pericarditis Flashcards
global ST elevations can indicate
pericarditis
causes of acute pericarditis
- viral
- IVDA
- malignancy
- post MI
clinical features of acute pericarditis
Chest pain- tends to be pleuritic in nature.
Pain tends to diminish when leaning forward.
Friction rub-
ECG findings
1) Global “J” pt. elevations which don’t make sense as far as teammates.
2) Hammock shaped S-T segments (rather than tombstone shaped)
3) P-R slurring
how to tx acute pericarditis
- NSAIDs/ASA
- colchicine for chronic
Rate of accumulation is important for hemodynamic compromise.
Can hold 2 Liters if fluid slowly accumulates
100 mL can cause tamponade from quick accumulation
large volume pericardial effusion (aka tamponade aka restrictive pericarditis) can lead to
- Beck’s triad (hypotension w/narrow pulse pressure, JVD, muffled heart sounds)
- Pulsus Paradoxis (HR decreases as a breath is taken)
- QRS alternans
Kussmuals sign: increased JVD with inspiration
is seen with
constrictive pericarditis
Dressler’s syndrome
Post MI pericarditis or postmyocardial infarction syndrome pericarditis.
It consists of fever, pleuritic pain, pericarditis and/or a pericardial effusion.
Symptoms begin 2 - 3 weeks after MI
Treat with ASA, Steroids but not 1st month due to delayed healing
endocarditis
-Infection of the valvular or endocardial surface of the heart
-Strep viridians favors abnormal heart valves.(Rhueamtic heart fever) Hx. Untreated Strep. Infections as a child
-Staph aureus favors previously normal heart valves
=(infective endocarditis)
which valves are most commonly infected from endocarditis?
right side
tricuspid and pumonic
MC presenting complaint for endocarditis?
- FEVER
- others will have petechia, splinter hemorrhages, –Janeway lesions ((nontender, erythematous or hemorrhagic macular or nodular lesions on the palms or soles)
- Roth Spots(hemorrhage in the retina with a white center)
- anemia is common
how to dx endocarditis?
- blood cultures
- TEE
- history
duke major criteria
2 POSITIVE BLOOD CULTURES Of an organism that typically causes IE Or, persistent bacteremia EVIDENCE ON ECHO DEVELOPMENT OF NEW REGURGE MURMUR
duke minor criteria
Fever > 38 C
Predisposition, predisposing heart condition, IV drug use.
Vascular phenomena
Immunologic phenomena
Serologic evidence of an active infection
definite IE is confirmed by this dukes criteria
Two Major Criteria
Or
One Major Three Minor
Or
Five Minor Criteriahow to tx IE?
-empiric anbx
vanco for gram +
ceftriaxone
should you anticoag IE pts?
no, unless they have afib
