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Cardio > Infective Conditions > Flashcards

Infective Conditions Flashcards

1
Q

what is IE?

A

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

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2
Q

IE

risk factors?

A
  • IVDU
  • rheumatic heart disease
  • mitral valve prolapse
  • prosthetic valves
  • congenital heart disease
    • bicupsid aortic valve most common
  • HoCM
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3
Q

IE

classification?

A
  • subacute bacterial endocarditis
    • slowly progressive condition
  • acute endocarditis
    • rapidly progressive illness
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4
Q

IE

most common organisms in IVDU?

A
  • staph aureus
    • most common cause of acute
  • bacillus cereus - RARE
  • candia
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5
Q

IE

most common organism in subacute?

A

strep viridans

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6
Q

IE

common cause of IE following dental procedures?

A

strep viridans

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7
Q

IE

most common bacteria involved in pts with prosthetic heart valves?

A

staph epidermidis

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8
Q

IE

other bacteria involved?

A
  • streptococcus bovis
  • enterococcus
  • gram negatives
    • poor dental hygiene and/or periodontal infection
  • candida
    • immunosuppressed/IVDU
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9
Q

IE

clinical features? mnemonic

A

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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10
Q

what are oslers nodes?

what are janeway lesions?

A
  • ON: raised, tender nodules on finger pulps
  • JL: non-tender macular lesions on palm
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11
Q

what are roth spots?

A

small retinal haemorrhages w pale centre

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12
Q

IE

diagnostic criteria?

A

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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13
Q

IE

how many criteria are required for diagnosis?

A
  • 2 major
  • 1 major + 3 minor
  • all 5 minor
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14
Q

IE

Ix

A
  • Bloods
    • FBC, ESR, CRP
    • cultures (minimum of 3, >12h apart)
    • RF
    • serology for unusual organisms
  • urine microscopy
  • ECG
  • Echo
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15
Q

IE

Rx?

A

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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16
Q

IE

complications?

A
  • septic emboli
  • arrhtyhmias
  • meningitis
  • intracranial haemorrhage
  • glomerulonephritis
17
Q

what is pericarditis?

A

inflammation of the pericardium

18
Q

classification of pericarditis

A
  • acute
  • constrictive
19
Q

aetiology of pericarditis

A
  • 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
20
Q

main clinical consequence of constrictive pericarditis ?

A

markedly restricted filling of the heart

21
Q

symptoms of pericarditis?

A

central/retrosternal chest pain

  • sharp
  • pleuritic
  • worse on movement & inspiration
  • relieved by sitting forwards, worse on lying flat
  • radiates to left shoulder
22
Q

signs of pericarditis?

A
  • pericardial friction rub at @ LSE
  • fever
23
Q

Ix of pericarditis?

A
  • Bloods
    • FBC, ESR, cultures, virology
  • ECG
    • widespread ST elevation, concave in shape
    • followed by T wave inversion
24
Q

Rx of pericarditis?

A
  • analgesia: NSAIDs
  • purulent: pericardiocentesis+ Abx
25
Q

what is constrictive pericarditis

A

heart encased in a rigid pericardium

26
Q

aetiology of constrictive pericarditis?

A

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

27
Q

clinical features of constrictive pericarditis

A
  • RHF w raised JVP
    • hepatosplenomegaly
    • ascites
    • oedema
  • Kussmaul’s sign
  • Quiet heart sounds
28
Q

Ix of constrictive pericarditis?

A

CXR: small heart + pericardial calcification

29
Q

Mx of constrictive pericarditis?

A

surgical excision- pericardiectomy

30
Q

Aetiology of Myocarditis

A
  • idiopathic - approx 50%
  • viral
    • coxsackie B most common, flu, HIV
  • bacterial
    • staph aureus, syphilis
  • drugs
    • cyclophosphamide
    • herceptin
    • phenytoin
  • auto-immune
    • assoc w SLE
31
Q

symptoms of myocarditis?

A
  • may be asymptomatic
  • flu-like prodrome
  • SOB, fatigue
  • chest pain
  • arrhythmia –> palpitations
32
Q

Ix of myocarditis?

A
  • Bloods
    • +ve trop
    • raised CK
  • ECG
    • ST elevation/depression
    • T wave inversion
  • Echo
33
Q

Mx of myocarditis?

A
  • supportive
  • treat cause

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