Pericarditis and Infective Endocarditis Flashcards
What is the distinctive rash that presents in pericarditis?
Hand foot and mouth - cocksackie virus (most common cause of pericarditis).
What ECG changes are seen in pericarditis?
‘saddle-shaped’ ST elevation
PR depression: most specific ECG marker for pericarditis
What is the gold standard investigation for pericarditis?
Transoesophageal echocardiogram is the mostsensitivediagnostic test.
Treatment for pericarditis?
NSAIDs and Colchizine
What are the differentials for this case:
A patient has had ‘chest pain’ for 4 days alongside some strange rashes. On further questioning the pain is sharp and central, relieved by leaning forwards.
▪Acute Pericarditis
▪Esophagitis
▪Costochondritis
▪ACS
▪Aortic dissection
▪Pneumonia
▪MI
What are the most common causes of acute pericarditis?
What is the treatment of acute pericarditis?
Usually self-resolving
Treat underlying cause
Combination of NSAIDs and colchichine
Symptom management
What is pulsus paradoxus?
A fall in systolic BP of >10mmHg during inspiration.
A women with acute pericarditis unfortunately she deteriorates… she had is short of breath and her heart is racing. You notice a pulsating high in her neck!!!
Pulsus paradoxus is a sign of…?
Cardiac tamponade
What is Libman sacks endocarditis and what is it associated with?
Autoimmune associated with SLE.
What are the bacterial causes of infective endocarditis?
Where are they found?
- Streptococcus viridans - found in the mouth.
- Staph aureus - most common - especially common in IV drug users.
- Staph epidermis - likes prosthetic heart valves, or infected IV catheter.
- Enterococcus faecalis and streptococus bovis - found in the bowel spread via colorectal cancer / UC.
How does IE present?
Fever and a murmur due to heart valve defects.
Splinter hemorrhages, janeway lesions and osler nodes.
How is IE diagnosed?
Multiple positive blood cultures.
Echocardiogram
What criteria is used to diagnose endocarditis?
Dukes criteria
What is Dukes criteria?
- Positive blood culture for a typic IE organism.
- Predisposing heart condition
- Temperature
- Peripheral stigmata
A man has a prosthetic aortic valve what is the most likely causative organism of his IE?
Staph epidermis
Summary of the antibiotic treatments of IE:
- Streptococcal endocarditis is treated with benzylpenicillin +/- gentamicin for 2-6 weeks
- Staphylococcus aureus is treated with flucloxacillin for at least 4 weeks
- Enterococcus is treated with amoxicillin and gentamicin for 4-6 weeks
Infective endocarditis in intravenous drug users most commonly affects what valve?
Infective endocarditis in intravenous drug users most commonly affects the tricuspid valve.
What is the most common cause of IE?
Staph aureus
Note: Historically Streptococcus viridans was the most common cause of infective endocarditis. This is no longer the case, except in developing countries.
Streptococcus viridans
Staphylococcus aureus (in intravenous drugs uses or prosthetic valves)
Staphylococcus epidermidis (in prosthetic valves)
Are all examples of what gram stain bacteria?
Gram positive cocci
Most commonly affected valve in IE?
In infective endocarditis, the aortic valve is most commonly affected
Treatment for acute peridcarditis:
A combination of NSAIDs and colchicine is now generally used for first-line for patients with acute idiopathic or viral pericarditis
What are the clinical signs on of infective endocarditis?
- Janeway lesions
- Osler nodes
- Roth spots
- Microscopic haematuria and glomerulonephritis
- Splinter haemorrhages
- PR prolongation or complete AV block.
What are Osler nodes?
Tender subcutaneous nodules on the finger pads and toes.
What are Roth spots?
Exudative haemorrhagic retinal lesions with pale centres
What are janeway lesions?
Non-tender macules on palms and soles.
What is PR prolongation or complete AV block a sign of in infective endocarditis?
PR prolongation or complete AV block - sign of aortic root abscess.
Complications of infective endocarditis:
- Acute valvular insufficiency causing heart failure
- Neurologic complications e.g. stroke, abscess, haemorrhage (mycotic aneurysm)
- Embolic complications causing infarction of kidneys, spleen or lung
- Infection e.g. osteomyelitis, septic arthritis
What investigations should be carried out in infective endocarditis?
- ECG
- Chest X-ray
- Blood tests: FBC, U&E, LFT, CRP
- At least 3 sets of blood cultures should be taken at different times from various sites.
- Transthoracic echocardiogram is thefirst line imaging investigation
- Transoesophageal echocardiogram is the mostsensitivediagnostic test
What finding on ECG can indicate the need for surgical intervention in infected endocarditis?
PR interval prolongation in a patient with Infective Endocarditis is an indication for surgery as it can be secondary to aortic root abscess.
