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Yr 5 Cardiology > Infection & inflammation > Flashcards

Infection & inflammation Flashcards

1
Q

What is infective endocarditis?

A

An infection involving the endocardium including the valvular structures, the chordae tendineae, sites of septal defects, or the mural endocardium.

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2
Q

How does infective endocarditis occur?

A

Non-bacterial thrombotic endocarditis (sterile platelet vegetation due to Venturi effect) acts as pre-requisite for adhesion and invasion → bacterial infection (usually via skin) penetrates endocardium of heart → intracardiac effects (valvular insufficiency) & systemic effects

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3
Q

What are the causes of endocarditis?

A 
Staph Aureus (IVDU)
Strep Viridans (Dental)
Staph Epidermis (Prosthesis)
Pseudomonas
HACEK organisms
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4
Q

What are the risk factors for endocarditis?

A 
Valvular disease
Rheumatic fever/valve disease
Structural congenital issues (ASD, VSD, PDA)
Hypertrophic cardiomyopathy
IVDU
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5
Q

What are the Sx of acute infective endocarditis?

A

Fever + new murmur = ENDOCARDITIS UNTIL PROVEN OTHERWISE
Fever >38/chills/rigors
HF- dyspnoea, crackles

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6
Q

How does sub-acute infective endocarditis present?

A

Fever >38, chills, rigors
Weight loss
Fatigue
Flu-like Sx

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7
Q

What are the signs of infective endocarditis?

A
  • Osler’s nodes: Painful pulp of finger
  • Roth spots: Retinal haemorrhages with pale centre
  • Janeway lesions: Irregular, painless, erythematous macule on hypo/thenar eminence
  • Splinter/Subungal haemorrhages
  • Petechiae: Conjunctiva, hands/feet, chest/abdo, oral mucosa
  • Clubbing
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8
Q

What murmur is heard in infective endocarditis?

A

AORTIC REGURG- Diastolic murmur & collapsing pulse

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9
Q

What criteria is used to diagnose infective endocarditis?

A

Duke’s criteria:

  • 2major
  • 1major + 3minor
  • 5minor
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10
Q

What are the investigations for infective endocarditis?

A

-3 serial blood cultures in 24hours
-TTE/TOE
Bloods: FBC, Film, CRP, ESR, LFTs
Urinalysis
ECG
CXR

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11
Q

How is infective endocarditis managed?

A

BUFALO if Septic
IV Abx: 4-6w Empirical =
NORMAL: Amox +/- Gent or Vanc + Gent
PROSTHETIC: Vans + Rifamp + Gent

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12
Q

What are the antibiotics used against specific organisms causing infective endocarditis:?

A

Staph = Fluclox >4w
Staph (prosthesis) = Fluclox + Rifamp + Gent for 6w
Strep = BenPen 4-6w
Enterococci/HACEK = Amox + Gent

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13
Q

What are the complications of infective endocarditis??

A

CVA: Stroke/TIA

Congestive cardiac failure

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14
Q

What are the major and minor components in Duke’s criteria?

A

MAJOR:
- Positive blood culture in 2 separate cultures
-Evidence of IE: mass on valve, abscess, new valvular regurg
MINOR:
- Predisposing heart condition
-IVDU
-Fever >38
-Vascular phenomenon: Janeway nodes, etc
- +ve blood culture not meeting major criteria
-Immunological: Osler nodes, RF, roth spots, GN

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15
Q

What is rheumatic fever?

A

Develops 2-6w following immunological reaction to recent Strep Pyogenes infection

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16
Q

How is rheumatic fever diagnosed?

A

2 major criteria
1 major criteria + 2 minor
Evidence of recent strep infection

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17
Q

What are the major & minor criteria for rheumatic fever?

A

MAJOR: Erythema marginatum, Sydenham’s chorea, Polyarthritis, Carditis (endo-, myo- or peri-), Subcut nodules
MINOR: ↑ESR/CRP, Pyrexia, Arthralgia, Prolonged PR

18
Q

What is pericarditis?

A

Inflammation of the pericardial sac

19
Q

How does pericarditis cause problems?

