Lecture 3: Cardiovascular Infections Flashcards
Endocarditis is an infection of the
valves
Fluid around the heart protects the heart from
infection
Risk factors for endocarditis
1) bacteremia (IV drug users, intravenous catheters) AND 2) structural heart disease (prosthetic valve, severe stenosis or regurg)
Endocarditis pathogens: subacute
Indolent lasts days to weeks. Strep viridians an dstrep bovis. Colonize in the nasopharynx and gums, nasophaynx procedures –> blood –> heart valves. seen in pairs and in chains.
Endocarditis pathogens: acute
Staph aureus. In IV drug users or IV devices, very fast. +cocci in clusters = staph
s/s strep spp endocarditis
subacute onset of low grade fever, fatigue and murmur due to slow valve destruction
s/s staph aureas endocarditis
acute onset high grade fever, shaking, chills and murmur due to rapid valve destruction
Valve vegetation
leads to valve destruction and systemic embolism. Comprised of a loose collection of fibrin, bacteria, platelets, and red blood cells together. –> s/s CHF and regurgitation d/t destroyed valve. Tricuspid is the first effected –> lung PEs and septic PE
Endocarditis presentation
fever/night sweats and new or worsening murmur (destroyed valves), s/s systemic emboli
Embolic phenomena of endocarditis- right sided valves
Lung emboli (presents as pneumonia)
Embolic phenomena of endocarditis- left sided valves
Embolic stroke MI Retinal emboli (Roth spots) Renal emboli (embolic damage, hematuria, renal failure) Janeway lesions Osler nodes Splinter hemorrhages
test for diagnosing endocarditis- blood culture
initial test (95% sensitive). Necessary to establish the diagnosis
test for diagnosing endocarditis- TTE
Initial imaging test. 60-70% sensitivity for vegetations. Visualization of vegetations is necessary for diagnosis. Negative TTE will require to perform TEE
test for diagnosing endocarditis- TEE
useful for establishing diagnosis if initial TTE is negative. 95%-100% sensitive. Maybe initial test for patients with prosthetic valve
ECG useful for diagnosing endocarditis?
No. Non-specific changes. Do not require for diagnosis
How do you establish the diagnosis of endocarditis?
positive blood cultures + vegetation on echo = endocarditis
How do you establish the diagnosis of endocarditis if blood cultures are negative?
(risk factors + embolic phenomene) + vegetation on echo= endocarditis
Recommended treatment for endocarditis?
Empiric coverage with intravenous Vancomycin (staph spp. including MRSA) + Ampicillin (strep spp.). Gentamycin can be added for synergism (4-6 weeks of abx)
- can be changed based on sensitivity when culture gets back
- may need surgery for ruptured valve and embolism (large vegetations)
Who needs prophylaxis abx for endocarditis?
high risk patients undergoing high risk procedures AKA significant valvular defect + high risk of bacteremia (need to have both to justify giving prophylaxis)
What counts as having significant valvular defects?
- Prosthetic valve
- Previous endocarditis
- Unrepaired/ partially repaired cyanotic defect (Tetralogy of Fallot)
who/ what procedures are at high risk for bacteremia?
- Dental work w/blood (extractions, root canal, dental cleaning)
- Respiratory tract procedures w/ blood (biopsy , tonsillectomy)
If patient should get prophylaxis, what is recommended treatment?
Amoxicillin or Clindamycin (single dose before the procedure)
what is pericarditis?
Infection/inflammation of pericardium
what are causes of pericarditis?
*Idiopathic
*Infection (viral- Coxckievirus)
Autoimmune disorders (Lupus)
Malignancy (Hodgkin lymphoma, lung cancer)
Metabolic causes (uremia)
Trauma (chest trauma)
