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AGPC 4!!!!!! > Lecture 3: Cardiovascular Infections > Flashcards

Lecture 3: Cardiovascular Infections Flashcards

1
Q

Endocarditis is an infection of the

A

valves

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2
Q

Fluid around the heart protects the heart from

A

infection

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3
Q

Risk factors for endocarditis

A

1) bacteremia (IV drug users, intravenous catheters) AND 2) structural heart disease (prosthetic valve, severe stenosis or regurg)

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4
Q

Endocarditis pathogens: subacute

A

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.

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5
Q

Endocarditis pathogens: acute

A

Staph aureus. In IV drug users or IV devices, very fast. +cocci in clusters = staph

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6
Q

s/s strep spp endocarditis

A

subacute onset of low grade fever, fatigue and murmur due to slow valve destruction

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7
Q

s/s staph aureas endocarditis

A

acute onset high grade fever, shaking, chills and murmur due to rapid valve destruction

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8
Q

Valve vegetation

A

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

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9
Q

Endocarditis presentation

A

fever/night sweats and new or worsening murmur (destroyed valves), s/s systemic emboli

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10
Q

Embolic phenomena of endocarditis- right sided valves

A

Lung emboli (presents as pneumonia)

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11
Q

Embolic phenomena of endocarditis- left sided valves

A 
Embolic stroke 
MI 
Retinal emboli (Roth spots)
Renal emboli (embolic damage, hematuria, renal failure)
Janeway lesions 
Osler nodes 
Splinter hemorrhages
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12
Q

test for diagnosing endocarditis- blood culture

A

initial test (95% sensitive). Necessary to establish the diagnosis

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13
Q

test for diagnosing endocarditis- TTE

A

Initial imaging test. 60-70% sensitivity for vegetations. Visualization of vegetations is necessary for diagnosis. Negative TTE will require to perform TEE

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14
Q

test for diagnosing endocarditis- TEE

A

useful for establishing diagnosis if initial TTE is negative. 95%-100% sensitive. Maybe initial test for patients with prosthetic valve

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15
Q

ECG useful for diagnosing endocarditis?

A

No. Non-specific changes. Do not require for diagnosis

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16
Q

How do you establish the diagnosis of endocarditis?

A

positive blood cultures + vegetation on echo = endocarditis

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17
Q

How do you establish the diagnosis of endocarditis if blood cultures are negative?

A

(risk factors + embolic phenomene) + vegetation on echo= endocarditis

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18
Q

Recommended treatment for endocarditis?

A

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)
19
Q

Who needs prophylaxis abx for endocarditis?

A

high risk patients undergoing high risk procedures AKA significant valvular defect + high risk of bacteremia (need to have both to justify giving prophylaxis)

20
Q

What counts as having significant valvular defects?

A
  • Prosthetic valve
  • Previous endocarditis
  • Unrepaired/ partially repaired cyanotic defect (Tetralogy of Fallot)
21
Q

who/ what procedures are at high risk for bacteremia?

A
  • Dental work w/blood (extractions, root canal, dental cleaning)
  • Respiratory tract procedures w/ blood (biopsy , tonsillectomy)
22
Q

If patient should get prophylaxis, what is recommended treatment?

A

Amoxicillin or Clindamycin (single dose before the procedure)

23
Q

what is pericarditis?

A

Infection/inflammation of pericardium

24
Q

what are causes of pericarditis?

A

*Idiopathic
*Infection (viral- Coxckievirus)
Autoimmune disorders (Lupus)
Malignancy (Hodgkin lymphoma, lung cancer)
Metabolic causes (uremia)
Trauma (chest trauma)

25
Q

clinical presentations of pericarditis?

A
  • Positional (relieved by sitting forward) and pleuritic chest pain
  • Friction rub (disappears with pericardial effusion)
26
Q

tests for pericarditis- ECG

A

Initial test. Done to r/o myocardial ischemia. ECG maybe non-specific in pericarditis or show diffused ST elevations and PR depressions

27
Q

tests for pericarditis- echo

A

To r/o pericardial effusion and tamponade. Pericarditis w/o effusion- normal ECHO

28
Q

tests for pericarditis- inflammatory markers

A

Non-specific, likely elevated

29
Q

tests for pericarditis- viral cultures

A

Rarely change the treatment

30
Q

tests for pericarditis- chest xray

A

will be normal

31
Q

what is the recommended treatment for pericarditis?

A

NSAIDs w/ or w/o Colchicine
Steroids if insufficient response to NSAIDs
Resolves in 2-6 weeks

32
Q

how can you tell if a murmur is innocent?

A 
NO STRUCTURAL PATHOLOGY 
Grade 1-3 (no thrill !) 
Always systolic (mid or early systolic)
Gets softer w/ standing/Valsalva 
No radiation beyond precordium 
Always asymptomatic !!!  
Common in children and young adults. In older adults innocent murmurs are extremely rare
33
Q

how can you tell if there is a pathologic murmur?

A

Diastolic, holosystolic or continuous
Grade >3
Radiating beyond the precordium
Associated with symptoms

34
Q

what is hpertrophic obstructive cardiomyopathy (HOCM)? causes?

A

Causes: autosomal dominant genetic

Dynamic outflow obstruction during systole

35
Q

grading of murmurs

A

Grade 1- faint (S1 and S2 is louder than a murmur)
Grade 2 - quiet (S1 and S2 = murmur)
Grade 3 – moderately loud (murmur is louder than S1 and S2)
Grade 4 – loud with palpable thrill
Grade 5 – very loud, with thrill. Maybe heard with a stethoscope is partly off the chest
Grade 6- very loud, with thrill. Maybe heard with a stethoscope entirely off the chest

36
Q

what is S1 & S2? listen with what?

A

auscultate with the diaphragm
S1= Beginning of the systole (closure of the mitral valve)
S2= Beginning of the diastole (closure of the aortic valve)

37
Q

S3, S4 (extra-sounds) – listen with?

A

auscultate with the bell

38
Q

S3 can be heard in?

A

Can be heard in volume overload CHF (systolic dysfunction)

Also in young adults

39
Q

S4 can be heard in?

A

Can be heard in decreased compliance of the ventricle in long-standing hypertension (diastolic dysfunction)
Also in older adults (common)

40
Q

In systole- what are each of the valves doing?

A

aortic valve open, mitral valve closed

41
Q

In diastole- what are each of the valves doing?

A

mitral valve open, aortic valve closed

42
Q

HOCM s/s

A

Syncope during exercise
Sudden death
Harsh systolic murmur radiates to carotid, heard best at right /left sternal border
Murmur gets louder with standing/Valsalva

43
Q

what should you do if a pt has an innocent murmur?

A

observe and re-evaluate

44
Q

what should you do if a pt has a pathological murmur?

A

evaluate (TTE first)

Transthoracic ECHO&raquo_space;> trans-esophageal ECHO&raquo_space;> cardiac catheterization

AGPC 4!!!!!! (10 decks)

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