A

Volume of pericardial fluid ↑ in serous pericardium or thickens (pericardial effusion)
Pressure on heart
DIASTOLIC HF → ↓SV ↓CO

20
Q

What is chronic pericarditis?

A

> 6m

↑fibroblasts = ↑fibrin resulting thick and stiff pericardium → pressure on heart → ↓SV → ↑HR)

21
Q

What are the causes of pericarditis?

A 
Idiopathic
Viral: Coxsackie B
Dressler Syndrome
Uraemic
Autoimmune diseases (RA, SLE)
Cancer + RT
22
Q

How does pericarditis present?

A

Fever
Central chest pain: Pleuritic, worse when supine, relieved by leaning forwards, radiates to neck
Dyspnoea
Pericardial rub, ↓heart sounds

23
Q

How is pericarditis investigated?

A

ECG: QRS changes
Stage1) Saddle ST elevation, PR depression
Stage2) ST normal, flattened T waves
Stage3) T waves invert
Stage4) Normal ECG
CXR: Pericardial effusion- Water bottle sign
ECHO:
Acute= heart looks like it’s ‘dancing’ in pericardial sac
Chronic = heart stiff & constricted

24
Q

How is pericarditis treated?

A

Rest
Tx cause: Dialysis = uraemia
Analgesia: NSAIDs- Naproxen

25
Q

What medication should be stopped in pericarditis?

A

Corticosteroids- worsen oedema/effusion

Phenytoin

26
Q

What are the complications of pericarditis?

A

Conversion to chronic
Tamponade
Effusion
Constrictive

27
Q

What is pericardial effusion?

A

Increased accumulation of fluid in serous pericardium

50ml → 2 L

28
Q

What are the types of fluid in pericardial effusion?

A

Transudative
Exudative
Blood

29
Q

How can pericardial effusions be grouped?

A

LARGE: Associated w/malignancy, TB, uraemic, myxoedema
LOCULATED: Common w/scarring- post-op/trauma

30
Q

What are risk factors for pericardial effusion?

A 
Idiopathic
Infectious: Viral, TB, HIV, Syphilis, Bacterial
MI
AKI/CKD: Uraemic
Malignancy
Hypothyroidism
31
Q

What are the Sx of pericardial effusion?

A 
Chest pain/pressure/discomfort- worse when supine, better sitting forward
Cough/dyspnoea
Hoarseness
Dizzy & syncope
Palpitations
Anxiety 
Confusion
Pericardial rub 
Ewart's sign: Large effusion compressing LLL causing bronchial breathing
32
Q

How is a pericardial effusion investigated?

A

CXR: Water bottle sign
ECG: Low voltage QRS complexes
ECHO: ECHO-free zone

33
Q

How is pericardial effusion managed?

A

Supportive
Tx cause
Pericardiocentesis

34
Q

What are the complications of pericardial effusion?

A

Cardiac tamponade

35
Q

What is lymphoedema?

A

Progressive swelling of a body part (usually limb) following disruption of the lymphatic system
Results in lymph accumulating in interstitial space

36
Q

What are the common causes of lymphoedema?

A

80% affected before lymphoedema occurs

  • Lymphatic hypoplasia
  • Obstruction
  • Fibrosis
  • Malignancy & Cancer Tx (LN dissection, RT, neoplastic infiltration)
  • Nematode infection
  • Trauma (penetrating)
37
Q

How are lymphoedema causes categorised?

A

PRIMARY: Rare, idiopathic & usually sporadic
SECONDARY: Occurs post-injury or Tx

38
Q

How does lymphoedema present?

A

Hx of trauma/malignancy
Limb heaviness/weakness
Non-pitting oedema
Skin changes: Hyperkeratosis, papillomatosis, induration, exudative (lymph fluid)

39
Q

How is lymphoedema investigated?

A

Lymphoscintigram: Inject isotope into area, wait 45m-2hr then image shows areas of no uptake

40
Q

How is lymphoedema managed?

A 
1) Skin care: Moisturise, bathing, protective clothing
AND
Compression bandaging
AND
Elevation
AND
Exercise & weight control
2) Manual drainage

Yr 5 Cardiology (8 decks)

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