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FA CARDIO 3 > Cardiac Valvular Disease 3 > Flashcards

Cardiac Valvular Disease 3 Flashcards

(53 cards)

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1
Q

bacterial or fungal infection of valves or endocardium including great vessels

A

infective endocarditis

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2
Q

IE risk factors NATIVE valve

A
  1. rheumatic, congenital or degenerative valve disease
  2. congenital heart disease
  3. IVDA
  4. HACIE (health care cause)
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3
Q

native IE pathophysiology

A

bacteria or fungi gain access to the valve during transient bacteremia

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4
Q

what might cause transient bacteremia

A 
chronic wound 
dental procedure 
IVDA 
central line 
UTI, pneumonia
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5
Q

why are those with cardiac valve abnormalities predisposed to IE

A

altered hemodynamics, creates areas with stasis with bacterial flow

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6
Q

average age of patient with IE? why?

A

OLDER

decreased rheumatic disease, increased degenerative disease

increased instrumentation, invasive procedures, lines predisposing pt

people living longer immunosuppression

significant # IE, nosocomial now

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7
Q

underlying diseases in IE

A 
Atherosclerotic 
MVP 
Congenital 
PVE 
Rheumatic
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8
Q

valves mc affected?

A

MITRAL

aortic, mitral and aortic, tricuspid

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9
Q

native valve organisms

A 
staphylococcus aureus 
streptococcus viridans 
group D streptococcus 
Enterococci 
HAECK
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10
Q

natural history of IE due to
rapid valvular destruction

organisms

A

CHF also

s. aureus
strep pneumoniae
strep pyogenes
neisseria gonorrhea

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11
Q

natural history of IE due to

indolent valvular destruction

A

few symptoms

strep viridians
enterococcus faecalis
GNRs

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12
Q

prosthetic valve replacement and IE

early IE

A

within 60 days

contamination in surgery or hematogenous seeding from extra cardiac site

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13
Q

prosthetic valve replacement and IE

late IE

A

oral site that seeds valve

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14
Q

IVDA and IE

A

majority don’t have known valve dz

more likely to affect tricuspid valve

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15
Q

tricuspid valve and IVDA IE

A

injection of drugs directly into vein (first stop)

drugs cut with TELK cause small bits of damage over the course of time

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16
Q

what organisms in IVDA IE?

A

s. aureus
pseudomonas
unusual pathogens
polymicrobial

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17
Q

vegetation

A

mass of fibrin and cellular elements of blood that become haven for bacterial growth

found @ sites of congenital malformation or areas of valve damage on L side of heart

low pressure side of valve

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18
Q

Pathology of IE

A

infection in blood and vegetation formation causes bacterial proliferation and destruction on valve

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19
Q

why low pressure

A

easier growth due to less rapid blood flow movement

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20
Q

IE on which lesions

A

small, tight lesions

high pressure differential also promotes

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21
Q

clinical IE presentation

A

Fever (MC)

heart murmur

embolic phenomena

clubbing

general illness symptoms

** timing can clue us into which pathogen

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22
Q

Classic symptoms of IE

Study These Flashcards
A

splinter hemorrhages

petechiae

roth spots

janeway lesions

osler nodes

23
Q

roth spots

Study These Flashcards
A

exudative, edematous hemorrhagic retinal lesions

24
Q

subungual, vertical lines

Study These Flashcards
A

splinter hemorrhages

25
laneway lesions
PAINLESS macules or nodular hemorrhages on palms and soles microabsecess with neutrophil invasion
26
osler nodes
PAINFUL raised lesions occur in crops on tips of fingers and toes or on hands/feet transient
27
IE diagnostic studies
TEE (check for vegetations) Blood culture (multiple sets, q 15 min x 3 sets)
28
diagnostic studies in IE other
CXR EKG CBC, BMP, additional labs
29
duke criteria IE
2 major, 1 major/3 minor or 5 minor
30
Major diagnostic criteria
1. positive blood culture for typical infective endocarditis 2. new regurgitant murmur or echo findings consistent with IE
31
IE complications (6)
1. cardiac valve destruction 2. metastatic infection (i.e. kidney, head, spleen, liver, lung) 3. embolization 4. Myocardial abscess 5. conduction derangement 6. immune mediated effects
32
IE treatment
hospitalize empiric abx after blood culture drawn following identification, narrow/targeted abx treament ID involvement
33
empiric abx IE
gram +, gram - +/- fungal or anaerobic coverage Rocephin and vancomycin
34
when might we consider fungal cause of IE?
IMMUNOSUPPRESED HIV, taking immunosuppresive meds, transplant patient, SLE, cancer, asplenia
35
targeted IE tx staph aureus
MSSA: naficillin IV x 6+ wks MRSA: vancomycin IV x6+wks
36
targeted IE tx enterococcus
ampicillin entamycin daptomycin
37
targeted IE tx strep
aq PCN V iv x4+ weeks
38
indications for surgical IE tx
acute HF (unresponsive to abx) infections unresponsive to meds abscess formation, recurrent emoli recurrent infection
39
what to look for if IE symptoms persist?
another pathogen? incorrect pathogen? giving right Abx? get new blood cultures, CT/MRI
40
IE prophylaxis for who? what do we give + dose?
considered for patients that have high risk cardiac conditions and getting a high risk procedure amox 2mg po 1 hr prior
41
who DOES not get IE prophylaxis
Rheumatic heart disease: MVP +/- MR, bicuspid aortic valve, HOCM, ASD h/o pacers, stents, ICD, CABG
42
two layer sac around heart
pericardium
43
normal amount of pericardial fluid
5-15mL provides lubrication between heart and surrounding viscera
44
diseases of pericardium
acute pericarditis pericardial effusion chronic pericarditis
45
inflammation of sac surrounding heart
acute pericarditis
46
collection of inflammatory fluid that forms between visceral and partial pericardial layers
pericardial effusion
47
permanent scarring of pericardium secondary to inflammation
chronic pericarditis
48
etiologies of acute pericarditis
1. viral 2. TB 3. Uremia (renal failure) 4. neoplastic syndrome 5. inflammatory (dresser's or connective tissue disorder)
49
symptoms of acute pericarditis
Chest pain dyspnea fever
50
Chest pain in acute pericarditis
sharp, sub sterna CP begins abruptly and non pleuritic exacerbated by lying down received when sitting up and leaning forward
51
sings of acute pericarditis
Friction rub s.s of altered hemodynamics EKG changes (saggy ST w.o. reciprocal changes)
52
diagnostic studies
echocardiography CBC + chemistries Cardiac markers ESR + CRP TSH/ANA/PPD
53
idiopathic tx of acute pericarditis
NSAIDS to relieve inflammation and pain colchicine (90 days) +/- oral corticosteroids and pericardial window

FA CARDIO 3 (5 decks)

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