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Clinical Medicine II > Cardiology: Pericarditis/Endocarditis > Flashcards

Cardiology: Pericarditis/Endocarditis Flashcards

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1
Q

An increased presence of pericardial fluid leading to inflammation of pericardial layers is known as…

A

pericardial effusion

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2
Q

Why is it not necessary to determine the etiology of pericarditis?

A

benign, self-limiting clinical course

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3
Q

Two most common causes of pericarditis are viral and idiopathic. What viruses are MC for viral pericarditis?

A

coxsackie and influenza

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4
Q

Pericarditis can be the 1st manifestation of…

A

underlying systemic disease

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5
Q

Pericarditis has what 4 major clinical manifestations?

A

chest pain

pericardial friction rub

ECG changes

New pericardial effusion

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6
Q

To diagnose pericarditis, how many of the 4 major clinical manifestations must be present?

A

2 of 4

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7
Q

What ECG changes are common in pericarditis?

A

new, widespread ST elevation

PR depression

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8
Q

On auscultation of the heart, you hear a scratchy, squeaky heart sound. What is this called?

A

pericardial friction rub

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9
Q

What type of chest pain is typically present in pericarditis?

A

sharp, pleuritic pain

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10
Q

95% of pericarditis presents with this sign…

A

sudden anterior chest pain

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11
Q

What makes the chest pain of pericarditis better?

A

sitting up and leaning forward

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12
Q

What makes the chest pain of pericarditis worse?

A

laying flat

inspiration

coughing/sneezing

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13
Q

What heart sound is highly specific to pericarditis?

A

pericardial friction rub

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14
Q

Where is pericardial friction rub best heard, and in what position?

A

left sternal border when sitting up and leaning forward

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15
Q

What percentage of pericarditis will occur with ECG changes like PR depression or ST elevation?

A

60%

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16
Q

What is the 1st diagnostic to asses for pericardial effusion?

A

echo

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17
Q

Beck’s triad for pericardial tamponade is…

A

hypotension

muffled heart sounds

JVD

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18
Q

A patient presents with the following:

BP 87/60

muffled heart sounds

profound JVD

what should you immediately suspect?

A

pericardial tamponade

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19
Q

What usually clues a clinician into a Dx of pericarditis?

A

sharp, retrosternal, pleuritic chest pain

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20
Q

What does the pericarditis workup consist of?

A

troponin, ESR, CRP, CBC

CXR

ECG

Echo

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21
Q

are abnormalities in blood work sensitive/specific to pericarditis?

A

no

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22
Q

If the dx isn’t apparent or etiology of pericarditis needs to be determined, what tests can be ordered?

A

TB test

ANA

HIV serology

contrast chest CT

Cardiac MRI

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23
Q

What patient with suspected pericarditis should get an ANA?

A

young woman w/ hx of rheum disorder

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24
Q

what are you looking for on contrast chest CT for pericarditis?

