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Cardiovascular Conditions (JBR) > Infective Endocarditis, Myocarditis, Pericarditis > Flashcards

Infective Endocarditis, Myocarditis, Pericarditis Flashcards

1
Q

What is infective endocarditis?

A

Infection of the endothelium of the heart vales

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2
Q

What are the risk factors for IE?

A 
Heart valve abnormalities
Calcification
Prosthetic valves
Sclerosis in elderly
Congenital heart disease
Post-rheumatic fever
IV drug user
IV lines
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3
Q

What is the pathogenesis of IE?

A 
Damaged heart valve
Turbulent blood flow
Platelet/fibrin deposited
Bacteraemia
Organisms settle in the fibrin/platelet thrombi - become microbial vegetation
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4
Q

Which side of the heart if usually affected?

A

Left side

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5
Q

Prosthetic valve are usually infected at time of insertion due to?

A

Staph Epidermidis

Staph aurus

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6
Q

What are common organisms?

A

Staph aureus
Strep Viridans
Enterococcus Sp
Staph epidermis

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7
Q

IE is often a complication of?

A

Dental treatment

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8
Q

What are unusual organisms that cause IE?

A 
Bartonella
Coxiella Burnetti
Brucella
Gram -ve
HACEK
Fungi
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9
Q

Which organisms make up HACEK?

A

Haemophilus, Aggregatibacter (previously Actinobacillus), Cardiobacterium, Eikenella, Kingella

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10
Q

In IV drug users, usually the ____ side is affected

A

right

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11
Q

What typically causes IE in IV drug uses?

A

Staph aureus

Septic pulmonary embolipneumonia

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12
Q

What are symptoms of IE?

A 
Fever 
Malaise
Weight loss
Tiredness
Breathlessness
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13
Q

What are signs of IE?

A 
New murmur 
Finger clubbing 
Splinter haemorrhages
Splenomegaly
Roth spots
Janeway lesions
Osler's nodes 
Microscopic haematuria
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14
Q

How do you diagnose IE?

A

3 sets of bloods (1 +ve may be contaminant)
TOE
Culture (MALDI-TOF?)

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15
Q

What is a typical contaminant?

A

Staph epidermidis

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16
Q

If cultures are negative but high clinical suspicion of IE you can?

A

Consider serology for atypical organisms

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17
Q

How do you treat native valve IE?

A

Amoxicillin + gentamicin IV

18
Q

How do you treat prosthetic valve IE?

A

Vancomycin IV
Gentamicin IV
Add in Rifampicin 3-5 days later (PO)

19
Q

How do you treat IE in a PWID?

A

Flucloxacillin IV

After that as guided by culture result

20
Q

How do you treat non-MSSA Staph Aureus?

A

Flucloxacillin IV

21
Q

How do you treat MRSA IE?

A

Same as prosthetic valve (Vancomycin IV, Gentamicin IV, add in Rifampicin 3-5 days later PO)

22
Q

How do you treat Viridans Strep IE?

A

Benzylpenicillin IV and gentamicin IV (synergistic)

23
Q

How do you treat enterococcus sp IE?

A

Amoxicillin or vancomycin and gentamicin IV

24
Q

How do you treat Staph epidermis IE?

A

Vancomycin and gentamicin and rifampicin PO

25
Q

IV antibiotics for IE are typically given for how long?

A

4-6 weeks

26
Q

What must be monitored during IE treatment?

A

Cardiac function
Temperature
CRP

27
Q

What is myocarditis?

A

Inflammation of cardiac muscle, commoner i younger people

28
Q

What causes myocarditis?

A

Mainly enterovirus
Coxsackie A&B
Echovirus
Others

29
Q

What are symptoms and signs of myocarditis?

A

Fever, chest pain, dyspnoea, palpitation
Arrhythmia, cardiac failure
Sudden death

30
Q

How do you diagnose myocaditis?

A

PCR/Viral culture

Throat swab for enterovirus & influenza

31
Q

What are complications of myocarditis?

A

Can lead to ongoing immune response causing sudden death

32
Q

How do you treat myocarditis?

A

Supportive (rest and analgesia)

33
Q

What is pericarditis?

A

Inflammation of the pericardium often coinciding with myocarditis

34
Q

What are causes of pericarditis?

A 
Mainly viral (less commonly bacterial) 
Idiopathic 
Autoimmune 
Drug induced
Trauma-related
Rarely spread from endocarditis or pneumonia
35
Q

What symptoms does pericarditis cause?

A

Chest pain

36
Q

How do you treat pericarditis?

A

Supportive treatment

If bacterial - antibiotics and drainage

37
Q

What is the character of pericarditis induced chest pain?

A

Relieved by sitting up

Worse on inspiration

38
Q

What does an ST elevation from pericarditis look like?

A

Saddle-shape

39
Q

How do you distinguish between a STEMI and pericarditis?

A

It is unlikely to be a STEMI if two different vascular territories are affected

40
Q

What are the ECG changes in pericarditis?

A

ST elevation

PR segment depression

Cardiovascular Conditions (JBR) (20 decks)

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