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Clin med cardiology > Cardiac infections > Flashcards

Cardiac infections Flashcards

1
Q

What is endocarditis

A

infection of the endocardium
*generally regarding valve leaflets

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2
Q

What is the median age of diagnosis for endocarditis

A

58

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3
Q

Which gender is more commonly effected by endocarditis

A

men

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4
Q

How many people who have endocarditis also have underlying cardiac conditions

A

50-60%

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5
Q

What are the major complications of endocarditis

A

stroke
valve surgery

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6
Q

What is the pathophysiology of endocarditis

A

bacteremia and damage in the endothelium allow for bacterial vegetations

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7
Q

What are the causes of endocarditis

A

Sepsis
IVDU
Atherosclerosis
systemic disease
mechanical valve
rheumatic/congenital valve disease

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8
Q

Which patient population is at high risk for endocarditis

A

IVDU
HD
DM
HIV
immunosuppression
dental procedures
valvular heart disease
endaovascular hardware

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9
Q

Which side does endocarditis generally occur

A

typically left side of heart

***IVDU gets right side endocarditis

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10
Q

Why is the left side of the heart more prone to endocarditis

A

more pressure
more O2
Valvular disorders more common

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11
Q

What are the common organisms associated with endocarditis

A

Staph (usually acute endocarditis)
Strep
Enterococci

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12
Q

What symptoms do patients with endocarditis generally have

A

Fever
New / changing murmur
acute HF from regurge

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13
Q

What are ‘classic’ manifestations of endocarditis

A

Oslers nodes
Janeway lesion
splinter hemorrhage
Petechiae
Clubbing
Roth spots

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14
Q

What are Oslers nodes

A

painful red lesions on hands and feet

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15
Q

What are Janeway lesions

A

Non-tender, flat, small red lesions on hands and feet

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16
Q

What are splinter hemorrhages

A

capillary hemorrhages under fingernails

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17
Q

What are Roth spots

A

retinal hemorrhages with pale center

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18
Q

How do you workup endocarditis

A

blood cultures
echo

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19
Q

What is the number 1 cause of endocarditis

A

Staph aureus

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20
Q

how do you draw blood cultures for endocarditis

A

2-3 sets from 2 DIFFERENT locations
**4-6 bottles

SHOULD be collected BEFORE empiric abx

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21
Q

How do you treat endocarditis

A

Early infectious disease consult
Empiric abx (broad spectrum)
treat for 2-6 weeks

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22
Q

How to choose which abx to give for endocarditis

A

the valve type
most likely organism
local resistance pattern

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23
Q

What is the Duke criteria

A

Criteria used to diagnose endocarditis
2 major
1 major + 1 minor
5 minor

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24
Q

What are the major criteria in the duke criteria

A

positive blood cultures

evidence of endocardial involvement by echo

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25
Q

What are the minor criteria of endocarditis

A

Fever
predisposition
micro evidence
vascular phenomena
echo findings that don’t meet major criteria

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26
Q

What are the main antibiotics for endocarditis

A

Penicillin or subtype of pCN

Cefazolin / ceftriaxone

*occasionally need to add Gentamicin / vancomycin

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27
Q

If antibiotics don’t work, how do you treat endocarditis

A

Surgical consult

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28
Q

How can you prevent endocarditis

A

Prophylaxis prior to:
-significant dental work
-invasive respiratory procedures
-procedures w/ skin or MSK

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29
Q

What is the preferred prevention regimen for endocarditis

A

Amoxicillin 2g PO 1 hr before procedure

Ampicillin / ceftriaxone 2g IV

*If PCN allergy: Cephalexin, clindamycin, azithromycin

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30
Q

What is the peak age for rheumatic fever

A

5-15 years old

31
Q

Which areas of the world are at higher risk for rheumatic fever

A

Developing countries

32
Q

What is rheumatic fever a sequelae of

A

strep pharyngitis
-> beta hemolytic strep

*symtoms develop 2-3 weeks post pharyngitis

33
Q

what is Jones criteria

A

The diagnostic criteria for rheumatic fever

34
Q

What does JONES criteria stand for

A

Joints
Heart
Nodules
Erythema marginatum
Sydenham chorea

35
Q

Why do we treat strep throat

A

To avoid rheumatic fever and the cardiac damage that can occur

36
Q

What is Erythema marginatum

A

Rapidly enlarging ring or crescent shaped macule w/ central clearing

37
Q

What do the subcutaneous nodules associated with rheumatic fever look like

A

Small, firm, non-tender nodules that adhere to underlying structures

38
Q

Which valve is most commonly effected by rheumatic fever

A

Mitral

39
Q

What kind of valvular damage can result from rheumatic fever

A

Stenosis
regurge
or both

40
Q

How do you treat rheumatic heart disease

A

best treatment is prevention
*acute rheumatic fever (NSAIDs, PCN, +/- prednisone)

