanted devices, pre-procedural prophylaxis, procedures, type of device

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what microorganisms cause infectious diseases?

staph aureus, staph epidermis which act as biofilms

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what are biofilms

slow growing vegetations that can cause infection over time

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what are some non-specific symptoms that present with infection?

fever, pain, swelling, redness, discharge, haematoma

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what ix if carried out if someone presents with non-specific symptoms of infection?

blood cultures=3 sets of bloods before Antibis given
gram film=distinguish between staph a & staphylococcus
echo= shows vegetations on valves

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what are the classes of infective endocarditis

subacute and acute

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what is infective endocarditis

infection of endothelium of heart valves

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True/False…

infective endocarditis is typically right sided

False…

typically left sided (mitral & aortic

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when does right sided infective endocarditis (usually tricuspid valve) usually present?

in PWIDs

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what microorganism is usually responsible for causing infective endocarditis in PWIDs

staph a / bacillus serious

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what is the pathophysiology of endocarditis

heart valve damage > turbulent blood flow > platelet & fibrin deposits > bacteraemia deposits in fibrin > vegetations that digest heart valves

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what are triggers of endocarditis?

valve abnormalities, prosthetic valves, PWIDs, IV lines

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what are presenting symptoms of acute infective endocarditis

sepsis, cardiac failure

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what are presenting symptoms of subacute endocarditis

fever, malaise, wt loss

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what are some signs of endocarditis

murmur, pyrexia, clubbing, splinter haemorrhages, roth spots, osler’s nodes, janeway lesions, haematuria

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which out of roth spots, osler’s nodes and janeway lesions are painful?

Osler’s Nodes

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what is haematuria

blood cells leak into urine

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why does clubbing occur

in cardiothoracic disease when there isn’t enough O2 in blood e.g. bronchiectasis

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how to ix infective endocarditis

echo etc and use DUKE’S criteria

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tx dependent on cause for infective endocarditis

native valve: amoxicillin/ gent
prosthetic valve: IV vancomycin & gent
PWIDs: flucloxacillin IV

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what drug is added to prosthetic valve tx 3-5 days after vancomycin & gent?

Rifampicin

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what antibi for staph aureus

IV flucloxacillin

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what antibi for viridian’s streptococci

IV benzylpenicillin & gent

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what antibi for for enterococci

IV amoxi & gent

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what antibi for staph epidermis

IV vancomycin & gent & rifampicin

what tx should be pursued if Antibis do not work

surgery

what are some complications of infective endocarditis

acute valvular incompetence, cardiac failure, fistula, abscess, pericarditis, emboli

what are 2 sub-types of infective endocarditis

prosthetic valve endocarditis, PWID endocarditis

what is main complication of PWID endocarditis

septic emboli

what are causes of non-infectious endocarditis

rheumatic fever, non-bacterial thrombotic endocarditis, carcinoid heart disease, systemic lupus, tumours

what is the commonest heart tumour

atrial myxoma

in what age group is myocarditis most common in

young people

what is myocarditis

inflammation of heart muscle

what does myocarditis look like

thick beefy inflamed myocardium

infective causes of myocarditis

lyme's disease, HIV, Chaga's Disease, viruses

what virus microorganism usually causes myocarditis

Coxsackie

non-infective causes of myocarditis

hypersensitivity reaction to infection (rheumatic fever) or to drugs (eosinophilic myocarditis), lupus

how does rheumatic fever affect the heart

mitral stenosis, thickening and fusion of valve leaflets, thick chordae tendinae

what are presenting symptoms of myocarditis

chest pain, SOB, fever, palpitations, fatigue, tachycardia, HF, S4 HS

signs of myocarditis

arrhythmia, cardiac failure

ix for myocarditis

Viral PCR, throat swab, stool sample ECG Echo Endomyocardial biopsy

what would be seen on an ECG of a patient with myocarditis?

ST changes, T wave inversion, atrial arrhythmias

Tx for myocarditis

supportive (fluid, NSAIDs)

what is the main complication of autoimmune myocarditis/ hypersensitivity myocarditis?

Can cause dilated cardiomyopathy

pericarditis has a similar epidemiology as...

myocarditis ie. young people often affected

classes of pericarditis

infectious, immune mediated, idiopathic (III)

what is pericarditis

inflammation of pericardial layers

triggers of pericarditis

myocarditis, post MI if pt has Dressler's syndrome | viruses, bacteria, fungi

what viruses are responsible for Pericarditis?

coxsackie, ECHO virus

what bacteria causes pericarditis

extension from elsewhere in body e.g. TB

True/False... | fungi cause pericarditis in cancer patients

True... | fungi may cause pericarditis in immunocompromised

presenting symptoms of pericarditis

chest pain which is relived by sitting forward

what is the main sign of pericarditis

pericardial rub

ix for pericarditis & what would be seen

ECG: saddle shaped ST elevation, PR depression

tx for pericarditis

supportive: fluids & NSAIDs

complications of pericarditis

pericardial effusion, cardiac tamponade, constrictive pericarditis, cardiac failure

what is pericardial effusion

fluid in pericardial sac

what are cause of pericardial effusion

aortic dissection, myocardial rupture, pericarditis (AMP)

clinical sings of pericardial effusion

dyspnoea, chest pain, muffled HS

how to diagnose a pericardial effusion

CXR- large, globular heart ECG- low QRS (pressure of fluid in pericardial cavity reduces ability of ventricles to expand) Echo- fluid around heart

mx of pericardial effusion

pericardiocentesis

what is a cardiac tamponade

blood in heart sac

clinical signs of a tamponade

tachycardia, hypotensive*, pulsus paradoxus, elevated JVP/ bulging neck veins, muffled HS

what is pulsus paradoxis

a greater than 10mmHg pressure change in systolic BP

how to ix cardiac tamponade

Beck's Triad (falling BP, raised JVP, muffled HS) - ECG (low QRS) - Echo (fluid)

what is constrictive pericarditis (CP)

heart encased in rigid sac

causes of CP

idiopathic, TB, pericarditis

clinical signs of CP

raised JVP, RV failure, diffused apex, quiet HS, oedema, hepatomegaly

ix for Constrictive Pericarditis

CXR- small heart ECG-low QRS with flat T wave Echo- thick pericardium

tx for CP

surgical resection of pericardium

what is strep viridans

viridian's streptococci are a gram+ bacteria that are a-haemolytic hence produce green coloration on blood agar plates