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Clin med cardiology > Cardiac infections > Flashcards

Cardiac infections Flashcards

(73 cards)

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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
What are the minor criteria of endocarditis
Fever predisposition micro evidence vascular phenomena echo findings that don't meet major criteria
26
What are the main antibiotics for endocarditis
Penicillin or subtype of pCN Cefazolin / ceftriaxone *occasionally need to add Gentamicin / vancomycin
27
If antibiotics don't work, how do you treat endocarditis
Surgical consult
28
How can you prevent endocarditis
Prophylaxis prior to: -significant dental work -invasive respiratory procedures -procedures w/ skin or MSK
29
What is the preferred prevention regimen for endocarditis
Amoxicillin 2g PO 1 hr before procedure Ampicillin / ceftriaxone 2g IV *If PCN allergy: Cephalexin, clindamycin, azithromycin
30
What is the peak age for rheumatic fever
5-15 years old
31
Which areas of the world are at higher risk for rheumatic fever
Developing countries
32
What is rheumatic fever a sequelae of
strep pharyngitis -> beta hemolytic strep *symtoms develop 2-3 weeks post pharyngitis
33
what is Jones criteria
The diagnostic criteria for rheumatic fever
34
What does JONES criteria stand for
Joints Heart Nodules Erythema marginatum Sydenham chorea
35
Why do we treat strep throat
To avoid rheumatic fever and the cardiac damage that can occur
36
What is Erythema marginatum
Rapidly enlarging ring or crescent shaped macule w/ central clearing
37
What do the subcutaneous nodules associated with rheumatic fever look like
Small, firm, non-tender nodules that adhere to underlying structures
38
Which valve is most commonly effected by rheumatic fever
Mitral
39
What kind of valvular damage can result from rheumatic fever
Stenosis regurge or both
40
How do you treat rheumatic heart disease
best treatment is prevention *acute rheumatic fever (NSAIDs, PCN, +/- prednisone)
41
How do you prevent recurrent episodes of rheumatic fever
PCN prophylaxis (IM every 4 weeks)
42
When is the highest risk period for rheumatic heart disease
Within 5 years post initial ARF episodes
43
What is myocarditis
inflammation of the myocardium
44
Which patient population is at highest risk for myocarditis
Kids pregnant females immunosuppressed
45
What agents cause infectious myocarditis
Viral is most common * occasionally a post viral immune response
46
How will myocarditis present
Flu like illness that persists for 7-14 days -dyspnea -chest pain -arrythmias -tachycardia -hypotension
47
What is a major complication of myocarditis in kids
sudden cardiac arrest
48
What might be seen on exam with myocarditis
S3 S4 Rales Tachycardia
49
What is the gold standard for dx of myocarditis
cardiac muscle bx
50
How is nuclear imaging useful with myocarditis dx
it can give the degree of damage
51
How do you acutely treat myocarditis
IV / O2 Tx of arrythmias Tx of HF
52
How do you treat subacute myocarditis
avoid NSAIDs Avoid cardiotoxic agents if severe - > refer to cardiology if mild -> recover over several months
53
What is pericarditis
inflammation of the pericardium
54
If pericarditis is infectious, what is the common cause
viral
55
If pericarditis is non-infectious, what is the common cause
autoimmune
56
What is Dressler's syndrome
Post - MI pericarditis
57
What is the classic presentation of pericarditis
Fever Sharp, retrosternal chest pain Pleuritic chest pain Pericardial rub on auscultation Kussmauls sing
58
What is kussmauls sign
Elevated JVP with inspiration
59
When are symptoms of pericarditis worse
When laying down With inspiration
60
What are classic EKG findings with pericarditis
Diffuse ST elevations in limb / precordial leads Diffuse PR depression in limb / precordial leads Reciprocal ST depression and PR elevation in aVR +/- VI
61
How do you treat pericarditis
Treat underlying cause Activity restriction until asymptomatic or until CRP normalizes
62
What is the first line medication treatment of pericarditis
High dose NSAID (or ASA) AND Colchicine *prednisone is second line
63
What is pericardial effusion
Build up of fluid in the pericardial space (between pericardium and heart)
64
When does pericardial effusion turn into pericardial tamponade
pressure gets above 15mmHg -causes restriction of venous return and ventricular filling
65
What else besides effusion can cause tamponade
hemorrhage
66
What is the number one cause of pericardial effusion
Viral *often secondary to viral pericarditis
67
How does pericardial effusion present
acute effusion (lower volumes) Chronic (higher volumes) -dyspnea /cough/ edema/ fatigue / tachycardia
68
What will be seen on physical exam with pericardial effusion
Pericardial friction rub
69
What will be seen on physical exam with cardiac tamponade
Becks triad pulses paradoxus tachycardia / tachypnea cool / clammy extremities
70
What is Becks triad
Hypotension JVD Muffled heart sounds
71
What is pathognomonic for pericardial effusion / tamponade
electrical alternans *alternating height of QRS (heart swinging in pericardial sac)
72
How do you workup pericardial effusion and tamponade
Echo (best for dx) pericardiocentesis (diagnostic and therapeutic)
73
If effusion is persistent/ recurrent/ very large how do you treat the patient
pericardial window

Clin med cardiology (10 decks)

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