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Cardiovascular > Inflammatory Heart Disease > Flashcards

Inflammatory Heart Disease Flashcards

1
Q

What is pericarditis?

A

Inflammation of the pericardium, the fibroelastic sac that surrounding the heart

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2
Q

What are the causes of pericarditis?

A

Infection

  • Coxsackle B
  • TB
  • Rheumatic fever/streptococcus A

Dressler Syndrome/post cardiac injury syndrome

Uremic pericarditis

Rheumatological disease, such as SLE and sarcoidosis

Malignancy and radiation

Medication

  • Penicillin
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3
Q

How does pericarditis present?

A

Sharp substernal chest pain

  • Worsens with movement, inspiration and lying flat
  • Relieved when sitting up/leaning forward

Fever

Auscultation

  • Diminished heart sounds
  • Pericardial friction rub, caused by layers rubbing against each other
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4
Q

What investigations are used in pericarditis diagnosis?

A

ECG

  • Widespread saddle shaped ST elevation

Raised troponin

  • Stays constantly elevated rather than peaking like MI

CXR

  • Water bottle sign, pool of white at bottom of heart

ECHO, restriction of heart movement

Angiogram, excludes MI as shows normal coronary arteries

Blood cultures

Raised CRP and ESR

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5
Q

What is the management of pericarditis?

A

Exercise restriction and NSAIDs, first line for viral

Adjunctive colchicine, use with caution in hepatic/renal impairment

Corticosteroids, for patients unable to tolerate NSAIDs or first line in non viral

Antibiotics in bacterial causes

Pericardiocentesis if purulent exudate

Pericardectomy if recurrent tamponade

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6
Q

Name some complications of pericarditis

A

Pericardial effusion

  • Inflammation causes fluid accumulation in pericardial sac, causing a globular heart on CXR

Cardiac tamponade

Constrictive pericarditis in long term disease

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7
Q

What is myocarditis?

A

Inflammation of the myocardium/middle muscular layer of the heart

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8
Q

What group of patients is myocarditis more common in?

A

Cause of sudden death in young people

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9
Q

What are the causes of myocarditis?

A

Infective

  • Coxsackie A&B
  • Chagas disease/trypanosoma cruzi
  • Trichinella roundworm
  • Lyme disease/borella burgdorferi
  • Toxoplasma Gondili

SLE

Polymyositis

Radiation

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10
Q

What is the most common cause of myocarditis?

A

Viral infection/Coxsackie

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11
Q

How does myocarditis present?

A

May be asymptomatic and broad symptoms

Cardiac chest pain

Fatigue

Palpitations

HF symptoms

Non specific signs on auscultation

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12
Q

What investigations are used in the diagnosis of myocarditis?

A

Raised troponin and creatinine kinase

>CRP

ECG

  • Non specific ST and t wave changes

CXR

ECHO

Endomyocardial biopsy, gold standard diagnosis

Viral screen

  • Stool samples
  • Throat swab
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13
Q

What is the management of myocarditis?

A

Usually self-limiting as usually viral

Antibiotics if bacterial

NSAIDs

HF medication

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14
Q

What is endocarditis?

A

Inflammation of inner layer/endovascular structures of the heart

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15
Q

What are the causes of endocarditis?

A

Risk factors

  • Increased age
  • Male
  • IVDU, associated with staph aureus
  • Poor dentition and dental infections

Co-morbidities

  • Mitral valve prolapse, aortic valve disease, rheumatic heart disease, artificial valves
  • Congenital heart disease such as VSD, pulmonary stenosis
  • HIV
  • Haemodialysis
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16
Q

What pathogens can cause endocarditis?

A

Strep viridans

Staph aureus, associated with IVDU

Staph epidermis, associated with valve replacement

Strep bovis, associated with IBD and colonic tumours

17
Q

What organism is the most common cause of endocarditis?

A

Strep viridans, but is staph aureus in IVDU

18
Q

How does endocarditis present?

A

FROM JANE

Fever

Roth’s Spots on iris

Osler’s nodes

Systolic murmur (MR) and night sweats

Janeway lesions

Anaemia and anorexia

Nail changes, including splinter haemorrhages and clubbing

19
Q

What investigations are used in endocarditis diagnosis?

A

Blood cultures

  • At least 3 from different sites, at a minimum of 1 hour apart

ECHO

  • Transthoracic is first line initial imaging
  • Transoesophageal is most sensitive diagnostic test

Raised CRP and ESR

FBC

  • Neutrophilia

U&E

ECG

  • Wide QRS
20
Q

How is endocarditis managed?

A

Broad spectrum IV Antibiotics

  • Minimum 6 weeks
  • Benzylpenicillin + Gentamicin
  • Add flucloxacillin in IVDUs
  • Vancomycin if staph aureus

Surgical repair

21
Q

Give indications for surgical repair in infective endocarditis

A

Haemodynamic instability

Severe heart failure (congestive is indication for urgent surgery)

Severe sepsis despite antibiotics

Valvular obstruction

Infected prosthetic valve

Persistent bacteraemia

Repeated emboli

Aortic root abscess/PR interval prolongation

22
Q

What compliations can occur in endocarditis?

A

Acute valvular insufficiency causing heart failure

Neurologic complications such as stroke, abscess, haemorrhage

Embolic complications causing infarction of kidneys, spleen or lung

Infection such as osteomyelitis, septic arthritis

23
Q

What criteria is used in endocarditis diagnosis?

A

Modified Duke’s Criteria

24
Q

What does Duke’s criteria require for endocarditis diagnosis?

A

Two major criteria

One major + three minor criteria

All five minor criteria

25
Q

What is included in the major criteria of endocarditis?

A

Blood culture positive for typical organism or persistently positive

Imaging positive

26
Q

What is included in the minor criteria of endocarditis diagnosis?

A

Predisposing factor/condition

Fever

Immunological phenomena due to immune complex deposition

Vascular phenomena

  • Arterial emboli
  • Infarcts
  • Mycotic aneurysms
  • Intracranial or conjunctival haemorrhages
  • aneway lesions

Immunological phenomena

  • Glomerulonephritis
  • Osler’s nodes
  • Roth’s spots
  • Rheumatoid factor

Microbiological evidence

  • Blood culture not meeting major criteria, or serological evidence of active infection with organism consistent with IE
27
Q

Summarise the differences between pericarditis and cardiac tamponade

A
28
Q

What valve does endocarditis most commonly affect?

A

Tricuspid

29
Q

What is the first line management of dresslers syndrome?

A

Aspirin

Cardiovascular (12 decks)

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