Paricarditis Vs Endocarditis

Question 1

Pericarditis Pathology

Answer 1

Inflammation of the pericardium. A thorough history is essential to making an accurate diagnosis

Question 2

Pericarditis Causes/Incidence

Answer 2

**Viruses: most common cause
Post myocardial infarction
Renal failure
Neoplastic, tuberculosis, septicemia
Endocarditis
Collagen diseases
Drug/trauma induced
Viral infection
Idiopathic

Question 3

Pericarditis Signs/Symptoms

Answer 3

Very localized retrosternal precordial chest pain, pleuritic and nature
Pain increased by deep inspiration, coughing, swallowing or recumbent
Pain relieved by sitting forward
Shortness of breath secondary to pain with inspiration

Question 4

Pericarditis Physical Findings

Answer 4

Pericardial friction rub characteristically present
Pleural friction rub maybe also present
Fever may be present depending on underlying cause

Question 5

Pericarditis Lab/Diagnostics

Answer 5

**ST segment elevation in all leads
**depression of PR segment highly indicated of pericarditis
Return of ST segment to normal in a few days followed by temporary T-wave inversion
ESR elevation
Blood cultures of bacterial cause suspected
CBC to rule out infection
Echocardiogram to confirm presence of pericardial fluid or other abnormalities
Baseline BMP

Question 6

Pericarditis management

Answer 6

NSAIDs are mainstay of treatment
Ibuprofen 400 to 600 mg every 6–8 hours
Indomethacin 25–50 mg every eight hours for two weeks
Corticosteroids are indicated only when there is total failure of high-dose NSAIDs over several weeks and with relapsing pericarditis. Can increase viral replication
When indicated dexamethasone 4 mg IV may relieve pain in a few hours; prednisone 60 mg daily then tapered
Antibiotics in case of bacterial infection
Codeine 15–60 mgPOQ ID for pain
Monitor for tamponade


Question 7

Endocarditis Pathology

Answer 7

Infection of the endothelial surface of the heart. Usually affects the valves.**A diagnosis of infective endocarditis must be considered and excluded and all patients with a heart murmur and fever of unknown origin

Question 8

Endocarditis Causes/Incidence

Answer 8

**Usually caused by bacteria
Known valvular disease especially in rheumatic, bicuspid aortic valve/mitral valve prolapse, with significant regurgitation
Recent dental/oropharyngeal surgery
Genitourinary instrumentation, surgery of the respiratory tract
Congenital heart disease
Prolonged use of IV catheters or total paren teal nutrition
Patience with burns
Hemodialysis

Question 9

Endocarditis Signs/Symptoms

Answer 9

Fever in Malays
Night sweats and weight loss
General sick feeling

Question 10

Night Sweats cause

Answer 10

Endocarditis
TB
Menopause
HIV aids
Hem/onc

Question 11

Endocarditis Physical Findings

Answer 11

Murmur often present but may be absent and up to 30% of patients especially those with right sided endocarditis
Medium to high fever
Osler’s nodes
Splinter hemorrhages
Splenomegaly observed and 50% of patients
Janeway lesions
Roth spots

Question 12

Osler’s nodes

Answer 12

Painful red nodules in the distal phalanges

Question 13

Splinter hemorrhages

Answer 13

Linear sub ungual splintering appearing

Question 14

Jane way lesions

Answer 14

Rarely observed, small and not painful macules on the palms and soles

Question 15

Roth Spots

Answer 15

Small retinal infarcts, white in color, encircled by area of hemorrhage

Question 16

Endocarditis Lab/Diagnostics

Answer 16

WBC maybe normal or elevated, but there is always a left shift with bands
Echocardiogram with valvular damage
Blood cultures for causative organism
ESR virtually always elevated

Question 17

Endocarditis Management

Answer 17

For suspected cases of sub acute endocarditis, empiric therapy is generally not starting until blood cultures result identify the pathogen
Acute endocarditis usually due to staphylococcus aureus, streptococci, and enterococcus, empiric therapy; vancomycin until culture results are available