Unit 10 Cardiac Infections & Structures Flashcards
What is Rheumatic fever?
What are the risk factors?
Acute inflammation of the heart involving all layers.
(common in 5-18 years old)
- Poor hygiene
- Close proximity
What is he jones modified criteria for Major and Minor signs and symptoms of Rheumatic Fever? Other?
Major:
- Carditis
- Polyarthritis
- Erythema marginatum (macular lesions on back aggravated by heat)
- Sydenham’s Chorea (facial twitching)
- Subcutaneous nodules (painless nodules)
Minor:
- Arthralgia (joint pain)
- Fever
- ASO titer (Antistrep antibodies)
- Hx of RF or R. heart disease
Other:
- SOB
- Symptoms of HF
- Murmor
- Cardiomegaly on CXR
What is Rheumatic Fever treated with?
Penicillin
if allergic, azithromycin
What does Rheumatic Fever lead to if not treated?
Rheumatic Heart Disease later in life.
What is confirmed diagnoses of Rheumatic Fever?
2 “major” symptoms
or
1 “major” and 2 “minor”
What is Myocarditis?
Inflammation of myocardium; viral or bacterial
What is the collaborative care of Myocarditis?
Can resolve w/o intervention
In later stages:
- Bedrest
- Supportive care
- Lasix
- Steroids
- IV Globulin Infusion
What are the symptoms of Myocarditis?
Flu-like symptoms
- Fever
- Fatigue
- Pleuritic chest pain
What is Infective Endocarditis?
What are the major organisms?
What are the portals of entry?
What are the risk factors?
Infection of the endocardial surface of the heart.
(acute or subacute)
Destroys heart valves, etc.
Major organisms: Staph, Strep
Portals of entry: Oral, skin, Invasive procedures
Risk factors: Congenital heart disease, atrial septal defect, PDA, IV drug abusers
What is a characteristic lesion of Infective Endocarditis? Describe.
Vegetation - growth of bacteria on heart valves
They are easily breakable and can occlude blood vessels.
What are general symptoms of Infective Endocarditis?
- Fever
- Fatigue
- Chills
- Malaise
- Anorexia
- Arthralgia (joint pain)
- Clubbing
- Petichiae
What are specific symptoms of Infective Endocarditis?
Splinter hemorrhage (black line under nails)
Osler’s nodes (painful red lesions on hands and feet)
Janeway lesions (painless lesions on palms and feel)
Roth spots (hemorrhage spots in eyes)
New murmurs
System/organ embolization
Heart failure
What are the diagnostics/labs used/seen in Infective Endocarditis? Describe.
-History and physical (recent procedures especially dental, hx of valve disease)
- CBC (increased leukocytes)
- ESR (increased)
- C/S (cultures taken before antibiotics)
- Urinalysis (may show microscopic hematuria)
- CXR (cardiomegaly)
- EKG (different types of heart blocks)
- ECHO (to detect vegetation)
- TEE (NPO, IV conscious sedation)
What medications/interventions are used with Infective Endocarditis?
Bedrest
Antibiotics: - will need for 6 weeks, PT gets PICC line
- Penicillins
- Vancomycin (watch BUN and creatinine)
- Amino-glycosides (gentymycin)
Antipyretics
Surgical repair
Follow-up lab work
Describe the level of risk and needing antibiotic prophylaxis for Infective Endocarditis.
Low risk:
-Hx of physiologic murmurs
Moderate risk:
- Heart murmurs
- Valvular disease
High risk:
- Prosthetic valves
- Surgical shunts
- Hx of endocarditis
- Other invasive procedures
What is Pericarditis?
What are the causes?
Inflammation of the pericardium
Causes: viral, bacterial, Post MI, ESRF, Rx’s like hydralazine
What are complications of Pericarditis?
Pericardial effusion
Cardiac Tamponade
Constrictive pericarditis
What is Cardiac Tamponade and what are the signs and symptoms?
Compression of the heart that occurs when fluids build up between pericardium and myocardium.
S and S’s:
- SOB
- JVD
- Tachycardia
- Paradox pulses
- EKG shows every other QRS big then small, repeating.
What are signs and symptoms of Pericarditis?
- Fever
- Anxiety
- Chest pain (increases when laying down)
- Tachycardia/Tachypnea
- Pulses paradox
- JVD
- Muffled heart sounds
- Friction rub
- EKG (slight ST elevation everywhere)
- CXR (cardiomegaly)
(All increase in severity when laying down)
What are diagnostics of Pericarditis?
Hx and physical
CBC
BMP
EKG
CXR
Mantaux test
Echocardiagram***gold standard
Pericardiocentesis
What are interventions for Pericarditis?
Rx for underlying cause
Bedrest
NSAIDS***(for pain and inflammation)
Steroids
Pericardiocentesis (done sitting up)
What are considered Diastolic murmurs?
MS ARD = Mitral stenosis, Aortic regurgitation = Diastolic
everything else is systolic.
What are the two atrio-ventricular valves?
Mitral valve (LA-LV)
Tricuspid valve (RA-RV)
Describe Valvular Heart Disease.
Most valvular lesions are due to Rheumatic heart disease.
Valve abnormalities are either:
Regurgitation = cannot close properly Stenosis = cannot open properly
