Infective Endocarditis + Pericarditis Flashcards
What is infective endocarditis?
Infection of the endothelium of the heart most commonly affecting the heart valves
What are the risk factors for developing infective endocarditis?
IVDU (Intravenous Drug User)
Prosthetic heart valve
Poor oral hygiene
Structural heart disease
CKD (especially dialysis)
Immunocompromised (Cancer, HIV or immunosuppressive medications)
History of infective endocarditis
What structural heart disease increase the risk of developing infective endocarditis?
Valvular heart disease
Hypertrophic cardiomyopathy
Prosthetic heart valves
Implantable cardiac devices
What are the most common causative organisms for infective endocarditis?
Staphylococcus aureus
Streptococcus (viridans group)
Enterococcus
Rare:
Pseudomonas, HACEK organisms
How does a patient with infective endocarditis present?
Fever
Fatigue
Night sweats
Muscle aches
Anorexia
Sepsis
What examination findings can be present with infective endocarditis?
New/change of heart murmur
Splinter haemorrhages
Janeaway lesions
Oslers nodes
Roth spots (retina on fundoscopy)
Splenomegaly
Finger clubbing
What is the pathophysiology of splinter haemorrhages in infective endocarditis?
Micro septic emboli in the finger nails
What is the pathophysiology of Roth spots on fundoscopy?
Haemorrhages on the retina
What investigations do you do to investigate infective endocarditis?
Blood cultures
ECHOCARDIOGRAM OR TRANSOESOPHAGEAL ECHOCARDIOGRAM (looking for vegetations)
May require PET CT if prosthetic valve
What is the name of the criteria used to diagnose infective endocarditis?
Modified Duke Criteria
What do you need to diagnose infective endocarditis according to the modified Duke criteria?
One major + Three minor criteria
Five minor criteria
What are the major criteria for diagnosing infective endocarditis?
Persistently positive blood cultures
Specific imaging findings (vegetations on echo)
What are the minor criteria for diagnosing infective endocarditis?
Predisposition/risk factors (IVDU or heart valve pathology)
Fever > 38
Vascular phenomena (Janeaway lesions, splenic infarction, intracranial haemorrhage)
Immunological phenomena (Oslers nodes, roth spots, glomerulonephritis)
Microbiological phenomena (positive cultures not qualifying for major criteria)
What is the management for infective endocarditis?
Refer cardiology and/or microbiology
IV broad spectrum (AMOXICILLIN + GENTAMICIN) then specific ABX once causative organism is identified
How long are antibiotics given to treat infective endocarditis?
4 weeks for normal native heart valve
6 weeks for prosthetic heart valve
How long are antibiotics given to treat infective endocarditis?
4 weeks for normal native heart valve
6 weeks for prosthetic heart valve
When is surgery appropriate for infective endocarditis?
Heart failure caused by valve pathology caused by the infective endocarditis
Large vegetations or abscesses
Infection not responding to ABX
What are some complications of infective endocarditis?
Heart valve damage leading to regurgitation
Heart failure
Infective and non infective emboli (abcesses, strokes and splenic infarction)
Glomerulonephritis
Which valve is most commonly affected in infective endocarditis in an IVDU and why?
Tricuspid valve
First valve come into contact if a patietn has an infection from being an IVDU
What’s is pericarditis?
Inflammation of the pericardium which is the membrane surrounding the heart
What are some causes of pericarditis?
Idiopathic
Infection (TB, HIV, EBV, coxsackievirus and other viruses)
Autoimmune (SLE, Rheumatoid arthritis)
Trauma to pericardium
Uraemia (renal impairment)
Cancer
Meds (methotrexate)
What is a pericardial effusion?
The potential space of the pericardium fills with fluid due to the infection or inflammation creating pressure on the heart which can lead to pericardial tamponade
What is pericardial tamponade?
Pericardial effusion large enough to raise the Intra-pericardial pressure enough to put pressure on the heart impairing its action in diastole reducing cardiac output
Why is pericardial tamponade an emergency?
How is it managed?
Can severely reduce cardiac output
Requires emergency drainage of the pericardial effusion to relieve the pressure
What are the 2 key features of a pericarditis presentation?
Chest pain
Low-grade fever
What type of chest pain is experienced with pericarditis?
Sharp
Central
Pleuritic
Worse on lying down
Better on sitting forward
What sound can be heard on auscultation with pericarditis?
Pericardial rub
What investigations would you do for pericarditis?
Bloods (WBC, CRP, ESR)
ECG
What ECG changes do you see with pericarditis?
Wide spread / Global ST ELEVATION
PR depression
What is the firstline medical management of pericarditis?
NSAIDs (aspirin or ibuprofen)
Colchicine (longer term)
What medication can be given second line to treat pericarditis?
Steroids in recurrent cases or associated inflammatory conditions
When may pericardiocentesis be necessary when treating pericarditis?
If there’s significant pericardial effusion or tamponade