A

thickened pericardium/effusion

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25
Who should get a cardiac MRI in pericarditis?
inconclusive echo, ongoing fever
26
CXR for pericarditis is typically normal, but if a significant effusion is present, what can be seen on X-ray?
enlarged cardiac silhouette
27
What is the primary method of managing pericarditis
manage underlying disorder and rest
28
What medications can be given for pericarditis and for how long?
NSAIDs, < 2 weeks
29
What can be added to NSAID treatment to mitigate GI issues?
proton pump inhibitor
30
Failure of NSAID therapy after 1 week suggests what?
non idiopathic/viral etiology
31
What can be given as an adjunct to NSAID therapy that reduces sxs and decreases rate of pericarditis recurrence?
colchicine
32
Under what three conditions can you consider glucocorticoids for pericarditis?
refractory to NSAIDs/Colchicine pericarditis due to connective tissue disease, pregnancy, autoimmune, or uremic contraindications to NSAID therapy
33
Glucocorticoids increase the risk of what?
recurrent pericarditis
34
What two surgical interventions can relieve cardiac tamponade?
pericardiocentesis pericardiectomy/pericardial window
35
What is used for guidance during pericardiocentesis?
US
36
A surgical removal of a small part of pericardial sac allowing for continual drainage...
pericardial window
37
Recurrent pericarditis occurs in ____ of patients...
1/3
38
when does pericarditis typically recur...
weeks to months after
39
recurrent pericarditis is NOT treated with ______
glucocorticoids
40
What is the definitive tx for constrictive pericarditis?
pericardiectomy
41
is pericardial constriction acute or chronic?
chronic
42
This condition is an acute pericarditis that also demonstrates myocardial inflammation.
myopericarditis
43
The workup for myopericarditis is similar to pericarditis, but what lab may be elevated?
troponin
44
this condition is the result of scarring and loss of pericardial elasticity that impairs cardiac filling.
constrictive pericarditis
45
what are two niduses for infection of endocarditis?
heart valves and pacemakers
46
This type of endocarditis presents with... normal heart valves commonly fatal if not tx w/in 6 weeks rapidly destructive and deadly
acute IE
47
This type of endocarditis presents... on damaged heart valves indolent in nature not usually fatal if treatment delayed
subacute
48
what makes the endocardium "sticky" enough to cause bacterial adhesion?
turbulent blood flow
49
what are the four most notable risk factors for IE?
age > 60 male ivdu poor dentition
50
What bacterial agent causes the majority of healthcare and ivdu IE?
staphylococci
51
What bacterial agents most commonly cause community acquired IE?
staph aureus viridans streptococci
52
what are the two hallmark symptoms that should make you think of endocarditis?
fever of unknown origin and new cardiac murmur
53
what two cutaneous manifestations are present in endocarditis?
petechiae splinter hemorrhage
54
What three physical exam findings are highly suggestive of IE?
janeway lesions osler nodes roth spots
55
nontender erythematous macules on palms and soles...micro abscess
janeway lesions
56
tender sub-q violacious nodules on pads of fingers and toes...microthrombi
osler nodes
57
exudative, edematous hemorrhagic lesions of retina with pale center...
roth spots
58
Janeway lesions are suggestive of acute or subacute IE?
acute
59
osler nodes are suggestive of acute or subacute IE?
subacute
60
in IE, septic emboli can shower through the body... complications of IE can often be the chief complaint. What are 4 common complications
cardiac neuro septic emboli metastatic infection
61
this IE complication can occur as vertebral osteomyelitis, septic arthritis, etc...
metastatic infx
62
this IE complication can cause infarct of the kidneys, spleen, lungs and other vital organs...
septic emboli
63
What neuro complications can manifest in IE?
embolic stroke hemorrhage abscess
64
what cardiac complications can present as a result of IE?
valvular insufficiency heart failure
65
A prolonged fever of unknown origin should immediately be suggestive of...
endocarditis
66
What are three diagnostic mainstays of IE?
clinical presentation blood culture echo
67
how many sets of blood cultures should be obtained?
3 sets to confirm results
68
where should venipuncture for blood cultures happen?
3 separate sites over 30-60 minutes
69
A pt. with negative blood cultures but persistent fever with one or more clinical findings should be suspected of having...
culture negative IE
70
what is the first diagnostic test that should be ordered for patients with suspected IE>
TTE
71
What is more sensitive for IE, TTE or TEE?
TEE
72
what type of antimicrobials are necessary for tx of IE, cidal or static or either?
cidal
73
For what patient with suspected IE should you delay empiric abx?
without acute sxs
74
What patient with IE should receive empiric abx and when?
acutely ill right after BCx drawn
75
who should you consult in cases of expected or observed IE complications?
CT surg, ID, cards
76
how can IE be monitored?
repeat blood cultures
77
What abx are given for native valve IE and for how long?
vanco for 4-6 weeks
78
for prosthetic valve IE, what does tx look like?
long, pathogen specific abx surgical replacement
79
What is the most common indication for cardiac surgery in patients with IE?
heart failure
80
what is the most common cause of death in patients with IE?
heart failure
81
what two factors other than heart failure are associated with higher mortality from IE?
prosthetic valve IE and IV drug use IE
82
do GI/GU procedures require abx prophylaxis for IE?
no
83
What procedures require abx prophylaxis to prevent IE?
dental procedures prosthetic heart valve prior IE congenital heart disease procedure on infected skin or MSK tissue

Clinical Medicine II (31 decks)

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