CIS Microbiology of Heart Disease--Hersh Flashcards Preview

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Flashcards in CIS Microbiology of Heart Disease--Hersh Deck (24)
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1

subacute vs acute Infective Endocarditis?

ACUTE:
- rapid onset (less than 7 days), toxic-appearing, super sick!!
-no underlying heart disease
-R more than L (Tri>Bi>aorta>pulmonary)
-S aureus
-SOB, high fever, chills, pleuritic chest pain, back pain

SUBACUTE:
-underlying heart disease
-gradual onset
-L more than R
-S viridans, HACEK, enterococcus
-low grade fever, anorexia, fatigue, N/V

2

IE- risk factors

-age older than 60; males
-IV drug use
-poor dentition
-predisposing conditions- valves!

3

signs of IE

-roth spots
-janeway lesions (painless- pams, soles)
-osler nodes (painful- fingers)
-splinter hemorrhages

4

workup for subacute IE?

-blood cultures x 3, TTE (transthoracic echocardiogram)

5

staph epidermidis

-G+ cocci in clusters, catalase positive, coagulase negative

6

what is empiric treatment?

-broad coverage! until you get cultures back

7

best empiric treatment for IE?

vancomycin and ceftriaxone!!

8

dental work- subacute IE- which organism?

-streptococcus viridans

9

duke criteria- major?

-positive blood culture
-electrocardiograph changes consistent with valvular disease
-new murmur

10

duke criteria- minor?

-prosthetic/abnormal vavle
-fever greater than 38 C
-immunologic phenomenon (GN, roth spots, osler nodes)
-vascular phenomenon (janeway lesions)

11

duke criteria- diagnosis

-2 major criteria
-1 major with 3 minor
-5 minor

12

when to use antibiotic prophylaxis for IE?

-cardiac conditions with high risk of IE- dental procedures
-ampicillin!!
-if alleregic- cephalexin, clindamycin

13

empiric treatment for IE?

-vancomycin + ceftriaxone

14

enterococcus- where?

GI tract!
-grow on bile salts culture

15

treatment for tb acute pericarditis

-isoniazid
-rifampin
-ethambutol
-pyrazinamide

16

treatment for pericarditis

-aspirin + colchicine

17

treatment for pericarditis that doesnt respond to aspirin

-colchicine + high dose corticosteroids

18

most common cause of pericardiits?

-Coxsackie B (also Echovirus, flu

19

other causes of pericarditis

-uremia
-neoplastic processes
-Dressler- post MI
-SLE
-drug induced
-radiation

20

pericarditis- presentation

-anterior pleuritic chest pain (uremic pts- painless)
-fever
-pericardial rub (very specific!!)
-dyspnea

21

Coxsackie virus B- morphology

-ssRNA naked icosahedral virus
(smallest virus)- picornavirus!

22

used in acute pericarditis to follow progress?

CRP!!

23

pericarditis- EKG progression

-diffuse ST elevation in all leads!
-ST normalization
-inverted T waves
-return to baseline

24

treatment for patent foramen ovlae?

indomethacin