Infective Endocarditis, Myocarditis, Pericarditis

Question 1

What is infective endocarditis?

Answer 1

Infection of the endothelium of the heart vales

Question 2

What are the risk factors for IE?

Answer 2

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

Question 3

What is the pathogenesis of IE?

Answer 3

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

Question 4

Which side of the heart if usually affected?

Answer 4

Left side

Question 5

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

Answer 5

Staph Epidermidis

Staph aurus

Question 6

What are common organisms?

Answer 6

Staph aureus
Strep Viridans
Enterococcus Sp
Staph epidermis

Question 7

IE is often a complication of?

Answer 7

Dental treatment

Question 8

What are unusual organisms that cause IE?

Answer 8

Bartonella
Coxiella Burnetti
Brucella
Gram -ve
HACEK
Fungi

Question 9

Which organisms make up HACEK?

Answer 9

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

Question 10

In IV drug users, usually the ____ side is affected

Answer 10

right

Question 11

What typically causes IE in IV drug uses?

Answer 11

Staph aureus

Septic pulmonary embolipneumonia

Question 12

What are symptoms of IE?

Answer 12

Fever 
Malaise
Weight loss
Tiredness
Breathlessness

Question 13

What are signs of IE?

Answer 13

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

Question 14

How do you diagnose IE?

Answer 14

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

Question 15

What is a typical contaminant?

Answer 15

Staph epidermidis

Question 16

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

Answer 16

Consider serology for atypical organisms

Question 17

How do you treat native valve IE?

Answer 17

Amoxicillin + gentamicin IV

Question 18

How do you treat prosthetic valve IE?

Answer 18

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

Question 19

How do you treat IE in a PWID?

Answer 19

Flucloxacillin IV

After that as guided by culture result

Question 20

How do you treat non-MSSA Staph Aureus?

Answer 20

Flucloxacillin IV

Question 21

How do you treat MRSA IE?

Answer 21

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

Question 22

How do you treat Viridans Strep IE?

Answer 22

Benzylpenicillin IV and gentamicin IV (synergistic)

Question 23

How do you treat enterococcus sp IE?

Answer 23

Amoxicillin or vancomycin and gentamicin IV

Question 24

How do you treat Staph epidermis IE?

Answer 24

Vancomycin and gentamicin and rifampicin PO

Question 25

IV antibiotics for IE are typically given for how long?

Answer 25

4-6 weeks

Question 26

What must be monitored during IE treatment?

Answer 26

Cardiac function Temperature CRP

Question 27

What is myocarditis?

Answer 27

Inflammation of cardiac muscle, commoner i younger people

Question 28

What causes myocarditis?

Answer 28

Mainly enterovirus Coxsackie A&B Echovirus Others

Question 29

What are symptoms and signs of myocarditis?

Answer 29

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

Question 30

How do you diagnose myocaditis?

Answer 30

PCR/Viral culture | Throat swab for enterovirus & influenza

Question 31

What are complications of myocarditis?

Answer 31

Can lead to ongoing immune response causing sudden death

Question 32

How do you treat myocarditis?

Answer 32

Supportive (rest and analgesia)

Question 33

What is pericarditis?

Answer 33

Inflammation of the pericardium often coinciding with myocarditis

Question 34

What are causes of pericarditis?

Answer 34

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

Question 35

What symptoms does pericarditis cause?

Answer 35

Chest pain

Question 36

How do you treat pericarditis?

Answer 36

Supportive treatment | If bacterial - antibiotics and drainage

Question 37

What is the character of pericarditis induced chest pain?

Answer 37

Relieved by sitting up | Worse on inspiration

Question 38

What does an ST elevation from pericarditis look like?

Answer 38

Saddle-shape

Question 39

How do you distinguish between a STEMI and pericarditis?

Answer 39

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

Question 40

What are the ECG changes in pericarditis?

Answer 40

ST elevation | PR segment depression