2 - Paeds - CVS - Myocarditis and Subacute Bacterial Endocarditis Flashcards
Myocarditis - common?
causes?
uncommon
viral infection mostly, can be bacterial, other causes of paed myocarditis: drug allergy, chemicals, fungus, parasites, radiation, drugs
Myocarditis - pathology?
pathogen and immune response damage heart > swollen and thick > HF
Myocarditis - Sx? in >2y?
mild/hard to detect initially
failure to thrive, anxiety, poor feeding, fever, HF, low urine output, pale peripheries
>2 - nausea, abdo pain, chest pain, cough, fatigue, swelling (legs feet face)
Myocarditis - O/E? Ix?
O/e - tachycardia, murmur?, basal crackles
CXR - cardiomegaly
Echo
Myocarditis- mgmt principles
no cure
minimise damage and trt Sx until resolution
rest to prevent strain
Myocarditis drugs used?
diuretics, ACEis and Cervedilol (bB)
Protect heart with - ABx, steroids, anti-inflams, IV Igs
Subacute bacterial endocarditis - RFs
CHD any age (except sec ASD)
risk highest if turbulent jet of blood (PDA, Coarctation, VSD) or prosthetic material inserted at surgery
Subacute bacterial endocarditis - diagnostic suspicion if…
sustained fever, malaise, raised ESR, unexplained anaemia/haematuria
Subacute bacterial endocarditis - clinical features - 11
anaemia/pallor fever splinter haemorrhages clubbing necrotic skin lesion changing cardiac signs splenomegaly neuro signs retinal infarcts microhaematuria arthritis/arthralgia
Subacute bacterial endocarditis - diagnosis?
multiple bl cultures before ABx started, detailed echo may show vegetations (fibrin, platelets,organism)
Acute phase reactants raised - used to monitor trt response
Most common cause of Subacute bacterial endocarditis
a-haemolytic strep (viridans)
Subacute bacterial endocarditis - MGMT
high dose penicillin in combo with aminoglycoside - 6 weeks IV therapy - if infected prosthetic material -> surgical removal
Subacute bacterial endocarditis prophylaxis?
good dental hygiene
ABx prophylaxis not used here but can be elsewhere for dental trt or any surgery
