Endocarditis, Myocarditis & Pericarditis Flashcards Preview

Endocarditis, Myocarditis & pericarditis > Endocarditis, Myocarditis & Pericarditis > Flashcards

Flashcards in Endocarditis, Myocarditis & Pericarditis Deck (56):
1

Define sepsis

Bacteria in the blood

2

Why can blood cultures be unreliable?

Easy contamination - skin contaminants

3

Strep pneumonia often indicates?

Pneumonia or meningitis

4

E coli/ Klebsiella/ cloakrooms often indicate?

Urniary tract/ GI infection

5

Staph aureus often indicates?

Skin/ wound infection
Bone/ joint infection
Endocarditis

6

Commonest coagulase -ve staph
Often a skin contaminant
Known to infect prosthetic material

Staph epidermidis

7

Fever = new murmur

Endocarditis until proven otherwise

8

Majority of people with infective endocarditis patients are from what age group?

> 50 years old

9

Predisposing factors for infective endocarditis?

Heart valve abnormalities (stenosis, post rheumatic fever, congenital heart disease)
Prosthetic heart valves
IV drug users
Intravascular lines

10

Brief pathogenesis?

Valve damage, turbulent blood flow, platelet/ fibrin deposition, bacteraemia (dental work?), microbial vegetation, breaking off of the vegetation, this lodges in a capillary bed, abscess or haemorrhage

11

Infective endocarditis more commonly effects which side of the heat?

Left side of the heart

12

Infective endocarditis more commonly effects which valves?

mitral and aortic

13

4 common causative organisms of infective endocarditis?

Staph aureus
Viridans streptococci
Enterococcus sp.
Staph epidermidis

14

Two classes of atypical causative organisms of infective endocarditis?

Gram -ve
Fungi

15

2 presenting symptoms of acute endocarditis?

Cardiac failure presentation, severe sepsis

16

5 subacute presentation of endocarditis?

Fever
Malaise
Weight loss
Breathlessness
Tiredness

17

Clinical signs of subacute infective endocarditis?

Fever, clubbing, new/ changed murmur, splinter haemorrhages, Microscopic haematuria, splenomegaly, Roth spots, Janeway lesions, Oslers nodes

18

Describe oslers nodes

Sore, red lesions

19

Describe Janeway lesions

Small, non-tender, red, non-hemorrhagic lesions on palms/ soles of feet

20

How should blood cultures be taken to diagnose infective endocarditis?

3 sets from different sites at the peak of fever BEFORE any antibiotics

21

Other diagnostic techniques for infective endocarditis?

U&Es - haematuria
CXR - cardiomegaly
ECG - long PR intervals at regular intervals

22

Which type of ECHO should be used diagnostically for infective endocarditis?

transoesophageal

23

What is the normal time and cause of early prosthetic valve infective endocarditis?

At the time of surgery
Staph aureus or Staph epidermidis

24

Time and causes late infective endocarditis?

Years after valve insertion
co-incidental infection, could be many types of organisms

25

What side does infective endocarditis normally affect in IV drug users?

Right

26

What does infective endocarditis often present as in IV drug users?

pneumonia

27

What is the prognosis for infective endocarditis in IV drug users like?

poor

28

What is the prognosis for infective endocarditis in IV drug users like?

poor

29

What is the general form of treatment of infective endocarditis?

High dose, frequent, IV antibiotics

30

Native value endocarditis treatment?

Benzylpenicillin & gentamicin

31

Prosthetic valve endocarditis treatment?

Vanomycin & gentamicin IV
valve replacement normally needed

32

Drug user endocarditis treatment?

Flucloxacillin IV

33

Staph aureus

Flucloxacillin IV

34

MRSA

Vanomycin & gentamicin IV

35

Viridans streptococci

Benzylpenicillin & gentamicin IV

36

Staph epidermidis

Vanomycin & gentamicin IV

37

Enterococcus sp.

Amoxicillin/ vanomycin/ gentamicin IV

38

How long are the antibiotics normally administered for?

4-6 weeks

39

How should the progress of an infective endocarditis patient be monitored?

Cardiac function
Temperature
Serum CRP

40

What 3 main things put people more at risk of contracting infective endocarditis?

Heart valve lesions
Congenital heart defects
Prosthetic heart valves

41

How can infective endocarditis be prevented?

Antibiotic prophylaxis in GI/ GU procedures if there is infection risk

42

Epidemiology of myocarditis?

Commonest in young people

43

Pathogenesis of myocarditis?

Mainly idiopathic

44

Symptoms of myocarditis?

Fever, chest pain, dyspnoea, fatigue, palpitations

45

Signs of myocarditis?

arrhythmias, cardiac failure, pyrexia

46

Main causes of myocarditis?

Enteroviruses (coxsackie A&B, echovirus and others)

47

Diagnosis of myocarditis?

viral culture (PCR)
Throat swab/ stool for enteroviruses
Throat swab/ serology for influenza

48

Treatment of myocarditis?

Treat the underlying cause

49

Pathogenesis of pericarditis?

Often occurs with myocarditis
Often secondary to virus (main), bactera, fungi or MI (dresslers)

50

Symptoms of pericarditis?

Chest pain: main feature, central, worse on lying flat, relieved on sitting up, worse on inspiration
Pericardial rub
Pericardial effusion
Cardiac tamponade
Fever

51

Diagnosis of pericarditis?

ECG - saddle shaped (concave) ST segment
Troponin levels raised

52

Treatment of infective pericarditis?

Supportive
Analgesia
Treat cause
Try colchicine before steroids in relapse

53

Treatment of bacterial pericarditis?

Antibiotics + drainage

54

Features of constrictive pericarditis?

Rigid pericardium
RHF symptoms (elevated JVP, Kussmaul's sign, soft diffuse apex, quiet heart sounds, third heart sound)

55

CXR features in constrictive pericarditis?

small heart, pericardial calcification

56

Treatment of constrictive pericarditis?

Surgical excision