Infective Endocarditis & Pericardial effusions Flashcards
What organisms commonly cause Infective Endocarditis?
Streptococcus Viridians
Staphylococcus Aureus
Coagulase negative streptococci
What are the 5 steps for the pathophysiology of Infective Endocarditis?
1) Endothelial/valve damage
2) Platelets/Fibrin deposited
3) Bacteraemia
4) Adherence/consolidation of bacteria
5) Fibrin aggregates protect the bacteria from defence mechanisms
What valve abnormalities can commonly occur with Infective Endocarditis?
Mitral regurgitation
Aortic regurgitation
Due to disruption of the valve cusps
How do patients with Infective Endocarditis present?
Heart murmur + Fever
Signs associated with systemic infection eg fever, malaise, myalgia, Wt loss
Signs associated with Valvular/Cardiac damage - Changing murmur - regurgitation. HF, conduction abnormalities
Signs associated with Immune Vasculitis - Roth spots (Retinal), Oslers nodes, Janeway lesions, Clubbing, Splinter haemorrhages, Glomerulonephritis
Embolisation can also occur
What are the Major criteria for Duke criteria for Infective Endocarditis?
A - Positive blood culture for Infective Endocarditis (Typical organisms in 2 separate cultures or Persistently positive cultures 3 sets)
B - Evidence of Endocardial involvement (Positive echocardiogram eg vegetation, abscess or New valvular regurgitation)
What are the Minor criteria for Duke criteria for Infective Endocarditis?
1) Predisposition eg IV drug abuser
2) Fever >38
3) Vascular/Immunological signs
4) Positive blood culture (But doesn’t meet Major criteria)
5) Positive echocardiogram (But doesn’t meet Major criteria)
Define Infective Endocarditis using the Duke criteria
2 Major OR 1 Major, 3 Minor OR 5 Minor
What investigations would you perform for a patient with suspected Infective Endocarditis?
Bloods - FBC, U&Es, LFTs, CRP, Blood cultures x3 CXR ECG Echocardiogram Urinalysis
What is the treatment for Infective Endocarditis?
A-E
4 weeks IV empirical antibiotics (Benzylpenecillin & Gentamicin)
What patients are at risk of Infective Endocarditis?
Structural CHD
Acquired valve disease
Prosthetic valves
Previous endocarditis
What advice would you give to a patient at risk of Infective Endocarditis?
Maintain good oral health
Symptoms and when to seek expert help
Risks of undergoing procedures including body piercing and tattoos
When undergoing GI/Genitourinary procedures give ABx that cover organisms causing Infective Endocarditis too
ABx prophylaxis is no longer recommended
Define Cardiac tamponade
Pericardial effusion causing haemodynamically significant cardiac compression
- Pericardial pressure increases inhibiting venous return to the heard
- Resulting in reduced cardiac output, hypotension and shock
What are the causes of acute Pericardial effusion?
Trauma
Iatrogenic - Anticoagulation, Cardiac surgery
Aortic dissection
Spontaneous bleed - Uraemia, Thrombocytopenia
Cardiac rupture post MI
What are the causes of sub-acute Pericardial effusion?
Malignancy Idiopathic pericarditis Uraemia Infection - Including TB Radiation
How do patients with a Pericardial effusion present?
Dependent on how quickly the fluid accumulates - If slow developing then SOB, cough, hiccups, dysphagia
Commonly - cardiac arrest, Hypotension, confusion, shock
