Endo and Peri -carditis

Question 1

What is infective endocarditis?

Answer 1

infection of the endothelium of the heart

Question 2

What areas are most commonly affected by infective endocarditis?

Answer 2

heart valves

Question 3

List the risk factors for infective endocarditis

Answer 3

IV drug use
structural heart pathology
CKD
immunocompromised pts
hx of infective endocarditis

Question 4

List some structural pathologies that can increase the risk of infective endocarditis

Answer 4

valvular heart disease
congenital heart disease
hypertrophic cardiomyopathy
prosthetic heart valves
implantable cardiac devices

Question 5

What is the most common cause of infective endocarditis?

Answer 5

staphylococcus aureus

Question 6

List the presenting symptoms of infective endocarditis

Answer 6

non-specific signs of infection:
fever, fatigue, night sweats, muscle aches, loss of appetite

Question 7

List the examination findings seen in infective endocarditis

Answer 7

new or changing heart murmur
splinter haemorrhages
petechiae
Janeway lesions
Osler’s nodes
Roth spots
Splenomegaly
Finger clubbing

Question 8

What are Janeway lesions?

Answer 8

painless red flat macules on the palms of the hands and soles of the feet

Question 9

What are Osler’s nodes?

Answer 9

tender red/purple nodules on the pads of the fingers and toes

Question 10

What are Roth spots?

Answer 10

haemorrhages on the retina, seen during fundoscopy

Question 11

If infective endocarditis is suspected, what investigation should be carried out prior to starting abx?

Answer 11

blood cultures
three samples are recommended, usually separated by at least 6 hours, unless in urgent cases

Question 12

What imaging is used to confirm infective endocarditis?

Answer 12

echocardiography
transoesophageal echo is more sensitive and specific, however is invasive

Question 13

What may be seen on echo scans in infective endocarditis?

Answer 13

vegetations - abnormal masses or collections
these are usually seen on the valves

Question 14

How is infective endocarditis diagnosed using the modified Duke criteria?

Answer 14

requires one major plus three minor criteria
alternatively, just five minor criteria

Question 15

What are the major criteria in the modified Duke’s criteria?

Answer 15

persistently positive blood cultures
specific imaging findings

Question 16

What are the minor criteria in the modified Duke’s criteria?

Answer 16

predisposition (risk factors)
fever
vascular phenomena - haemorrhage, Janeway lesions
immunological phenomena - Osler’s nodes, Roth spots
microbiological phenomena

Question 17

What is the management for infective endocarditis?

Answer 17

admission
IV broad-spectrum abx e.g., amoxicillin
these are continued for at least 4 weeks, and 6 in the case of prosthetic heart valves

Question 18

When may surgery be required for infective endocarditis?

Answer 18

heart failure relating to valve pathology
large vegetations
infections not responding to abx

Question 19

List some key complications of infective endocarditis

Answer 19

heart valve damage, causing regurgitation
heart failure
emboli
glomerulonephritis, causing renal impairment

Question 20

What is pericarditis?

Answer 20

inflammation of the pericardium

Question 21

What is the pericardium?

Answer 21

the membrane surrounding the heart

Question 22

What are the most common causes of pericarditis?

Answer 22

idiopathic
viral

Question 23

What is the function of the pericardium?

Answer 23

to separate the heart from the rest of the contents of the mediastinum

Question 24

Describe the structure of the pericardium

Answer 24

made up of two layers, with lubrication in between
there is a potential space between the layers, called the pericardial cavity

Question 25

List the potential underlying causes of inflammation in pericarditis

Answer 25

idiopathic infection autoimmune/inflammatory conditions injury to pericardium cancer medications e.g., methotrexate

Question 26

What is a pericardial effusion?

Answer 26

this is where the potential space of the pericardial cavity fills with fluid

Question 27

What is cardiac tamponade?

Answer 27

this is where the pericardial effusion is large enough to raise the intra-pericardial pressure

Question 28

What effect does cardiac tamponade have on the heart's function?

Answer 28

increased intra-pericardial pressure squeezes the heart, so reduces filling during diastole therefore, cardiac output is reduced

Question 29

What are the two key presenting features of pericarditis?

Answer 29

chest pain low grade fever

Question 30

Describe the chest pain felt in pericarditis

Answer 30

sharp central/anterior pleuritic - worse with inspiration worse on lying down better on sitting forward

Question 31

What is the key investigation finding in pericarditis?

Answer 31

pericardial friction rub on auscultation this is a rubbing, scratching sound

Question 32

What do bloods show in pericarditis?

Answer 32

raised inflammatory markers: WBCs CRP and ESR

Question 33

What ECG changes are likely to be seen in pericarditis?

Answer 33

saddle shaped ST-elevation PR depression

Question 34

What is the diagnostic investigation for pericarditis?

Answer 34

echocardiogram

Question 35

What is the management of pericarditis?

Answer 35

NSAIDs first line colchicine taken longer term to reduce risk of recurrence

Question 36

What is the second line management of pericarditis?

Answer 36

steroids

Question 37

What is the management for significant pericardial effusion or cardiac tamponade?

Answer 37

pericardiocentesis

Question 38

What is chronic pericarditis?

Answer 38

recurrent pericarditis that returns after previously having resolved, or persistent long-term inflammation