IVDU rheumatic heart disease mitral valve prolapse prosthetic valves congenital heart disease bicupsid aortic valve most common HoCM

subacute bacterial endocarditis slowly progressive condition acute endocarditis rapidly progressive illness

IE most common organisms in IVDU?

staph aureus most common cause of acute bacillus cereus - RARE candia

IE other bacteria involved?

streptococcus bovis enterococcus gram negatives poor dental hygiene and/or periodontal infection candida immunosuppressed/IVDU

IE diagnostic criteria?

Duke's criteria Major +ve blood culture endocardium involved +ve echo or new valvular regurgitation Minor predisposing factor fever Vascular phenomena ie janeway lesions, splinter haemorrhages etc immunological phenomenon (oslers nodes, roth spots) culture w atypical bacteria

IE how many criteria are required for diagnosis?

2 major 1 major + 3 minor all 5 minor

Bloods FBC, ESR, CRP cultures (minimum of 3, \>12h apart) RF serology for unusual organisms urine microscopy ECG Echo

broad-spectrum IV Abx until culture results available acute severe: IV vancomycin + Gent subacute: amoxicillin + IV Gent add fluclox if IVDU

Infective Conditions Flashcards by MTizzle C

what is IE?

infection of endothelium- cardiac valves develop vegetations composed of bacteria, platelets and fibrin

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risk factors?

IVDU
rheumatic heart disease
mitral valve prolapse
prosthetic valves
congenital heart disease
- bicupsid aortic valve most common
HoCM

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classification?

subacute bacterial endocarditis
- slowly progressive condition
acute endocarditis
- rapidly progressive illness

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most common organisms in IVDU?

staph aureus
- most common cause of acute
bacillus cereus - RARE
candia

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most common organism in subacute?

strep viridans

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common cause of IE following dental procedures?

strep viridans

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most common bacteria involved in pts with prosthetic heart valves?

staph epidermidis

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other bacteria involved?

streptococcus bovis
enterococcus
gram negatives
- poor dental hygiene and/or periodontal infection
candida
- immunosuppressed/IVDU

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clinical features? mnemonic

Fever

Roth spots

Osler’s nodes

Murmur - usually regurgitation

Janeway lesions

Anorexia and weight loss

Nail bed haemorrhage

Emboli (systemic)

+ haematuria

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what are oslers nodes?

what are janeway lesions?

ON: raised, tender nodules on finger pulps
JL: non-tender macular lesions on palm

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what are roth spots?

small retinal haemorrhages w pale centre

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diagnostic criteria?

Duke’s criteria

Major

+ve blood culture
endocardium involved
- +ve echo or new valvular regurgitation

Minor

predisposing factor
fever
Vascular phenomena ie janeway lesions, splinter haemorrhages etc
immunological phenomenon (oslers nodes, roth spots)
culture w atypical bacteria

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how many criteria are required for diagnosis?

2 major
1 major + 3 minor
all 5 minor

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Bloods
- FBC, ESR, CRP
- cultures (minimum of 3, >12h apart)
- RF
- serology for unusual organisms
urine microscopy
ECG
Echo

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Rx?

broad-spectrum IV Abx until culture results available

acute severe: IV vancomycin + Gent
subacute: amoxicillin + IV Gent

add fluclox if IVDU

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complications?

septic emboli
arrhtyhmias
meningitis
intracranial haemorrhage
glomerulonephritis

what is pericarditis?

inflammation of the pericardium

classification of pericarditis

acute
constrictive

aetiology of pericarditis

viral
- coxsackie B, flu, EBV, HIV
bacterial
- staphs, rheumatic fever, TB
fungal
uraemia
post-MI- Dressler’s
malignancy
drugs
- penicillin, isoniazid, hydralazine
auto-immune - RA, Sarcoid, SLE

main clinical consequence of constrictive pericarditis ?

markedly restricted filling of the heart

symptoms of pericarditis?

central/retrosternal chest pain

sharp
pleuritic
worse on movement & inspiration
relieved by sitting forwards, worse on lying flat
radiates to left shoulder

signs of pericarditis?

pericardial friction rub at @ LSE
fever

Ix of pericarditis?

Bloods
- FBC, ESR, cultures, virology
ECG
- widespread ST elevation, concave in shape
- followed by T wave inversion

Rx of pericarditis?

analgesia: NSAIDs
purulent: pericardiocentesis+ Abx

what is constrictive pericarditis

heart encased in a rigid pericardium

aetiology of constrictive pericarditis?

thought to be due to long-term or chronic inflammation of the pericardium

clinical features of constrictive pericarditis

* RHF w raised JVP * hepatosplenomegaly * ascites * oedema * Kussmaul's sign * Quiet heart sounds

Ix of constrictive pericarditis?

CXR: small heart + pericardial calcification

Mx of constrictive pericarditis?

surgical excision- pericardiectomy

Aetiology of Myocarditis

* idiopathic - approx 50% * viral * coxsackie B most common, flu, HIV * bacterial * staph aureus, syphilis * drugs * cyclophosphamide * herceptin * phenytoin * auto-immune * assoc w SLE

symptoms of myocarditis?

* may be asymptomatic * flu-like prodrome * SOB, fatigue * chest pain * arrhythmia --\> palpitations

Ix of myocarditis?

* Bloods * +ve trop * raised CK * ECG * ST elevation/depression * T wave inversion * Echo

Mx of myocarditis?

* supportive * treat cause