41
Q

How do you prevent recurrent episodes of rheumatic fever

A

PCN prophylaxis (IM every 4 weeks)

42
Q

When is the highest risk period for rheumatic heart disease

A

Within 5 years post initial ARF episodes

43
Q

What is myocarditis

A

inflammation of the myocardium

44
Q

Which patient population is at highest risk for myocarditis

A

Kids
pregnant females
immunosuppressed

45
Q

What agents cause infectious myocarditis

A

Viral is most common

  • occasionally a post viral immune response
46
Q

How will myocarditis present

A

Flu like illness that persists for 7-14 days
-dyspnea
-chest pain
-arrythmias
-tachycardia
-hypotension

47
Q

What is a major complication of myocarditis in kids

A

sudden cardiac arrest

48
Q

What might be seen on exam with myocarditis

A

S3
S4 Rales
Tachycardia

49
Q

What is the gold standard for dx of myocarditis

A

cardiac muscle bx

50
Q

How is nuclear imaging useful with myocarditis dx

A

it can give the degree of damage

51
Q

How do you acutely treat myocarditis

A

IV / O2
Tx of arrythmias
Tx of HF

52
Q

How do you treat subacute myocarditis

A

avoid NSAIDs
Avoid cardiotoxic agents
if severe - > refer to cardiology
if mild -> recover over several months

53
Q

What is pericarditis

A

inflammation of the pericardium

54
Q

If pericarditis is infectious, what is the common cause

A

viral

55
Q

If pericarditis is non-infectious, what is the common cause

A

autoimmune

56
Q

What is Dressler’s syndrome

A

Post - MI pericarditis

57
Q

What is the classic presentation of pericarditis

A

Fever
Sharp, retrosternal chest pain
Pleuritic chest pain
Pericardial rub on auscultation
Kussmauls sing

58
Q

What is kussmauls sign

A

Elevated JVP with inspiration

59
Q

When are symptoms of pericarditis worse

A

When laying down
With inspiration

60
Q

What are classic EKG findings with pericarditis

A

Diffuse ST elevations in limb / precordial leads

Diffuse PR depression in limb / precordial leads

Reciprocal ST depression and PR elevation in aVR +/- VI

61
Q

How do you treat pericarditis

A

Treat underlying cause

Activity restriction until asymptomatic or until CRP normalizes

62
Q

What is the first line medication treatment of pericarditis

A

High dose NSAID (or ASA) AND Colchicine

*prednisone is second line

63
Q

What is pericardial effusion

A

Build up of fluid in the pericardial space (between pericardium and heart)

64
Q

When does pericardial effusion turn into pericardial tamponade

A

pressure gets above 15mmHg
-causes restriction of venous return and ventricular filling

65
Q

What else besides effusion can cause tamponade

A

hemorrhage

66
Q

What is the number one cause of pericardial effusion

A

Viral
*often secondary to viral pericarditis

67
Q

How does pericardial effusion present

A

acute effusion (lower volumes)
Chronic (higher volumes)

-dyspnea /cough/ edema/ fatigue / tachycardia

68
Q

What will be seen on physical exam with pericardial effusion

A

Pericardial friction rub

69
Q

What will be seen on physical exam with cardiac tamponade

A

Becks triad
pulses paradoxus
tachycardia / tachypnea
cool / clammy extremities

70
Q

What is Becks triad

A

Hypotension
JVD
Muffled heart sounds

71
Q

What is pathognomonic for pericardial effusion / tamponade

A

electrical alternans
*alternating height of QRS (heart swinging in pericardial sac)

72
Q

How do you workup pericardial effusion and tamponade

A

Echo (best for dx)
pericardiocentesis (diagnostic and therapeutic)

73
Q

If effusion is persistent/ recurrent/ very large how do you treat the patient

A

pericardial window

Clin med cardiology (10 decks)

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