Pericarditis/Endocarditis Flashcards
What is the treatment for pericarditis
- NSAIDs
- Colchicine
If contraindicated for patient, glucocorticoids
What is the most common cause of death in patients with endocarditis
Heart failure
What position relieves the pain in pericarditis
Sitting up and leaning forward
Diagnosis for endocarditis is based on what three things
- Clinical manifestations
- Blood cultures
- Echo
What are the non-cardiac risk factors for endocarditis
- IV durg use
- Indwelling intravenous catheter
- Immunosuppression
- Sental or surgical procedure
- Being old
What unique feature of endocarditis is the reason why a patient’s presenting complaint may not be centered around the heart, but rather on a body system affected by IE
Spectic emboli (vegetations) shower throughout the body
Treatment for endocarditis
No acute symptoms = wait 3 days for blood culutre
Acute symptoms = vancomycin
In the patient population that does not include healthcare workers and IV drug users, what are the most common pathogens associated with infectious endocarditis
Staphy aureus
Viridans Streptococci
Euqal proportions
What is the most common indication for cardiac surgery in patient with infective endocarditis
Heart failure
Which is more difficult to treat, endocarditis of native valve or prosthetic valve
Prosthetic valve - may require surgical replacement
Dental procedures that require prophylaxis with abx only include these things:
Prosthetic heart valve
Prior infectious endocarditis
Congenital heart disease
Procedures on infected skin or MSK tissue
What is Beck’s triad
Hypotension
Muffled heart sounds
JVD
What is the definitive treatment for constrictive pericarditis
Pericardiectomy
Which echo has a higher sensitivity for endocarditis
Transesophageal echo
What are the cardiac risk factors associated with endocarditis
- Prior infectious endocarditis
- Prosthetic valve
- Cardiac device
- Valvular/congenital heart disease
What is the MOST COMMON symptoms of infectious endocarditis
FEVER!
Especially if it is longer than a week
FEVER OF UNKNOWN ORIGIN
Petechiae and splinter hemorrhages are cutaneous manifestations of:
Endocarditis
How many patients with pericarditis have recurrent pericarditis
1/3
What is a normal amount of ultrafiltrae of plasma in the pericardial sac
15-50mL
You think your patient has pericarditis but you don’t hear that classic pericardial friction rub, a scratchy squeaky noise over the left sternal border. Can you rule it out?
Nope, the pericardial friction rub can vary in intesity and can come and go
Which pathogen is responsible for the majority of cases of healthcare- associated infectous endocarditis AND IE in IV drug users
Staph aureus
What are osler nodes
Tender subcutaemous violaceous nodules pads of fingers and toes
Endocarditis
What is the name of the triad assocaited with cardiac tamponade
Beck’s triad
What are Janeway lesions?
What are they associated with
Non-tender erythematous macules, palms and soles
Endocarditis
Why are glucocorticoids not a first line treatment for pericarditits
Because they can cause recurrent pericarditis
What are Roth spots
What are they associated with
Exudative, edematous hemorrhagic lesions of the retina with pale centers
Endocarditis
How do you take blood cultures for infective endocarditis
At least three sets
Separate venipuncture sites
Spaced over 30-60 minutes
Where does the pain radiate in pericarditis
Tricccccck it doesn’t!
Janeway lesions are more common in acute or subacute endocarditis
Acute
Osler nodes are more common in acute or subacute endocarditis
Subacute
What labs can you order for pericarditis that are sensitive and specific?
None!
You can order troponin, ESR, CRP, and CBCN but none of them are sensitive nor specific
What physical exam findings occur is most cases of infectious endocarditis (85%)
Cardiac murmurs
What is the traetment for cardiac tamponade
Cardiac tamponade DEMANDS PERICARDIOCENTESIS or SURGERY
The majority (60%) of patient with pericarditis will have an associated :
Pericardial effusion
What does pleuritic mean
Worse when you take a deep breath
If the etiology of pericarditis needs to be delineated (because its lasting a long time) what tests can you order to help you determine the cause
- TB test
- ANA (rheum stuff)
- HIV serology
- Chest CT (effusion)
- MRI
What type of chest pain is associated with pericarditis
SHARP, PLEURITIC
How do you describe a pericardial friction rub
Scratchy or squeaking heart sound
In western countries, what is the most common etiology of pericarditis
Viral
Which viruses are most common for causing pericarditis
Coxsackievirus and influenza
