Infective Endocarditis, Myocarditis, Pericarditis Flashcards
What is infective endocarditis?
Infection of the endothelium of the heart vales
What are the risk factors for IE?
Heart valve abnormalities Calcification Prosthetic valves Sclerosis in elderly Congenital heart disease Post-rheumatic fever IV drug user IV lines
What is the pathogenesis of IE?
Damaged heart valve Turbulent blood flow Platelet/fibrin deposited Bacteraemia Organisms settle in the fibrin/platelet thrombi - become microbial vegetation
Which side of the heart if usually affected?
Left side
Prosthetic valve are usually infected at time of insertion due to?
Staph Epidermidis
Staph aurus
What are common organisms?
Staph aureus
Strep Viridans
Enterococcus Sp
Staph epidermis
IE is often a complication of?
Dental treatment
What are unusual organisms that cause IE?
Bartonella Coxiella Burnetti Brucella Gram -ve HACEK Fungi
Which organisms make up HACEK?
Haemophilus, Aggregatibacter (previously Actinobacillus), Cardiobacterium, Eikenella, Kingella
In IV drug users, usually the ____ side is affected
right
What typically causes IE in IV drug uses?
Staph aureus
Septic pulmonary embolipneumonia
What are symptoms of IE?
Fever Malaise Weight loss Tiredness Breathlessness
What are signs of IE?
New murmur Finger clubbing Splinter haemorrhages Splenomegaly Roth spots Janeway lesions Osler's nodes Microscopic haematuria
How do you diagnose IE?
3 sets of bloods (1 +ve may be contaminant)
TOE
Culture (MALDI-TOF?)
What is a typical contaminant?
Staph epidermidis
If cultures are negative but high clinical suspicion of IE you can?
Consider serology for atypical organisms
How do you treat native valve IE?
Amoxicillin + gentamicin IV
How do you treat prosthetic valve IE?
Vancomycin IV
Gentamicin IV
Add in Rifampicin 3-5 days later (PO)
How do you treat IE in a PWID?
Flucloxacillin IV
After that as guided by culture result
How do you treat non-MSSA Staph Aureus?
Flucloxacillin IV
How do you treat MRSA IE?
Same as prosthetic valve (Vancomycin IV, Gentamicin IV, add in Rifampicin 3-5 days later PO)
How do you treat Viridans Strep IE?
Benzylpenicillin IV and gentamicin IV (synergistic)
How do you treat enterococcus sp IE?
Amoxicillin or vancomycin and gentamicin IV
How do you treat Staph epidermis IE?
Vancomycin and gentamicin and rifampicin PO
IV antibiotics for IE are typically given for how long?
4-6 weeks
What must be monitored during IE treatment?
Cardiac function
Temperature
CRP
What is myocarditis?
Inflammation of cardiac muscle, commoner i younger people
What causes myocarditis?
Mainly enterovirus
Coxsackie A&B
Echovirus
Others
What are symptoms and signs of myocarditis?
Fever, chest pain, dyspnoea, palpitation
Arrhythmia, cardiac failure
Sudden death
How do you diagnose myocaditis?
PCR/Viral culture
Throat swab for enterovirus & influenza
What are complications of myocarditis?
Can lead to ongoing immune response causing sudden death
How do you treat myocarditis?
Supportive (rest and analgesia)
What is pericarditis?
Inflammation of the pericardium often coinciding with myocarditis
What are causes of pericarditis?
Mainly viral (less commonly bacterial) Idiopathic Autoimmune Drug induced Trauma-related Rarely spread from endocarditis or pneumonia
What symptoms does pericarditis cause?
Chest pain
How do you treat pericarditis?
Supportive treatment
If bacterial - antibiotics and drainage
What is the character of pericarditis induced chest pain?
Relieved by sitting up
Worse on inspiration
What does an ST elevation from pericarditis look like?
Saddle-shape
How do you distinguish between a STEMI and pericarditis?
It is unlikely to be a STEMI if two different vascular territories are affected
What are the ECG changes in pericarditis?
ST elevation
PR segment depression
