Infective Conditions Flashcards
what is IE?
infection of endothelium- cardiac valves develop vegetations composed of bacteria, platelets and fibrin
IE
risk factors?
- IVDU
- rheumatic heart disease
- mitral valve prolapse
- prosthetic valves
- congenital heart disease
- bicupsid aortic valve most common
- HoCM
IE
classification?
- 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
most common organism in subacute?
strep viridans
IE
common cause of IE following dental procedures?
strep viridans
IE
most common bacteria involved in pts with prosthetic heart valves?
staph epidermidis
IE
other bacteria involved?
- streptococcus bovis
- enterococcus
- gram negatives
- poor dental hygiene and/or periodontal infection
- candida
- immunosuppressed/IVDU
IE
clinical features? mnemonic
Fever
Roth spots
Osler’s nodes
Murmur - usually regurgitation
Janeway lesions
Anorexia and weight loss
Nail bed haemorrhage
Emboli (systemic)
+ haematuria
what are oslers nodes?
what are janeway lesions?
- ON: raised, tender nodules on finger pulps
- JL: non-tender macular lesions on palm
what are roth spots?
small retinal haemorrhages w pale centre
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
IE
Ix
- Bloods
- FBC, ESR, CRP
- cultures (minimum of 3, >12h apart)
- RF
- serology for unusual organisms
- urine microscopy
- ECG
- Echo
IE
Rx?
broad-spectrum IV Abx until culture results available
- acute severe: IV vancomycin + Gent
- subacute: amoxicillin + IV Gent
add fluclox if IVDU
IE
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
